A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial

Abstract

Introduction: The literature regarding undisplaced femoral neck fractures (FNF) is sparse. The aim of this prospective feasibility study is to compare the clinical outcome after undisplaced FNF treated with internal fixation (IF) and displaced FNF treated with hip arthroplasty. We hypothesized that hip arthroplasty would give a lower incidence of reoperations. Methods: A total of 235 patients were included with a median age of 84 years (range 65-99). A consecutive series of 65 patients with undisplaced FNF were treated with IF, and 170 patients with displaced FNF were treated with either a total hip arthroplasty or a hemiarthroplasty. Follow-up interviews were conducted at 1 year using the Harris Hip Score (HHS), WOMAC, and pain numeric rating scale (PNRS). The minimum follow-up time was 22 months. There was no difference in baseline data between the groups. Results: Nineteen (8%) hips required reoperation at least once at a mean of 6 months (range 0-35). The rate of reoperation was higher in the IF group compared to the hip arthroplasty group (13.8% vs. 5.9%, 95% CI 0.9-6.4). The overall 1-year and 2-year mortality was 28% and 40%, respectively, with no difference between the groups. The most common reasons for reoperations in the IF group were non-union and avascular necrosis, and 6 patients were treated with hip or excision arthroplasty. In the arthroplasty group, the most common indications were deep infection and dislocation. We did not find any differences between the groups in terms of HHS, WOMAC, and PNRS. Conclusions: In this feasibility study, we found no differences in patient-reported outcomes between the groups although IF required a higher rate of reoperations. Further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly.

Mortality and revision risk after femoral neck fracture: comparison of internal fixation for undisplaced fracture with arthroplasty for displaced fracture: a population-based study from Danish National Registries

“…This could lead to surgical bias, as a surgeon might be more prone to choose an IF for a 72-year-old patient with a 20-degree posterior tilt compared with an 82-year-old patient. This could explain some of the baseline difference, which, however, could also be due to an underlying confounding in the population sustaining a displaced or undisplaced FNF, but previous studies have not found a major difference between groups (Mukka et al 2020, Richards et al 2020. There is, however, no difference in the 1-year mortality between hemiarthroplasty and IF despite the baseline difference.…”

“…This could explain some of the baseline difference, which, however, could also be due to an underlying confounding in the population sustaining a displaced or undisplaced FNF, but previous studies have not found a major difference between groups (Mukka et al. 2020 , Richards et al. 2020 ).…”

“…A difference in mortality could be investigated by assuming that there is no difference per se in mortality risk between patients with a displaced and undisplaced FNF. This assumption is supported by studies comparing IF for undisplaced FNF with arthroplasty for displaced FNF showing no difference in mortality (Mukka et al 2020, Richards et al 2020.…”

“…This assumption is supported by studies comparing IF for undisplaced FNF with arthroplasty for displaced FNF showing no difference in mortality (Mukka et al. 2020 , Richards et al. 2020 ).…”

The Risk of Avascular Necrosis Following the Stabilization of Femoral Neck Fractures: A Systematic Review and Meta-Analysis

“…The sample size ranged from 17 to 417 participants. Three studies reported solely on pediatric populations [ 16 , 17 , 18 ], while nine studies included only participants above 50 years of age [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The studies included those that reported the use of both closed and open fracture-reduction techniques and employed a wide range of implants, most commonly cannulated screws (28 studies).…”