National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database

Boniello, Anthony J.; Lieber, Alexander M.; Denehy, Kevin; Cavanaugh, Priscilla K.; Kerbel, Yehuda E.; Star, Andrew M.

doi:10.5312/wjo.v11.i1.18

Cited by 10 publications

(20 citation statements)

References 25 publications

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“…HA became prevalent in the 1990s, reflecting recognition of the high risk of failure of IF in older patients. 8,34 Stronach et al 35 and Boniello et al 36 observed acute THA use increase from 8% to 14% of FNF surgeries between 2004 and 2015. We observed that this practice continues to be embraced by ABOS Part II examination candidates.…”

Section: Discussionmentioning

confidence: 99%

Management of Femoral Neck Fractures in Patients 50 Years or Older by American Board of Orthopaedic Surgery Part II Examination Candidates

Patterson,

Heckmann,

Garvin

et al. 2023

Journal of Orthopaedic Trauma

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Objective: Assess associations between fellowship training, procedure, and performance in femoral neck fracture (FNF) surgery on adults by American Board of Orthopaedic Surgery (ABOS) Part II Examination candidates. Setting: ABOS SCRIBE database exam years 2007-2020. Participants: 6,777 candidates performing 39,283 FNF surgeries on adults age ≥ 50 years. Intervention: Fellowship training. Main Outcome Measurements: Case volume; procedure performed: internal fixation (IF), hemiarthroplasty (HA), or total hip arthroplasty (THA); complications; readmission; reoperation. Results: Over the observation period, fewer candidates reported FNF surgery (68% overall, -0.6%/year, R2=0.80) while more candidates reported fellowship training (87% overall, +1.4%/year, R2=0.81). The rate of any complication was significantly associated with fellowship training (32% overall, p<0.001). Readmission (12%, p=0.080) and reoperation (5%, p=0.531) were not significantly associated with fellowship training. The odds of any complication (odds ratio [OR]=-0.03 [95% CI -0.07 to -0.001] per 10 cases) and surgical complication (OR=-0.12 [95% CI -0.17 to -0.07] per 10 cases) were negatively associated with candidate FNF case volume. 3,396 THA for FNF were performed (8% of cases). THA use increased 25 cases/year (R2=0.83) and was associated with adult reconstruction (p<0.001) and oncology (p<0.001) fellowship training. Any complication of THA for FNF (32%, p=0.261), readmission (9% overall, p=0.321), and reoperation (5%, p=0.200) were not significantly associated with fellowship training. Conclusions: Between 2007-2020, femoral neck fracture surgery was performed by fewer ABOS Part II Examination candidates and there was greater use of THA. Over this time period there was a greater prevalence of fellowship training but complications were not associated with fellowship training. Complications were associated with FNF case volume. 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%

Management of Femoral Neck Fractures in Patients 50 Years or Older by American Board of Orthopaedic Surgery Part II Examination Candidates

Patterson,

Heckmann,

Garvin

et al. 2023

Journal of Orthopaedic Trauma

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“…Recent studies indicate lower rates of failure, revision, mortality, and hospital length of stay. These same reports also demonstrate superior clinical and functional outcomes with THA compared with hemiarthroplasty [ [5] , [6] , [7] , [8] ].…”

Section: Introductionmentioning

confidence: 88%

“…Owing to the high rate of nonunion encountered with internal fixation, estimated to be approximately 33%, arthroplasty is becoming a more frequently selected treatment [ 4 , 5 ]. In 2013 alone, nearly a 40% increase in utilization of THA for FNFs was seen compared to the previous decade [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures

et al. 2021

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Background Total hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral). Methods A retrospective review identified 52 patients who underwent primary THA for FNF between 2009 and 2018, including 20 via the DA approach and 32 by alternative approaches. All procedures were exclusively performed by high-volume arthroplasty surgeons. Perioperative results, complications, and clinical outcomes were compared with those of routine statistical methods. Mean follow-up duration was 3 years (range, 1-8). Results The average age was 74 years (range, 57-92) with similar baseline characteristics between the 2 groups ( P = .09). The DA cohort demonstrated significantly shorter length of stay (3 days vs 5 days, P < .01) and discharge to home vs skilled nursing facility (40.0% vs 9.4% P = .014). There was a trend toward decreased complications (0% vs 16%, P = .08). There were no dislocations or fractures in either cohort. Final Harris Hip Scores (94 vs 81, P = .07) and return to community ambulation (96%) were similar between DA and alternative approach groups. Conclusion The DA approach to THA performed for FNF appears safe with improved outcomes compared with alternative approaches. Larger studies are needed to verify these results.

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“…Early fracture treatment improves survival, reduces hospital stay, and restores long-term functional capacity [3]. Not only do patients undergoing surgery for FNF have a higher risk of mortality and postoperative complications, but surgical choices and indications on femoral neck fractures also vary depending on the country [4][5][6]. Despite growing support for the use of THA in the management of acute FNFs, concerns regarding potential increased blood loss, operation duration, and dislocation risks remain.…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of Using the Direct Anterior Approach for Total Hip Arthroplasty or Bipolar Hemiarthroplasty to Treat Femoral Neck Fractures among the Elderly

Ishiguro¹,

Asanuma

Hagi

et al. 2022

Advances in Orthopedics

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Purpose. Femoral neck fractures (FNFs) are a significant cause of mortality and disability among the elderly. Total hip arthroplasty (THA) is the preferred treatment method in active, cognitively intact patients. In less active or cognitively impaired patients, bipolar hemiarthroplasty (BHA) is the practical option in Japan. Even with the direct anterior approach (DAA), clinical concerns about conducting THA in elderly patients include possible dislocations, critical complications, and medical cost-effectiveness. This study is aimed at rethinking the practical surgical indications for FNFs. Methods. Between April 2019 and March 2021, BHA patients with displaced FNF (n = 21) performed through the DAA were compared with THA patients with displaced FNF (n = 19). The perioperative complications, clinical and radiologic outcomes, and mortality were compared between groups retrospectively at six months. Results. THA patients had an increased average operation time (103.3 min vs. 89.1 min, P < 0.05 ) and similar amounts of bleeding (183.16 ml. vs. 121.1 ml.). The percentages of patients who received biological transfusion showed no difference, with low rates of perioperative complications (4% vs. 0%) and similar mortality rates compared to BHA patients. One THA patient experienced posterior dislocation during a state of postoperative delirium. Conclusion. THA through the DAA might be a credible and safe option for FNF patients, with excellent functional outcomes and fewer surgery-related complications. Early posterior dislocation might be related to optimized offset distance and not related to leg discrepancy or other radiographic items. Hence, orthopedic surgeons should reconsider their options before conducting BPH for elderly and cognitively intact FNF patients.

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National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database

Cited by 10 publications

References 25 publications

Management of Femoral Neck Fractures in Patients 50 Years or Older by American Board of Orthopaedic Surgery Part II Examination Candidates

Management of Femoral Neck Fractures in Patients 50 Years or Older by American Board of Orthopaedic Surgery Part II Examination Candidates

Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures

The Feasibility of Using the Direct Anterior Approach for Total Hip Arthroplasty or Bipolar Hemiarthroplasty to Treat Femoral Neck Fractures among the Elderly

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