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Comparative Study
. 2017 May;31(5):260-263.
doi: 10.1097/BOT.0000000000000814.

Outcomes of Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fracture: A Medicare Cohort Study

Zhong Wang  1 , Timothy Bhattacharyya
Affiliations
Comparative Study

Outcomes of Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fracture: A Medicare Cohort Study

Zhong Wang et al. J Orthop Trauma. 2017 May.

Abstract

Objectives: For patients with femoral neck fractures, total hip arthroplasty (THA) demonstrates superior outcomes compared with hemiarthroplasty. However, hemiarthroplasty remains a common treatment for femoral neck fractures and the conversion rates are unknown. We compared the results of the 2 procedures using a Medicare database.

Methods: We assembled a cohort of 70,242 patients 65 to 90 years of age with an ICD9 diagnosis and matching Current Procedure Terminology code for femoral neck fracture between 2008 and 2012. Patients were followed forward for 2 years minimum. Incidences of dislocation and mortality were measured. Reoperation for revision of THA or conversion of hemiarthroplasty to THA was assessed by Current Procedure Terminology code. Groups were compared through proportional hazard models controlling for age, race, sex, and comorbidity index.

Results: Hemiarthroplasty represented 95% of the patients treated using arthroplasty for femoral neck fracture. The proportional hazard of reoperation and dislocation were significantly lower for hemiarthroplasty than THA (P < 0.0001 for both). At 2 years, fewer than 2% of hemiarthroplasty patients underwent conversion to total hip replacement. Patients treated with THA were more likely to be alive for 2 years (adjusted hazard ratio = 1.67, 95% confidence interval: 1.59-1.92).

Conclusion: Patients treated with hemiarthroplasty after femoral neck fractures had significantly lower proportional hazard of reoperation than those treated with THA. THA may be associated with lower mortality.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Figures

Figure 1
Figure 1. Mortality after Arthroplasty for Treatment of Femoral Neck Fracture. The dark line represents the cumulative incidence of mortality
The shaded areas represent the 95% confidence interval.
Figure 2
Figure 2. Incidence of Reoperation after Total Hip Arthroplasty or Hemiarthroplasty for Treatment Femoral Neck Fracture
For the total hip arthroplasty cohort, reoperation represents revision arthroplasty. For the hemiarthroplasty cohort, reoperation represents conversation to total hip arthroplasty
Figure 3
Figure 3. Incidence of Dislocation after Total Hip Arthroplasty or Hemiarthroplasty for Treatment Femoral Neck Fracture
See this image and copyright information in PMC

References

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