Functional Outcomes Following Hip Arthroplasty in End-Stage Renal Disease Patients with Intracapsular Femoral Neck Fractures and Concomitant Hyperparathyroidism | ||
| The Egyptian Orthopaedic Journal | ||
| Volume 60, Issue 2, June 2025, Pages 173-180 PDF (679.27 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/EOJ.2025.431799 | ||
| Authors | ||
| Muhammad F.M. Salleh* ; Sarbhjit S.L. Singh; Ahmad F. Kassim; Muhammad A. Abdullah | ||
| Department of Orthopaedic, Hospital Sultanah Bahiyah, Jalan Langgar, Alor Setar, Kedah, Malaysia. | ||
| Abstract | ||
| Background Managing femoral neck fractures in patients with end-stage renal disease (ESRD) presents unique challenges due to poor bone quality, delayed presentation, and the prevalence of hyperparathyroidism. This study evaluates factors influencing functional outcomes, surgical timing, and the impact of hyperparathyroidism management in these patients. Patients and Methods We conducted a retrospective case series involving 17 patients (20 hips) with ESRD who underwent total hip arthroplasty or bipolar hemiarthroplasty for femoral neck fractures. Data on patient demographics, surgical timing, bone mineral density, parathyroid hormone levels, and functional outcomes (Oxford hip scores) were analyzed. The association between these variables and outcomes, including revision rates, was assessed. Results Simultaneous hip arthroplasty and parathyroidectomy yielded the highest functional scores (mean 42.75), while delayed parathyroidectomy were associated with the poorest outcomes. For each day of delay in hospital presentation, hip arthroplasty, and parathyroidectomy, functional scores decreased by 0.067, 0.066, and 0.011 points, respectively. Bipolar hemiarthroplasty showed a significantly higher revision rate (50%) compared with total hip arthroplasty (P=0.028). Progression from secondary to tertiary hyperparathyroidism, due to delayed monitoring or treatment, led to prosthesis failure. Conclusions Timely surgical intervention and optimized management of hyperparathyroidism are critical to improving functional outcomes in ESRD patients with femoral neck fractures. Simultaneous hip arthroplasty and parathyroidectomy should be prioritized for eligible patients, while regular monitoring of bone quality and parathyroid function is essential to prevent complications. Prospective studies are warranted to validate these findings and refine treatment strategies for this complex patient population. | ||
| Keywords | ||
| Bone mineral density; End-stage renal disease; Femoral neck fracture; Hip arthroplasty; Hyperparathyroidism; Oxford hip score; Parathyroidectomy | ||
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