Displaced femoral neck fractures in patients 60-69 years old – treatment and patient reported outcomes in a register cohort

Abstract

BackgroundSeveral randomized studies have compared arthroplasty and internal fixation (IF) and found better patient reported outcome measure (PROM) and fewer reoperations for arthroplasty. But consensus is lacking regarding which method to use in the "young elderly” patients aged 60-69; IF tend to fail in up to 1/3 of the cases but can offer the benefits of a biologically intact hip if successful. To add to this, revision of failed IF with secondary arthroplasty has increased risk for complications. This register study aims to describe current treatment and mortality rates for displaced hip fractures based on register data, with focus on young elderly. A secondary aim is to compare changes in PROM between treatments. MethodsData was retrieved from the Swedish Fracture Register, SFR. We found 9,564 femoral neck fractures classified as displaced (AO/OTA 31-B3) in patients 60 years or older. 883 patients were aged 60-69 years. In the final analysis of treatment allocation and PROM mean differences, 723 of these met the inclusion criteria. We adjusted for age, sex and baseline PROM, in patients treated with either IF or total hip arthroplasty (THA) in a regression model. ResultsIn the 60-69 years group, THA was used in 512 (58%), IF 211 (24%) and hemi arthroplasty (HA) 160 (18%) of the patients. As HA patients differed from those selected to THA and IF in regards to baseline characteristics and response rates, we omitted them from the PROM-analysis. When comparing only THA and IF we found no significant differences in mortality nor PROM means one year after injury. Treatment with THA was more common in women. Conclusions: In young elderly patients THA is a common treatment for displaced FNF in Sweden. Patients in this segment treated with HA differ from patients treated with THA and IF, with baseline results in PROM indicating poorer health and function, as well as higher mortality and lower response rates. We found no differences in crude mortality between IF and THA treatment, and no significant influence from treatment on PROM outcome comparing THA and IF.