Risk factors for mortality in patients following total hip arthroplasty and hemiarthroplasty due to femoral neck fractures.

Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: A retrospective case-control study of 199 hips.

Femoral neck fracture is a common problem among the elderly. There is no cure for these fractures until now. Internal fixation, hemi arthroplasty and total arthroplasty are widely used methods for treating these fractures. The purpose of this study was to compare two techniques of arthroplasty and total hemiarthroplasty in femoral neck fractures in the elderly. This clinical trial had been performed among the elderly over 65 years with a diagnosis of femoral neck fracture, hip replacement surgery. They were randomly assigned to two groups (n = 50) of hemiarthroplasty and total hip arthroplasty. Duration of surgery, intraoperative blood loss, and duration of hospitalization were analyzed. Patients Follow up were performed once a month for six months and then quarterly for a year after study. Hip function of patients were assessed using the Harris hip score in the fourth and twelve months after surgery. The rate of intraoperative bleeding and the mean duration of surgery was lower in hemiarthroplasty than THA group (P = 0.01). The mean pain score in patients with total hip arthroplasty after 6month was 38 and after 12 months was 43. In Hemiarthroplasty group, the pain intensity score after 6 months was 40 and after 12 month was 42 (P = 0.04). Average functional score and activity of hip joint in total arthroplasty group was 31.5 (47-5) after six months, and 35.3 (47-8) in yearly follow up, and in hemiarthroplasty group, it was 28 (45-5) and 32 (47-8), respectively (P = 0.028). This study results shows that treatment of femoral neck fractures in elderly through total hip arthroplasty surgery lead to a better results in terms of knee function and also less pain and fewer complications in the one-year follow-up.

A direct lateral approach to the hip is described which allows adequate access for orientation of the implant, for the insertion ofthe cement and for the correction ofdiscrepancy in leg length. An anatomical observation was made that the gluteus medius muscle is inserted into the greater trochanter by a tendon and that the axis of the shaft of the femur lies anterior to the main bulk of the muscle which was left

Background Total hip arthroplasty (THA) is an increasingly popular treatment option for fractured neck of femur (NOF). The primary aim of this study is to systematically review all literature on primary THA and hemiarthroplasty (HA) after fractured NOF to calculate an overall revision rate. Furthermore, we wanted to compare primary THA implantations after fractured NOF between different countries in terms of THA number per inhabitant. Methods All clinical studies on THA and HA for femoral neck fractures between 1999 and 2019 were reviewed and evaluated with a special interest on revision rate. Revision rate was calculated as “revision per 100 component years.” THA registers were compared between different countries with respect to the number of primary implantations per inhabitant. Results THA studies showed a mean revision rate of 11.8% after 10 years, which was lower than a 24.6% 10-year revision rate for HA. We identified 8 arthroplasty registers that revealed an annual average incidence of THA for fractured NOF of 9.7 per 100,000 inhabitants. Conclusion This study showed that patients with THA were less likely to be revised at 10 years compared to HA. We found similar annual numbers of THAs for fractured NOF per inhabitant across countries. The results of this analysis can be used to rank present and future national THA numbers within an international context.

The choice between total hip arthroplasty (THA) and hemiarthroplasty (HA) to treat displaced femoral neck fractures, particularly among the elderly, is still controversial. Acetabular erosion consists of a late multifactorial process that may happen after hip HA resulting in significant postoperative burden. This study aims to investigate the impact of acetabular erosion progress after hip HA in patients over 70 years old. This is a 5-year (2013-2018) retrospective study including consecutive series of patients >70 years who were treated with bipolar hip HA for femoral neck fractures. Patients were categorised into 3 groups for analysis (A = 70-75 years, B = 75-80 years, C = >80 years). The study enrolled a total number of 813 patients who met the inclusion criteria. We assessed acetabular erosion through radiological examinations and measured functional deterioration using the modified Harris Hip Score (mHHS) at 6 and 12 months follow-up. Our comprehensive investigation extended over a maximum period of 5 years. The correlation of patients' characteristics and HA features on erosion progress was assessed. There were no significant differences in sex distribution, injury side, BMI, ASA score, bipolar head diameter, mHHS and leg-length discrepancy among the groups (p > 0.05). During the follow-up period, acetabular erosion with consequential conversion to THA was observed in 6.13%, 4.22% and 1.96% for Groups A, B and C respectively (p = 0.009). A statistically significant difference of acetabular erosion was observed in Group A compared to patients of Group C. Age constitutes a significant factor of acetabular wear after HA in the elderly. The higher rate of acetabular wear in patients <75 years suggests that THA is a more viable option, as HA is for patients >80 years old.

Previous randomized studies have suggested that there is no short-term difference between the risk of revision following total hip arthroplasty (THA) and hemiarthroplasty (HA) for hip fracture in elderly patients. The aim of the present study was to compare the long-term revision rates of primary THA and HA for femoral neck fracture in order to determine whether unipolar or bipolar HA increases the all-cause risk of revision in patients 50 to 79 years old. Data for 36,188 patients who underwent primary arthroplasty, including 13,035 unipolar and 8,220 bipolar HAs and 14,863 THAs, from September 1, 1999, to December 31, 2019, were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Unadjusted analyses were performed, as well as analyses adjusted for age, sex, femoral cement, and procedure year. The primary outcome was time to first revision for any cause. Secondary analyses were performed for the reason for revision (i.e., infection, dislocation, and periprosthetic fracture). Instrumental variable analysis of hospital preference (for either HA or THA) was performed in order to mitigate the effect of any unmeasured confounding. All analyses were restricted to hospitals performing at least 10 procedures in the prior year. A total of 18,955 procedures were available for the comparison of modular unipolar HA to THA. Both the adjusted analysis performed with use of Cox proportional hazards (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.64 to 2.31; p < 0.001) and the instrumental variable analysis (HR, 2.82; 95% CI, 1.89 to 4.22; p < 0.001) demonstrated a higher risk of revision following modular unipolar HA compared with THA from 3 months postoperatively. A total of 13,168 procedures were available for the comparison of bipolar HA to THA. The adjusted analysis performed with use of Cox proportional hazards showed a significantly higher risk of revision for bipolar HA (HR, 1.29; 95% CI, 1.08 to 1.54; p = 0.01). The instrumental variable analysis showed a similar effect size that was not significant (HR, 1.27; 95% CI, 0.91 to 1.78; p = 0.16). Bipolar HA and THA demonstrated no significant difference in revision risk at long-term follow-up. Unipolar HA demonstrated higher risk of revision from 3 months postoperatively compared to THA. The higher risk of revision for dislocation observed following THA may be offset by the higher risk of revision for acetabular erosion or pain following bipolar HA, resulting in more equivalent revision risk. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS) fixation, dynamic hip screw (DHS) fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA) in terms of surgical and functional outcomes, reoperation and postoperative complications. We searched PubMed, The Cochrane Library, Clinical trials, CINAHL, and Embase for randomized controlled trials (RCTs) or quasi-RCTs up to 31 July 2022. A frequentist network meta-analysis was performed to assess the comparative effects of the four operative procedures, using fixed-effects and random-effects models. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. A total of 33 RCTs with 5703 patients were included in our network meta-analysis. CS fixation was best in terms of operation time (CS: MD = - 57.70, 95% CI - 72.78; - 42.62; DHS: MD = - 53.56, 95% CI - 76.17; - 30.95; HA: MD = - 20.90, 95% CI - 30.65; - 11.15; THA: MD = 1.00 reference) and intraoperative blood loss (CS: MD = - 3.67, 95% CI - 4.44; - 2.90; DHS: MD = - 3.20, 95% CI - 4.97; - 1.43; HA: MD = - 1.20, 95% CI - 1.73; - 0.67; THA: MD = 1.00 reference). In life quality and functional outcome, measured at different time points with EQ-5D and the Harris Hip Score (HHS), THA ranked first and HA second (e.g. EQ-5D 2years postoperatively: CS: MD = - 0.20, 95% CI - 0.29; - 0.11; HA: MD = - 0.09, 95% CI - 0.17; - 0.02; THA: MD = 1.00 reference; HHS 2years postoperatively: CS: MD = - 5.50, 95% CI - 9.98; - 1.03; DHS: MD = - 8.93, 95% CI - 15.08; - 2.78; HA: MD = - 3.65, 95% CI - 6.74; - 0.57; THA: MD = 1.00 reference). CS fixation had the highest reoperation risk, followed by DHS fixation, HA, and THA (CS: OR = 9.98, 95% CI 4.60; 21.63; DHS: OR = 5.07, 95% CI 2.15; 11.96; HA: OR = 1.60, 95% CI 0.89; 2.89; THA: OR = 1.00 reference). In our cohort of patients with displaced and non-displaced femoral neck fractures, HHS, EQ-5D, and reoperation risk showed an advantage of THA and HA compared with CS and DHS fixation. Based on these findings, we recommend that hip arthroplasty should be preferred and internal fixation of femoral neck fractures should only be considered in individual cases. a systematic review of randomized controlled trials. PROSPERO on 10 August 2022 (CRD42022350293).

BackgroundHip replacement is divided into total hip arthroplasty (THA) and hemiarthroplasty (HA); it is still controversial whether to choose THA or HA for femoral neck fractures (FNF). The goal of this study was to review relevant studies in order to determine the HA compared to THA for the treatment of FNF.Patients and methodsUsing appropriate keywords, we identified relevant studies using PubMed, Cochrane, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through August 2019 were considered for inclusion. For each study, we assessed odds ratios (ORs), mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes.ResultsWe included 19 studies with a total of 413,140 patients in the HA group and 44973 in the THA group. The blood loss, surgery time, and dislocation were all significantly decreased in the HA group than the THA group. The length of hospital, pneumonia, and renal failure were significant increased in the HA group than THA group. There has no significant difference of complication, mortality, reoperation, infection, pulmonary embolism, and myocardial infarct between the two groups.ConclusionHA has favor in decrease blood loss and surgery time. THA has favor in decrease the length of hospital, the incidence of pneumonia and renal failure. For the selection of surgical methods for femoral neck fracture in the elderly, we should consider several aspects, such as the age of the patient, whether there is osteoporosis, the type of femoral neck fracture, the preoperative reduction situation, and the needs of the patient and his family for the postoperative situation.

Displaced femoral neck fractures (FNFs) are among the most common and debilitating injuries in elderly. The optimal surgical management-total hip arthroplasty (THA) or hemiarthroplasty (HA), remains a subject of debate. This study aimed to compare clinical outcomes reported in literature of patients with a femoral neck fracture treated with either hemiarthroplasty or total hip arthroplasty (THA).This review incorporates findings from landmark randomized controlled trials (RCTs), meta-analyses, and major guidelines, including NICE (2023), Falotico et al (2025) , the HEALTH trial (2019) , Ekhtiari et al (2020), Tang et al (2020) , Lewis et al (2019) , and large registry analyses Edelstein et al 2023 which included population based retrospective studies of elderly &gt;65 years of age with neck of femur fracture. Across over 60,000 patients, mortality rates were similar between THA and HA. THA demonstrated modest improvements in medium-term function and quality of life, particularly in cognitively intact, independent patients. However, THA carried a higher dislocation risk and required longer operative time and greater blood loss. Revision and reoperation rates were comparable. Cost-effectiveness analyses favoured THA in healthy, active individuals but not in frail or dependent patients. Our study concludes that THA offers small functional advantages but with higher dislocation risk. Procedure choice should be individualized based on patient health, functional status, and life expectancy. HA remains appropriate for frail or low-demand patients.

Background: Femoral neck fractures (FNFs) remain “the unsolved fracture” and optimal management is still controversial. The outcomes of hemiarthroplasty (HA) and total hip arthroplasty (THA) in the treatment of FNFs are inconsistent. As demand for management of FNFs continues to grow globally, evaluation of the appropriateness of treatment remains essential, particularly in resource-constrained settings. Methods: We conducted a retrospective chart review of all patients presenting with isolated low energy intracapsular FNFs to an orthopaedic academic unit in Sub-Saharan Africa from January 2016 to April 2019. The decision regarding HA or THA was largely based upon the Sernbo score and ASA classification. The majority of patients with a Sernbo score of ≥15 and ASA class III or better received THA. Results: There were 117 patients (33 male/84 female) 72 years (33–97 years) with FNFs who underwent 56 THA and 61 HA between January 2016 and April 2019. The mean Sernbo score was 15.99 overall (range 8–20) and was 18.95 (11–20) for THA patients compared to 14.46 (8–20) for HA patients (p = 0.042). Time taken from admission to the theatre was 8–19 days (1–22) and 7–61 days (2–31) for HA and THA respectively. The average length of stay (LOS) was 16.04 days and the main reason for same-day cancellations was the lack of post ICU/High Care beds. The 30-day mortality rates were 1.78% and 4.91% for THA and HA patients, respectively (p = 0.07). The mortality rate for patients with a Sernbo score < 15 was 15.38% overall, 8.93% for THA patients, and 21.31% for HA patients, respectively (p = 0.021). Conclusion: The 30-day mortality rate was comparable with published rates from developed countries. There were significant delays in time to theatre, high rates of same-day surgical cancellations, and increased LOS for both HA and THA. These factors play a cumulative role in inflating costs on a strained healthcare system in a developing country. A multidisciplinary approach including the care provision of a specialized geriatric unit is recommended.Retrospective Study, Level III evidence

This study aimed at comparing clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) inelderly patients with neuromuscular imbalance (stroke, Parkinsonism, etc.). A total of 226 elderly patients with neuromuscular imbalance and femoral neck fractures treated with THA or HA were recruited at a single center, and their clinical data retrospectively reviewed. Mean follow-up time was 40.5months (range 24-78), the primary outcome was secondary hip procedure while secondary outcomes included function, pain, health-related quality of life, complications, and death. Kaplan-Meier survival curves were used to determine the estimated survivorship, with re-operation as the end point. Logistic regression analyses were performed to assess the effects of different surgical procedures on mortality while linear regression analysis was used to evaluate the function, pain and quality of life. Kaplan-Meier survivorship, with an end point of re-operation for any reason in the THA group, was 90.3% (95% CI 82.3-98.3), which was not significantly different from 95.9% (95% CI 93.0-98.8) for the HA group (p = 0.137). The most common cause of re-operation in both groups was dislocation. There were no significant differences with regards to postoperative complications (including dislocation). Compared to HA, THA exhibited better functional outcomes, quality of life and low pain intensity. Notably, there was no difference in 2year mortality rates between the groups, however, HA was associated with a higher mortality rate beyond 2years (OR 0.137; 95% CI 0.030-0.630; p = 0.011). THA is an effective therapeutic procedure for femoral neck fractures in elderly patients with neuromuscular imbalance.

BackgroundFemoral neck fractures are a significant source of morbidity and mortality in older adults. This study compared demographics, outcomes and complications between the following treatment options: Open Reduction and Internal Fixation (ORIF), Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA).MethodsThis was a population-based study using the Centers for Medicare & Medicaid Services dataset from 2017-2021. A total of 67,759 isolated hip fracture patients were analyzed. Multivariate regression analyses adjustmented for age, comorbidities and hospital volume. Outcomes were compared using odds ratios (OR) with 95% confidence intervals (CI).ResultsORIF patients were the oldest (36.7% aged 85+), while THA patients were younger (18.6% aged 65-69). Females predominated for overall fracture incidence (66.9%–81.8%). HA patients had significantly higher risks of discharge mortality OR = 1.51 (95% CI 1.24, 1.83), deep venous thrombosis OR = 1.31 (95% CI 1.07, 1.60), cardiac arrest OR = 1.85 (95% CI 1.33, 2.57), pulmonary embolism OR = 1.76 (95% CI 1.38, 2.36), acute kidney injury OR = 1.32 (95% CI 1.24, 1.40) and overall infection compared to ORIF. THA and HA patients were associated with lower odds of rehab discharge (OR = 0.65 and OR = 0.90, respectively). THA was linked to shorter hospital stays (4.3 days) but an increased pulmonary embolism risk OR = 2.39 (95% CI 1.17, 4.88).ConclusionsFor femoral neck fractures, ORIF had the lowest complication rates. Hemiarthroplasty posed the highest complication risks, including mortality and thromboembolic events. THA appeared better suited for healthier individuals, with shorter hospital stays but higher rates of pulmonary embolism. Complication profiles vary significantly across fixation methods for femoral neck fractures. Individualized surgical planning is essential to balance risks and optimize outcomes for femoral neck fracture patients. There may be an opportunity to more carefully scrutinize surgical decision making for femoral neck fractures that would otherwise be treated with either ORIF or HA.

Health Utility of Early Hemiarthroplasty vs Delayed Total Hip Arthroplasty for Displaced Femoral Neck Fracture in Elderly Patients: A Markov Model

Background:The purpose of the present study is to use a statewide, population-based data set to identify mortality rates at 30-day and 1-year postoperatively following total hip arthroplasty (THA) and hemiarthroplasty (HA) for displaced femoral neck fractures. The secondary aim of the study is to determine whether arthroplasty volume confers a protective effect on the mortality rate following femoral neck fracture treatment.Methods:New York’s Statewide Planning and Research Cooperative System was used to identify 45 749 patients older than 60 years of age with a discharge diagnosis of femoral neck fracture undergoing THA or HA from 2000 through 2010. Comorbidities were identified using the Charlson comorbidity index. Mortality risk was modeled using Cox proportional hazards models while controlling for demographic and comorbid characteristics. High-volume THA centers were defined as those in the top quartile of arthroplasty volume, while low-volume centers were defined as the bottom quartile.Results:Patients undergoing THA for femoral neck fracture rather than HA were younger (79 vs 83 years, P < .001), more likely to have rheumatoid disease, and less likely to have heart disease, dementia, cancer, or diabetes (all P < .05). Thirty-day mortality after HA was higher (8.4% vs 5.7%; P < .001) as was 1-year mortality (25.9% vs 17.8%; P < .001). After controlling for age, gender, ethnicity, and comorbidities, risk of mortality following THA was 21% lower (hazard ratio [HR] 0.79; P = .003) at 30 days and 22% lower (HR 0.78; P < .001) at 1 year than HA. Patients undergoing THA at high-volume arthroplasty centers had improved 1-year mortality when compared to those undergoing THA at low-volume hospitals (HR 0.55; P = .008).Conclusions:Based on this large, population-based study, there is no basis to assume THA carries a greater mortality risk after hip fracture than does standard HA, even when accounting for institutional volume of hip arthroplasty.

Background and purpose — Femoral neck fractures (FNFs) are commonly treated with some kind of arthroplasty, but evidence on whether to use hemiarthroplasty (HA) or total hip arthroplasty (THA) is lacking. HA reduces the risk of dislocation, but may lead to acetabular erosion. THA implies longer surgery and increased bleeding. THA may result in better function and health-related quality of life, but evidence is contradictory. We compared HA and THA and in terms of revision, reoperation and death.Patients and methods — Data were extracted from the Swedish Hip Arthroplasty Register for 11,253 patients with acute FNF receiving cemented HA or THA during 2008–2012. 2,902 patients with THA were matched by propensity score matching with as many patients with HA based on age, sex, BMI, and ASA classification. We used competing risks survival regression with reoperation or death and revision or death as endpoints.Results — THA patients had significantly reduced risk of revision (absolute risk reduction 0.51; 95% CI 0.39–0.67) and reoperation (0.58; 0.46–0.74). THA was associated with an almost 50% reduced mortality (risk ratio as competing risk for reoperation 0.51; 0.46–0.57).Interpretation — In our national register study of femoral neck fractures, THA had a lower risk than HA for further surgical procedures related to the hip. The reasons for lower mortality after THA are not known. Despite matching, there might be a selection of more healthy patients for this procedure, and other factors unknown to us, with or without relation to the choice of implant.