Decreasing Incidence of Femoral Neck Fractures in the Medicare Population

Abstract

This study was designed to evaluate trends in incidence and treatment patterns for intracapsular hip fractures and to evaluate risk factors for complications and mortality. Patients with an intracapsular hip fracture who underwent internal fixation, hemiarthroplasty, or total hip arthroplasty (THA) were identified from a 5% nationwide sample of Medicare data (1998-2007). The authors identified 41,053 patients with intracapsular hip fractures between 1998 and 2007. The number of intracapsular hip fractures treated with internal fixation, hemiarthroplasty, or THA decreased by 21.8%, from 4602 in 1998 to 3601 in 2007. In 2007, 54.3% of patients with an intracapsular hip fracture were treated with hemiarthroplasty, compared with 41.2% who were treated with internal fixation and 4.5% who were treated with THA. Compared with internal fixation, hemiarthroplasty had higher adjusted risks of dislocation (+98%) and infection (+53%) at 90 days and higher rates of death (+8%) and reoperation (+33%) at 1 year. Patients who underwent THA had a higher risk of complications at 90 days compared with those who underwent hemiarthroplasty, with 114%, 39%, and 123% greater risk of dislocation, deep venous thrombosis, and mechanical complications, respectively. At 1 year, patients treated with THA had a 42% lower mortality risk and an 85% lower risk of reoperation compared with those who underwent internal fixation. Primary THA is performed more often in younger patients with fewer comorbidities. The incidence of intracapsular hip fracture decreased by 21.8% over the past decade. This decrease is likely the result of multiple factors, most significantly increased awareness and medical management of osteoporosis.

The rising use of total hip arthroplasty for femoral neck fractures in the United States

“…Arthroplasty is superior to open fixation of displaced femoral neck fractures in the elderly with total hip arthroplasty being the preferred option over HA in active patients with long life expectancy due to improved patient outcomes and function. [5][6][7][9][10][11][12]14,[25][26][27][28][29] The THA population was healthier in comparison to the HA population with a worsening rate of comorbidities in HA patients during the study period as reflected by an increasing ECI. There was a higher rate of same admission mortality in the HA population as well.…”

Learning From England's Best Practice Tariff

“…Prior studies have pointed toward a similar decline in the rate of hip fracture hospitalization. [23][24][25][26] Their discussion of increasing bisphosphonate use and reduction in estrogen therapy, 23,24,27 emergence of public health fall education campaigns, [28][29][30] and contested utility of ongoing changes in operative trends, [31][32][33][34] likely explains much of the decreasing incidence observed (particularly the drop between 2006-2012 among adults aged 75-84y) but does nothing to obviate the increasing costs or stagnant mortality. For that, something more needs to change.…”

Epidemiology and Management of Proximal Femoral Fractures in Italy between 2001 and 2016 in Older Adults: Analysis of the National Discharge Registry

“…Given the high incidence of these fractures in subjects older than 65 years, and given the population-aging phenomenon, the management of proximal femoral fractures represents an increasingly important topic for national healthcare systems worldwide, as well as for the orthopedic community. Several reports from different countries highlighted an increase in the total number of proximal femoral fractures [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ], even if the age-adjusted incidence is reported to be stable or decreasing [ 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. The choice of treatment and other aspects such as the time interval between injury and surgery may significantly influence the clinical outcome [ 23 , 24 , 25 ], and thus the investigation of these topics would be of paramount importance for the future planning of proximal femoral fractures management.…”