Dr. Summers is a resident in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Grau is a resident in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Mr. Massel is a medical student in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Ong is Assistant Professor in the Rothman Institute Department of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Orozco is Assistant Professor in the Rothman Institute Department of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Rosas is a research fellow in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Hernandez is Assistant Professor in the Department of Orthopedic Surgery, University of Miami, Miami, Florida.
Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Address correspondence to: Victor Hugo Hernandez, MD, MS, Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Ave, Miami, FL 33136 (tel, 305-243-3000; fax: 305-689-4979; email, vhh1@med.miami.edu).
Am J Orthop. 2018;47(12). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.
Spencer Summers MD Luis Carlos Grau Dustin Massel BS Alvin Ong Fabio Orozco Samuel Rosas Victor Hernandez MD MSc . Trends in Utilization of Total Hip Arthroplasty for Femoral Neck Fractures in the United States. Am J Orthop. December 7, 2018
TAKE-HOME POINTS
The femoral neck patient population is older and has more medical comorbidities.
Hemiarthroplasty (HA) is being performed more commonly in patients > 50 years old for femoral neck fractures.
Open reduction and internal fixation is being performed more commonly in patients > 80 years old for femoral neck fractures.
The rate of adverse events following femoral neck fracture is higher in the total hip arthroplasty (THA) group than in the HA group.
THA is an independent risk factor for adverse events following femoral neck fracture.
References
ABSTRACT
The ideal mode of fixation for patients with femoral neck fractures is not well defined in the current literature. This study describes the recent trends in surgical management of femoral neck fractures with an analysis on perioperative outcomes.
The National Hospital Discharge Survey was used to identify femoral neck fractures in the United States between 1990 and 2007 (n = 1,155,960) treated with open reduction and internal fixation (ORIF), total hip arthroplasty (THA), or hemiarthroplasty (HA). Trends were examined over the following 3 time periods: 1990 to 1995 (group 1), 1996 to 2001 (group 2), and 2002 to 2007 (group 3). Elixhauser Comorbidity Index and perioperative complications were calculated.
Use of HA increased (74.4% to 84.6%), whereas that of THA (7.3% to 4.9%) and ORIF (18.3% to 10.6%) decreased, from group 1 to group 3 in the age group of >80 years. The use of ORIF increased (63.9% to 81.4%), whereas the use of both HA and THA decreased, from group 1 to group 3 in the age group of <50 years. The rate of adverse events increased across all fixation types but was greatest among THA (32.2% to 48.3%).
The femoral neck patient population is now older and has more medical comorbidities. We observed a trend toward performing HA in older patients and ORIF in younger patients. Despite superior functional outcomes reported in THA, this study found a decreased utilization of THA in all age groups along with an increase in adverse events and nonroutine discharges for patients with femoral neck fractures treated with THA.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
