Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2020; 11(1): 18-26
Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.18
National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database
Anthony J Boniello, Alexander M Lieber, Kevin Denehy, Priscilla Cavanaugh, Yehuda E Kerbel, Andrew Star
Anthony J Boniello, Priscilla Cavanaugh, Andrew Star, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
Alexander M Lieber, Drexel University College of Medicine, Philadelphia, PA 19123, United States
Kevin Denehy, Bluegrass Orthopaedics, Lexington, KY 40509, United States
Yehuda E Kerbel, Deparment of Orthopaedics, Hospital of University of Pennsylvania, Philadelphia, PA 19104, United States
Author contributions: Boniello AJ conceived the study concept and designed the research with Lieber AM, Denehy K and Star A, Lieber AM and Cavanaugh P performed data collection; Lieber AM and Kerbel YE performed statistical analysis; Boniello AJ, Lieber AM, Kerbel YE and Star A edited and revised the manuscript.
Institutional review board statement: HCUP databases such as the National Inpatient Sample (NIS) are considered limited data sets and therefore do not require IRB approval under HIPAA. See attached document of exemption.
Informed consent statement: HCUP databases such as the National Inpatient Sample (NIS) are considered limited data sets and therefore an informed consent statement is not relevant in this context.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: Statistical code available by contacting the corresponding author.
STROBE statement: STROBE checklist for the present study is available online.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Alexander M Lieber, BSc, Research Fellow, Department of Orthopedics, Jefferson University Hospital, 1025 Walnut Street, College Building, Suite 516, Philadelphia, PA 19107, United States. alex.m.lieber@gmail.com
Received: June 1, 2019
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
ARTICLE HIGHLIGHTS
Research background

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).

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.