Hemiarthroplasty for Femoral Neck Fracture in the Nonagenarian Population: A Comparative Study on Survival Outcomes.

Abstract

Purpose: The study aimed to assess the impact of age and comorbidities on mortality in patients with femur neck fractures, focusing on those individuals aged over 90 years. The objective was to determine if chronological age alone defined frailty and if a dedicated hip fracture unit would improve patient outcomes.

Materials and methods: The retrospective study was conducted over 16 months (January 2017 to April 2018), and included patients undergoing hemiarthroplasty, categorized into Group 1 (aged <90 years) and Group 2 (aged 90 years and above). Detailed data were collected on demographics, mobility, co-morbidity, operative aspects, delays, and mortality. Statistical analysis employed IBM SPSS ver. 25.0, utilizing Mann-Whitney U, Fisher exact, and chi-squared tests with a significance level of <0.05.

Results: Of the 203 patients in our study cohort, 151 were in Group 1, and 52 in Group 2. A significant correlation between high American Society of Anesthesiologists (ASA) grade and mortality after one year (P=0.028) was revealed by logistic regression. Spearman test indicated a positive correlation (0.354) between Charlson comorbidity index scores and ASA grades. Compared to Group 1, Group 2 showed no significant decrease in survival at any studied time point.

Conclusion: Patients over 90 years did not represent a uniquely high-risk subset. Frailty was not defined solely by chronological age; a combination of comorbidities and biological age influenced survival rates. The study reinforced that treatment in dedicated hip fracture units and adherence to established guidelines, led to positive outcomes, and reduced mortality, irrespective of age groups.