Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

Abstract

Introduction: There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied.

Methods: Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications.

Results: Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly.

Discussion: Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications.

Conclusion: Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population.

Keywords: adult reconstructive surgery; fragility fractures; geriatric medicine; geriatric trauma; trauma surgery.

Figure 1.

Comorbidity, complications, and mortality trends among patients surgically treated for hip fracture between 1990 and 2007.

Figure 2.

Operative trends in surgical fixation by fracture type between 1990 and 2007.

Figure 3.

Operative trends by surgical fixation type and age group between 1990 and 2007.