Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.18
Peer-review started: June 4, 2019
First decision: September 21, 2019
Revised: September 25, 2019
Accepted: November 7, 2019
Article in press: November 7, 2019
Published online: January 18, 2020
Processing time: 222 Days and 8.2 Hours
Femoral neck fractures despite decreasing steadily in incidence still represent a tremendous economic burden world-wide. Total hip arthroplasty (THA) is an increasingly utilized treatment for displaced femoral neck fractures especially for younger, healthier, ambulatory patients. Notably, multiple studies have demonstrated that THA has superior functional outcomes and results in less pain postoperative compared to hemiarthroplasty (HA).
The motivation for this research study was to further characterize factors associated with patients undergoing THA or HA following displaced femoral neck fracture. This was done in the hopes of better understanding which patients are more likely to undergo THA and what factors may predict adverse in this patient population.
The research objectives in this study was to assess the incidence of patients undergoing THA and HA after displaced femoral neck fracture in the United States. Furthermore, we explored whether hospital length of stay (LOS), discharge disposition, and cost differed between patients undergoing THA or HA.
This was a retrospective study which utilized the Nationwide Inpatient Sample between 2010 and 2014. We identified patients undergoing THA and HA for femoral neck fractures using Ninth Edition diagnosis and procedure codes. Chi-square tests were used to compare categorical variables and t tests for continuous variables. Yearly trends were analyzed using linear regression modeling. P values less than 0.05 were considered statistically significant.
Of the total 502060 patients who were treated for femoral neck fracture in our study, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean LOS was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality.
Our study was consistent with previous research that the number of patients undergoing THA for femoral neck fractures has increased. Furthermore, we found that THA was more common in urban hospitals and in patients with private insurance. Both of these trends have been reported prior, however further research should better examine the etiology between these associations. We found no difference in mortality between patients undergoing HA and THA reflecting that mortality is more dependent on patient comorbidies than surgical technique.
Future research most more closely examine the relationship between surgical choice of femoral neck fracture fixation and insurance type especially since we found increased cost for patients undergoing THA. Prospective studies are needed to effectively examine this research question. Additionally, randomized controlled studies are needed to better develop treatment algorithms to guide orthopedic surgeons on which patients may benefit most from THA compared to HA.