Postoperative Outcomes of Femoral Neck Fracture Management in Dialysis-Dependent Patients

Abstract

Femoral neck fractures are common in patients with chronic kidney disease (CKD) due to abnormalities of bone metabolism. In patients on dialysis, femoral neck fractures have been shown to occur at a younger age than in nondialysis patients. The purpose of this study was to compare the associated complication rates of femoral neck fractures among dialysis patients treated with total hip arthroplasty (THA) versus hemiarthroplasty (HA) as well as evaluate for any differences in outcomes compared to the nondialysis patient population. This was a retrospective cohort study performed using the National Surgical Quality Improvement Program database that included 54,328 patients with femoral neck fractures managed surgically from 2006 to 2016. One-thousand seventy patients were identified as dialysis-dependent. Demographics, medical comorbidities, perioperative complication rates, and mortality rates were collected. Data was first analyzed descriptively and with analysis of variance or chi-squared analyses as appropriate. Odds ratios were then calculated for perioperative outcomes and complications. Femoral neck fractures in patients on dialysis occurred at a significantly younger age (73.3 vs. 77.0, p < 0.001) than nondialysis patients. In dialysis patients who underwent THA, complication rates, postoperative length of stay, readmission rates, and 1-year mortality were greater when compared to nondialysis patients. There were no significant differences in perioperative medical or surgical complication rates within the dialysis population when comparing THA to HA. Dialysis patients treated with THA for femoral neck fracture experience more complications compared to nondialysis patients. However, among dialysis patients treated with THA compared to HA, there were no significant differences in outcomes. THA is, therefore, a viable option for dialysis-dependent patients with femoral neck fractures who are otherwise medically stable.