A new 14-year (average, with 10-year minimum) follow up study of patients who have been treated for femoral head fractures reached an important conclusion: long-term femoral head fracture treatment outcomes can be unpredictable.
In the study, “Patient-Reported Outcomes of Femoral Head Fractures with a Minimum 10-year Follow-Up,” published in the December 2020 issue of the Journal of Orthopaedic Trauma, the researchers evaluated the clinical-reported and patient-reported outcomes of patients with femoral head fractures treated at a single level I trauma center.
The 101 consecutive femoral head fractures which were identified in the retrospective review had a minimum of 10 years of follow-up. The 28 patients that were included in the final study had a minimum of 10 years of clinical follow-up.
All the patients were treated with one or a combination of the following treatments: nonoperative management, open reduction and internal fixation, fragment excision, or total hip arthroplasty.
The researchers collected data for each patient on the Oxford Hip Score at final follow-up along with clinical and radiological complications such as avascular necrosis, post-traumatic osteoarthritis, heterotopic ossification, and conversion to total hip arthroscopy.
The average age of the 28 patients was 39.2 years. The average follow-up was 14 years. Eighty-six percent of the patients required surgical treatment which occurred within 4 days of the injury.
Overall, 75% of the patients experienced a complication and 7 of the patients were later converted to a total hip arthroscopy at an average of 6 years from the initial injury.
The researchers also found that three of the seven patients that had late total hip arthroscopy also required later revisions.
Oxford Hip Scores were reported for all 28 patients. The average score was 36.6. The mean Oxford Hip Score of the native hips was 37 at an average follow-up of 13.6 years. The mean Oxford Hip Score of primary total hip arthroscopy was 41, and the mean score of secondary total hip arthroscopy at final follow-up was 31.4, but this was not statistically significant.
The researchers wrote, “Patients should be counseled that the long-term results of open reduction and internal fixation may be satisfactory, but unfortunately are not predictable.”