Christina Liu , Stephen Moye , Austin T. Gregg , Thirushan Wignakumar , Adriana Liimakka , Yibin Zhang , Alex Farid , Antonia F. Chen , Nishant Suneja
{"title":"Trends in hemiarthroplasty and total hip arthroplasty for femoral neck fractures: Surgeon or patient driven?","authors":"Christina Liu , Stephen Moye , Austin T. Gregg , Thirushan Wignakumar , Adriana Liimakka , Yibin Zhang , Alex Farid , Antonia F. Chen , Nishant Suneja","doi":"10.1016/j.injury.2025.112662","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The primary objective was to analyze the trends in hemiarthroplasty (HA) and total hip arthroplasty (THA) for adult patients with fractures (FNFs), with a focus on geriatric population, over the past two decades. The secondary objectives were to compare outcomes between HA and THA and evaluate its association with patient- and surgeon- specific factors.</div></div><div><h3>Methods and materials</h3><div><em>Design:</em> Retrospective cohort.</div><div><em>Setting:</em> Two Level 1 Trauma Centers.</div><div><em>Patient Selection Criteria:</em> Adult patients with FNFs between 2001 and 2023.</div></div><div><h3>Results</h3><div>A total of 3180 cases of FNF treated with arthroplasty were included in the study, comprising 2497 patients who received HA and 683 patients who received THA. There was an overall increase in both THA and HA performed for geriatric FNFs with THA increasing at a faster rate (223 % vs. 172 %, respectively). Patients receiving THA were younger (70.8 vs. 81.4 years, <em>p</em> < 0.001) and more likely to be female (70.9 % vs. 65.1 %, <em>p</em> = 0.006). Patients receiving HA had lower BMI (24.6 vs. 25.4kg/m<sup>2</sup>, <em>p</em> = 0.002), higher Charlson Comorbidity Index (7.5 vs. 4.6, <em>p</em> < 0.001), and higher rates of dementia (29.9 % vs. 7.8 %, <em>p</em> < 0.001).Factors associated with selection of THA over HA included arthroplasty fellowship training (21.5 % vs. 10.4 %, <em>p</em> < 0.001) and greater surgical experience, as measured by years in practice (15.1 vs. 12.5 years, <em>p</em> < 0.001).. Patients receiving THA had shorter hospitalizations (6.3 vs. 7.9 days, <em>p</em> < 0.001) and were more likely to be discharged home (24.3 % vs. 5.5 %, <em>p</em> < 0.001). Despite similar reoperation rates (4.5 % vs. 5.1 %, <em>p</em> = 0.58), THA resulted in a higher complication rate (9.2 % vs. 6.1 %, <em>p</em> = 0.006). HA had higher 90-day (11.1 % vs. 1.6 %, <em>p</em> < 0.001) and 1 year (21.1 % vs. 3.8 %, <em>p</em> < 0.001) mortality rates.</div></div><div><h3>Conclusions</h3><div>There has been a rising trend in THA for the treatment of FNFs over the past two decades, and factors affecting treatment decision are both patient and surgeon driven.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112662"},"PeriodicalIF":2.0000,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Injury-International Journal of the Care of the Injured","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0020138325005224","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
The primary objective was to analyze the trends in hemiarthroplasty (HA) and total hip arthroplasty (THA) for adult patients with fractures (FNFs), with a focus on geriatric population, over the past two decades. The secondary objectives were to compare outcomes between HA and THA and evaluate its association with patient- and surgeon- specific factors.
Methods and materials
Design: Retrospective cohort.
Setting: Two Level 1 Trauma Centers.
Patient Selection Criteria: Adult patients with FNFs between 2001 and 2023.
Results
A total of 3180 cases of FNF treated with arthroplasty were included in the study, comprising 2497 patients who received HA and 683 patients who received THA. There was an overall increase in both THA and HA performed for geriatric FNFs with THA increasing at a faster rate (223 % vs. 172 %, respectively). Patients receiving THA were younger (70.8 vs. 81.4 years, p < 0.001) and more likely to be female (70.9 % vs. 65.1 %, p = 0.006). Patients receiving HA had lower BMI (24.6 vs. 25.4kg/m2, p = 0.002), higher Charlson Comorbidity Index (7.5 vs. 4.6, p < 0.001), and higher rates of dementia (29.9 % vs. 7.8 %, p < 0.001).Factors associated with selection of THA over HA included arthroplasty fellowship training (21.5 % vs. 10.4 %, p < 0.001) and greater surgical experience, as measured by years in practice (15.1 vs. 12.5 years, p < 0.001).. Patients receiving THA had shorter hospitalizations (6.3 vs. 7.9 days, p < 0.001) and were more likely to be discharged home (24.3 % vs. 5.5 %, p < 0.001). Despite similar reoperation rates (4.5 % vs. 5.1 %, p = 0.58), THA resulted in a higher complication rate (9.2 % vs. 6.1 %, p = 0.006). HA had higher 90-day (11.1 % vs. 1.6 %, p < 0.001) and 1 year (21.1 % vs. 3.8 %, p < 0.001) mortality rates.
Conclusions
There has been a rising trend in THA for the treatment of FNFs over the past two decades, and factors affecting treatment decision are both patient and surgeon driven.
期刊介绍:
Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.