Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Bishop, Julius A.; Yang, Arthur; Githens, Michael; Sox, Alex H. S.

doi:10.1177/2151458516658328

Cited by 19 publications

(15 citation statements)

References 23 publications

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“…In terms of HA utilization, Bishop et al found that this technique decreased in patients aged 60 to 69 years and increased in patients aged 80 years and up. ( 17 ) Similar to Bishop et al, ( 17 ) we also found that THA and HA utilization increased, while cannulated screw fixation decreased. To our knowledge, the finding that the percent of cases using open reduction internal fixation/prosthetic placement procedures increased has not been reported in prior studies.…”

Section: Discussionsupporting

confidence: 89%

“…( 16 ) Similarly, studies of the Nationwide Inpatient Sample (NIS) database, from 1990 to 2010, reported that HA was the most common surgical technique across all age groups, accounting for 62.3 to 75.3% of femoral neck fracture surgeries. ( 15 , 17 ) Our study also found that HA was more common than THA or internal fixation, but only 34.2% of our patients underwent HA. Instead, open reduction internal fixation/prosthetic placement was the most common procedure type among our patients.…”

Section: Discussionsupporting

confidence: 66%

“…( 15 ) Bishop et al reported an overall increase in the rates of THA and HA, and decrease in internal fixation cases, from 1998 to 2010. ( 17 ) Bishop et al also reported that THA utilization increased in patients aged 60 to 79 years, and decreased in patients aged 80 years and over. In terms of HA utilization, Bishop et al found that this technique decreased in patients aged 60 to 69 years and increased in patients aged 80 years and up.…”

Section: Discussionmentioning

confidence: 94%

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Trends in surgical treatment of femoral neck fractures in the elderly

Lehtonen

Stibolt

Smith

et al. 2018

Einstein (São Paulo)

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Objective To analyze recent demographic and medical billing trends in treatment of femoral neck fracture of American elderly patients.Methods The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2006 to 2015, for patients aged 65 years and older, using the Current Procedural Terminology codes 27130, 27125, 27235, and 27236. Patient demographics, postoperative complications, and frequency of codes were compared and analyzed over time. Our sample had 17,122 elderly patients, in that, 70% were female, mean age of 80.1 years (standard deviation±6.6 years).Results The number of cases increased, but age, gender, body mass index, rates of diabetes and smoking did not change over time. Open reduction internal fixation was the most commonly billed code, with 9,169 patients (53.6%), followed by hemiarthroplasty with 5,861 (34.2%) patients. Combined estimated probability of morbidity was 9.8% (standard deviation±5.2%), and did not change significantly over time. Postoperative complication rates were similar between treatments.Conclusion Demographics and morbidity rates in femoral neck fractures of elderly patients did not change significantly from 2006 to 2015. Open reduction internal fixation was the most common treatment followed by hemiarthroplasty.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 94%

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Trends in surgical treatment of femoral neck fractures in the elderly

Lehtonen

Stibolt

Smith

et al. 2018

Einstein (São Paulo)

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“…In light of these findings, few studies have evaluated the factors affecting utilization rates when compared to HA and the role certain factors such as race, ethnicity, insurance status, and other socioeconomic measures may have on the odds of receipt. 26 The purpose of this study was to evaluate the associations of patients’ race, sex, geography, and other socioeconomic factors on receipt of THA versus HA in the treatment of femoral neck fracture.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Total Hip Arthroplasty Versus Hemiarthroplasty in the Management of Geriatric Femoral Neck Fractures

Dangelmajer

Yang

Githens

et al. 2017

Geriatr Orthop Surg Rehabil

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Introduction:Recent clinical evidence suggests that total hip arthroplasty (THA) provides improved clinical outcomes as compared to hemiarthroplasty (HA) for displaced femoral neck fractures in elderly individuals. However, THA is still utilized relatively infrequently. Few studies have evaluated the factors affecting utilization and the role socioeconomics plays in THA versus HA.Methods:In the United States, the National Inpatient Sample (NIS) database was used to identify patients treated surgically for femoral neck fracture, between 2009 and 2010. Patients were identified using International Classification of Diseases, Ninth Revision, codes for closed, transcervical femoral neck fractures and closed fractures at unspecified parts of the femoral neck. All candidate predictors of THA versus HA were entered into a multilevel mixed-effect regression model.Results:Older patient age, being Asian or Pacific Islander, and having Medicaid payer status were all associated with lower odds of receiving THA. Patients with private insurance including Health Maintenance organization (HMO) had higher odds of THA as did patients with other insurance. Odds of THA were significantly lower among patients in teaching hospitals and higher at hospitals with greater THA volume.Discussion:Ethnicity, payer status, hospital size, and institutional THA volume were all associated with the utilization of THA versus HA in the treatment of geriatric femoral neck fractures.Level of Evidence:Level III Retrospective Cohort study.

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“…6 – 8 Published literature show a rising trend in arthroplasty for femoral neck fracture and also elaborate on the advantages and risks involved. 9 , 10 There is ongoing debate regarding the method of replacement—hemiarthroplasty or total hip arthroplasty (THA)—best suited for management for intracapsular fractures. 10 – 12 We aim to retrospectively analyze the preoperative factors that seem to influence the decision between hemiarthroplasty and THA in patients admitted to the trauma unit.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Factors Influencing Decision Between Hemiarthroplasty and Total Hip Arthroplasty in Femoral Neck Fractures in Indian Patients—Retrospective Single-Center Study

Selvam¹,

Soundarapandian²,

Soundarapandian³

et al. 2017

Geriatr Orthop Surg Rehabil

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Introduction:The percentage of elderly population is increasing worldwide, with increasing incidence of femoral neck fractures. An increasing trend of arthroplasty for femoral neck fracture is observed. We aim to retrospectively analyze the preoperative factors that seem to influence the decision between hemiarthroplasty and total hip arthroplasty for managment of the same.Materials and Methods:Patients admitted with femoral neck fracture during January 2010 to March 2015 in our institute were included in the study. The preinjury independency status was assessed using Katz index scoring system. Based on the data obtained from case sheets, the patients were segregated into hemiarthroplasty group and total hip arthroplasty group. Variables that preferentially appeared in the individual group were identified.Results:A total of 206 hips of 199 patients were included in the study. The factors that seem to influence the decision between hemiarthroplasty and total hip arthroplasty with a statistical significance were age, Katz index score, and American Society of Anesthesiologists (ASA) grade. Higher ASA grades caused delay in surgery, increasing the length of hospital stay, and these patients more commonly underwent hemiarthroplasty.Discussion:Patients’ preinjury functional status influenced the decision between hemiarthroplasty and total hip arthroplasty, especially in the age between 65 and 80 years. Preoperative comorbidities did not prevent the patient from undergoing total hip replacement due to early optimization for surgery with the help of the dedicated orthogeriatric team.Conclusion:We conclude that preinjury functional independency of a patient is an important decisive factor in the choice between hemiarthroplasty and total hip arthroplasty. In addition to other factors including age and comorbidity pattern, scoring methods for preinjury functional status of patient could aid in decision-making. Early optimization, early surgery, and faster rehabilitation help the patients to achieve their preinjury functional status.

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Evaluation of Contemporary Trends in Femoral Neck Fracture Management Reveals Discrepancies in Treatment

Cited by 19 publications

References 23 publications

Trends in surgical treatment of femoral neck fractures in the elderly

Trends in surgical treatment of femoral neck fractures in the elderly

Disparities in Total Hip Arthroplasty Versus Hemiarthroplasty in the Management of Geriatric Femoral Neck Fractures

Preoperative Factors Influencing Decision Between Hemiarthroplasty and Total Hip Arthroplasty in Femoral Neck Fractures in Indian Patients—Retrospective Single-Center Study

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