Association between Hemiarthroplasty vs. Total Hip Arthroplasty and Major Surgical Complications among Patients with Femoral Neck Fracture

Abstract

Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95%Confidence interval(CI), 2.21–3.27; p < 0.001; RD, 2.82; 95%CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.

Prosthesis or osteosynthesis for the treatment of a pathological hip fracture? A nationwide registry-based cohort study

“…Pin/screw fixation usually results in poor biomechanical stability in MBD, whatever the fracture pattern. In our study functional results between hemiarthroplasty and total hip replacement were comparable, supporting the view that in MBD, where short-term functional results are of importance considering the short patient survival, the use of hemiarthroplasty rather than total hip replacement is preferable in the majority of patients since it is associated with a lower risk for dislocation and shorter operative time [16] , [17] . This is contrary to the traumatic hip fracture scenario, where total hip arthroplasty is associated with better functional outcome [18] .…”

Associations between Early Surgery and Postoperative Outcomes in Elderly Patients with Distal Femur Fracture: A Retrospective Cohort Study

“…Regardless of the timing of surgery, the 30-day mortality in the present study was less than 1% and much lower than the rates of 3% to 8% seen in previous studies on geriatric distal femur fracture [2,7,10,11]. However, the low 30-day mortality was consistent with the 30-day mortality rates in geriatric hip fracture studies that used data from large databases (0.6% to 1.0% in Japan; 5.8% to 6.5% in Canada; 6.3% in Sweden) [3,[18][19][20]. In our cohort with a very low 30-day mortality, early surgery did not have clinical effectiveness for 30-day mortality.…”

“…The secondary outcomes were all-cause in-hospital mortality, composite outcome of death or postoperative complications during hospitalization, length of hospital stay, length of time from surgery to discharge, and total hospitalization costs [19]. The composite outcome was defined as death during hospitalization or at least one postoperative complication in the post-admission complication diagnoses detected by relevant ICD-10 codes (listed in Supplementary Materials Table S1) [20]. Length of hospital stay was defined as the duration of hospital admission to hospital discharge.…”

SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case–control study

“…Intracapsular FNFs in the elderly are generally treated using both THA and HA. These latter are associated with lower surgical time and dislocation rate [17], representing thus a viable option especially in the very elderly.…”