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Randomized Controlled Trial
. 2020 Nov:34 Suppl 3:S9-S14.
doi: 10.1097/BOT.0000000000001940.

Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study

Shaikh Afaq  1 , Nathan N OʼHara, Emil H Schemitsch, Sofia Bzovsky, Sheila Sprague, Rudolf W Poolman, Frede Frihagen, Diane Heels-Ansdell, Mohit Bhandari, Marc Swiontkowski, Gerard P Slobogean; FAITH Investigators; HEALTH Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study

Shaikh Afaq et al. J Orthop Trauma. 2020 Nov.

Abstract

Objective: To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs).

Design: Retrospective cohort study.

Setting: Secondary data analysis of 2 multinational randomized controlled trials.

Participants: Patients aged 50 years or older with a FNF.

Intervention: Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF.

Main outcome measurement: The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life.

Results: The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01).

Conclusions: Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial.

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

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References

    1. Bhandari M, Devereaux PJ, Tornetta P III, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87:2122–2130.
    1. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017;377:2053–2062.
    1. Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003;85:1673–1681.
    1. Dolatowski FC, Frihagen F, Bartels S, et al. Screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in elderly patients: a multicenter randomized controlled trial. J Bone Joint Surg Am. 2019;101:136–144.
    1. Sikand M, Wenn R, Moran CG. Mortality following surgery for undisplaced intracapsular hip fractures. Injury. 2004;35:1015–1019.

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