Abstract
Previous studies have shown better clinical outcomes after total hip arthroplasty (THA) compared to hemiarthroplasty (HA) for displaced femoral neck fracture. However, few studies have focused on the surgical risks of the two procedures. Therefore, we investigated the perioperative complications of HA and THA in femoral neck fracture, using a large nationwide inpatient database. A total of 286,269 patients (281,140 patients with HA and 5129 with THA) with a mean age of 81.7 were enrolled and HA and THA patients were matched by a propensity score to adjust for patient and hospital characteristics. Patients in a matched cohort were analyzed to compare complications and mortality. The systemic complication rate was not significantly different after a propensity score matching of 4967 pairs of patients. However, the incidence of both hip dislocation and revision surgery was more frequent in the THA group (Risk difference (RD), 2.74; 95% Confidence interval (CI), 2.21–3.27; p < 0.001; RD, 2.82; 95% CI, 2.27–3.37; p < 0.001, respectively). There was no significant difference in 30 day in-hospital mortality among the two groups. The risk of dislocation and reoperation was higher for THA than for HA in elderly patients with a femoral neck fracture in this retrospective study using a nationwide database.
Highlights
Femoral neck fracture is a representative trauma causing disability and morbidity, especially among elderly people
Patient baseline characteristics; main diagnoses for admission, activity of daily life score and comorbidities presented on admission, and complications after admission; surgical procedures coded with Japanese original codes; and length of hospital stay were the data contained in this database
Our results showed that the risk of hip dislocation during the postoperative inshown that the postoperative dislocation rate is higher in total hip arthroplasty (THA) than in HA [28,29], whereas other studies have indicated no increase in the complication rate, including dislocation rate, after THA [6,7]
Summary
Femoral neck fracture is a representative trauma causing disability and morbidity, especially among elderly people. Open reduction and internal fixation often result in poor outcomes, and either hemiarthroplasty (HA) or total hip arthroplasty (THA) is recommended for displaced femoral neck fractures [1,2]. Previous studies have found that functionally demanding patients occasionally have problems after HA, such as pain, acetabular erosion, or implant loosening which, requires revision surgery. The average age of patients who require surgery becomes higher, as the aging population increases, which could contribute to increased risk of surgical complications [11,12,13,14]. When making decisions regarding surgical procedures, surgeons need to consider surgical extensiveness and complications in addition to functional outcomes
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