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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Sebastian Mukka, Umeå University, Sweden
- Second opponent: Professor Bjarke Viberg, Odense University Hospital, Denmark
- Third member and chair of the evaluation committee: Professor II Hanne Solveig Dagfinrud, University of Oslo
Chair of the Defence
Associate Professor Thomas Kibsgård, University of Oslo
Principal Supervisor
Associate Professor Frede Frihagen, University of Oslo
Summary
Hip fracture is a common and serious fragility fracture in the elderly, with about 8500 fractures annually in Norway. The patients typically possess substantial comorbidities and cognitive impairment. Complications may thus not be well tolerated. Still, deep infection, dislocation of the prosthesis, bleeding, periprosthetic fracture and fracture nonunion are not unusual. 1 year after the injury, about 25 % of the patients are dead and 40-50 % are unable to walk independently.
The thesis aim was to search for strategies to prevent surgical complications after hip fracture and to investigate the outcome of complications after hip hemiarthroplasty.
We established a care pathway of standardized measures in our ward to reduce surgical delay and to improve postoperative function. Waiting time for surgery after hospital admittance was reduced by 5 hours (from 29 to 24 hours, 95 % confidence interval 1.6-7.6) and we found a tendency towards improved postoperative function.
Two surgical approaches in hemiarthroplasty (lateral versus posterior) were compared, and there was an 8-fold increased probability for prosthetic dislocation when the posterior approach was used (RR=8.0. 95 % CI 2.7-23.8). More than 50 % of the patients suffered subsequent complications when a dislocation first occurred.
We compared acetabular cartilage wear in unipolar versus bipolar hemiarthroplasty, and found 0.6 mm less cartilage wear in bipolar hemiarthroplasty 2 years after surgery.
We evaluated the treatment strategies applied for periprosthetic fractures after hemiarthroplasty, and registered the surgical complications. 47 of 56 patients had no complications to the treatment, but 30 % of the patients needed a permanently higher level of care.
In conclusion, hip fracture treatment should constitute of a robust care pathway. We recommend the lateral surgical approach to the hip joint, and the use of a well-documented bipolar cemented stem in hemiarthroplasty.
Additional information
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