Bipolar Hemiarthroplasty Does Not Result in a Higher Risk of Revision Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures

Farey, John; Cuthbert, Alana R.; Adie, Sam; Harris, Ian

doi:10.2106/jbjs.21.00972

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…We applied the leading statistical method for addressing this type of bias: the 2-stage instrumental variable technique [25][26][27][28] . In the first stage of the analysis, the likelihood that a patient would undergo either a THA or HA was estimated with use of a probit specification.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, instrumental variables must be predictive of the type of surgery that a patient underwent but not independently predictive of surgical outcomes, which are conditional on the type of surgery performed. Guided by prior research, we identified 3 instrumental variables as potentially important determinants of a surgeon's choice of surgery: (1) the annual overall volume of THAs (elective procedures and those performed for fractures) at the surgeon's practicing facility, (2) the annual proportion of THAs at the surgeon's practicing facility that were performed for fracture, and (3) the annual proportion of femoral neck fracture cases at the surgeon's practicing facility that were treated with HA 25 . All volume variables were averaged over a 2-year period.…”

Section: Discussionmentioning

confidence: 99%

“…The limitations of the present study include the use of observational data. It is possible that unobserved variables biased the results, but we attempted to limit this with use of an instrumental variable analysis, as has been done previously in studies of THA versus HA for femoral neck fracture 25 . Second, we were unable to control for surgical approach, implant details including the femoral head size or the use of dual mobility, and body mass index, which may have influenced the rates of dislocation and revision/conversion.…”

Section: Discussionmentioning

confidence: 99%

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Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Patients

Edelstein,

Dillingham,

McGinley

et al. 2023

Journal of Bone and Joint Surgery

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Background: There is practice variation in the selection of a total hip arthroplasty (THA) or a hemiarthroplasty (HA) for the treatment of displaced femoral neck fractures in elderly patients. Large data sets are needed to compare the rates of rare complications following these procedures. We sought to examine the relationship between surgery type and secondary hip surgery (revision or conversion arthroplasty) at 12 months following the index arthroplasty, and that between surgery type and dislocation at 12 months, among elderly Medicare beneficiaries who underwent THA or HA for a femoral neck fracture, taking into account the potential for selection bias. Methods: We performed a population-based, retrospective study of elderly (>65 years of age) Medicare beneficiaries who underwent THA or HA following a femoral neck fracture. Two-stage, instrumental variable regression models were applied to nationally representative Medicare medical claims data from 2017 to 2019. Results: Of the 61,695 elderly patients who met the inclusion criteria, of whom 74.1% were female and 92.2% were non-Hispanic White, 10,268 patients (16.6%) underwent THA and 51,427 (83.4%) underwent HA. The findings from the multivariable, instrumental variable analyses indicated that treatment of displaced femoral neck fractures with THA was associated with a significantly higher risk of dislocation at 12 months compared with treatment with HA (2.9% for the THA group versus 1.9% for the HA group; p = 0.001). There was no significant difference in the likelihood of 12-month revision/conversion between THA and HA. Conclusions: The use of THA to treat femoral neck fractures in elderly patients is associated with a significantly higher risk of 12-month dislocation, as compared with the use of HA, although the difference may not be clinically important. A low overall rate of dislocation was found in both groups. The risk of revision/conversion at 12 months did not differ between the groups. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Patients

Edelstein,

Dillingham,

McGinley

et al. 2023

Journal of Bone and Joint Surgery

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“…Prior studies have sought to determine the optimal form of arthroplasty for the treatment of displaced femoral neck fractures in older patients. Some retrospective studies found THA to be superior to hemiarthroplasty 11 whereas others did not detect any differences 19 and still others have suggested that THA could be associated with a higher complication rate 13-17 . In a meta-analysis of 13 randomized clinical trials published between 1986 and 2018, THA was associated with improved outcomes, including a lower reoperation rate at an average of 5.3 years postoperatively 12 .…”

Section: Discussionmentioning

confidence: 99%

“…There is likely no single best arthroplasty procedure for the treatment of displaced femoral neck fractures in older patients 2,12,18,19 . Instead, the optimal procedure likely varies based on patient characteristics.…”

mentioning

confidence: 99%

Unipolar Hemiarthroplasty, Bipolar Hemiarthroplasty, or Total Hip Arthroplasty for Hip Fracture in Older Individuals

Okike,

Prentice,

Chan

et al. 2023

Journal of Bone and Joint Surgery

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Background: Practice patterns regarding the use of unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (THA) for femoral neck fractures in older patients vary widely. This is due in part to limited data stipulating the specific circumstances under which each form of arthroplasty provides the most predictable outcome. The purpose of this study was to investigate the patient characteristics for which unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA might be preferable due to a lower risk of all-cause revision. Methods: A U.S. health-care system’s hip fracture registry was used to identify patients ≥60 years old who underwent unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA for hip fracture from 2009 through 2021. Unipolar and bipolar hemiarthroplasty were compared with THA within patient subgroups defined by age (60 to 79 versus ≥80 years) and American Society of Anesthesiologists (ASA) classification (I or II versus III); patients with an ASA classification of IV or higher were excluded. Multivariable Cox proportional hazard regression analysis was used to evaluate all-cause revision risk while adjusting for confounders, with mortality considered as a competing risk. Results: There were 14,277 patients in the final sample (median age, 82 years; 70% female; 80% White; 69% with an ASA classification of III; median follow-up, 2.7 years), and the procedures included 7,587 unipolar hemiarthroplasties, 5,479 bipolar hemiarthroplasties, and 1,211 THAs. In the multivariable analysis of all patients, both unipolar (hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.48 to 3.12; p < 0.001) and bipolar (HR = 1.92, 95% CI = 1.31 to 2.80; p < 0.001) hemiarthroplasty had higher revision risks than THA. In the age-stratified multivariable analysis of patients aged 60 to 79 years, both unipolar (HR = 2.17, 95% CI = 1.42 to 3.34; p = 0.004) and bipolar (HR = 1.69, 95% CI = 1.08 to 2.65; p = 0.022) hemiarthroplasty also had higher revision risks than THA. In the ASA-stratified multivariable analysis, patients with an ASA classification of I or II had a higher revision risk after either unipolar (HR = 3.52, 95% CI = 1.87 to 6.64; p < 0.001) or bipolar (HR = 2.31, 95% CI = 1.19 to 4.49; p = 0.013) hemiarthroplasty than after THA. No difference in revision risk between either of the hemiarthroplasties and THA was observed among patients with an age of ≥80 years or those with an ASA classification of III. Conclusions: In this study of hip fractures in older patients, THA was associated with a lower risk of all-cause revision compared with unipolar and bipolar hemiarthroplasty among patients who were 60 to 79 years old and those who had an ASA classification of I or II. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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How to Distinguish Correlation From Causation in Orthopaedic Research

Zaniletti

Larson

Lewallen

et al. 2023

The Journal of Arthroplasty

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Bipolar Hemiarthroplasty Does Not Result in a Higher Risk of Revision Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures

Cited by 8 publications

References 35 publications

Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Patients

Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Patients

Unipolar Hemiarthroplasty, Bipolar Hemiarthroplasty, or Total Hip Arthroplasty for Hip Fracture in Older Individuals

How to Distinguish Correlation From Causation in Orthopaedic Research

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