Comparison of Outcomes of Total Hip Arthroplasty to Hemiarthroplasty for Geriatric Hip Fractures: A Literature Review of Large Database Studies

Abstract

AbstractThe objective of this article is to review large database comparisons of total hip arthroplasty (THA) to hemiarthroplasty (HA) for geriatric hip fracture patients. This article followed a systematic review of the literature using published studies identified via PubMed as the data source. A literature search was done iteratively with a systematic use of variations of key search terms. The initial search identified 490 references. Of the 490, 15 full-text papers were reviewed. Ultimately, nine papers were included in the review. Five of the included studies utilized the National Surgical Quality Improvement Program database, one utilized Hospital Episode Statistics, one utilized The National Hospital Discharge Survey, one utilized Swedish Nation Hip Fracture/Arthroplasty Register, and the last utilized the ENCLAVE system of the Centers for Medicare & Medicaid Services. These all included data ranging from 2005 to 2013 and included at least 1,000 patients. Clinical postoperative outcomes of THA and HA were grouped and compared among the nine studies. The studies used multivariable analysis to make comparisons, and it is of note that HA is much more common than THA in this patient population. Primary outcome variables evaluated included major/minor complications, mortality, length of stay, postoperative transfusion, readmission, dislocation, and revision. Overall, major and minor adverse events (or a combination of the two) were lower for THA than for HA patients, and postoperative transfusions were more common for THA patients. Mortality was significantly less for THA patients by 3% to 4%. Length of stay was lower for THA patients. Dislocation rates were higher for THA patients at 30 days, 18 months, 24 months, and 4 years by odds ratios of three to five times. One study found THA patients more likely to undergo reoperation. In select geriatric patients with femoral neck fractures, THA and HA may be appropriately considered. For those patients, studies suggest that THA may be associated with fewer postoperative challenges than HA; however, postoperative transfusion and dislocation rates were noted to be higher for THA patients.