The rising use of total hip arthroplasty for femoral neck fractures in the United States

Abstract

Background: We examined the trends in the treatment of femoral neck fractures with arthroplasty in the United States from 2004–2013. Methods: We used the National Inpatient Sample database in conjunction with codes from the International Classification of Diseases, Ninth Revision, to identify patients receiving hemiarthroplasty (HA) or total hip arthroplasty (THA) for the treatment of closed femoral neck fracture from 2004–2013. We evaluated the trend of these 2 treatments along with demographics, comorbidities, length of stay and same admission mortality. Results: Our study identified 1,059,414 patients who underwent arthroplasty for the treatment of femoral neck fracture. We found a 42% increase in the use of THA during the study period from 8.4% in 2004 to 12.9% in 2013. While the large majority of patients received HA (87.1%), there was an overall decline in the use of HA (89,132 in 2004 to 85,635 in 2013) and increase in the use of THA (8,177 in 2004 to 11,375 in 2013). Patients receiving THA were younger (mean age 74.7 THA vs. 80.4 HA, p < 0.001) with fewer comorbidities, higher likelihood of discharge to home (24% THA vs. 10% HA, p < 0.001) and lower inpatient mortality rates (1.5 % THA vs. 2.4 % HA, p < 0.001) in comparison to HA. Conclusion: There has been a significant increase in the use of THA over the last decade. Patients receiving THA were younger and healthier with fewer comorbidities, less likely to sustain a same admission mortality and more likely to discharge to home in comparison to HA patients.

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

“…An increasing number of patients with FNF receive a total hip arthroplasty (THA) (64)(65)(66). A THA consists of replacing both the acetabulum and the femoral neck and head.…”

Impacto de la demencia en la supervivencia de los pacientes con fractura de cadera intervenidos mediante prótesis total y parcial

“…Hip fractures without surgery were not included because the clinical interest of the survival analysis is due to the fact that it is a criterion for deciding the type of surgical procedure or the patients with fractures in the trochanteric area in whom the surgical management is different. Partial arthroplasty, preferably cemented, is the most indicated option for those patients with a limited life expectancy, with poorer function and mobility, or with cognitive alterations 13 . In recent years there has been an increase in the use of total arthroplasty for the surgical treatment of femoral neck fractures 13 , but an analysis of results from the clinical and also the economic point of view is necessary to know in what type of patients its use is more efficient.…”

“…Partial arthroplasty, preferably cemented, is the most indicated option for those patients with a limited life expectancy, with poorer function and mobility, or with cognitive alterations 13 . In recent years there has been an increase in the use of total arthroplasty for the surgical treatment of femoral neck fractures 13 , but an analysis of results from the clinical and also the economic point of view is necessary to know in what type of patients its use is more efficient. Total arthroplasty is more expensive, requires a longer surgery time, is more aggressive for the patient and with a higher probability of postoperative anemia and the need for transfusions.…”

Geriatric Femoral Neck Fractures: Hemiarthroplasty Implant Trends Across a Health System From 2006 to 2018

“…6 Less is known about the economic impact of selecting cemented versus press-fit (non-cemented) implants in the US market. 11,12 Studies have demonstrated that the additional operative time and accessories used to achieve the cement technique result in a higher cost than when utilizing a pressfit construct. 13 Because there is little evidence to suggest superior clinical outcomes through contemporary implants and fixation methods, the choice of the device can result in cost savings without impacting the quality of care.…”