Outcomes of Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fracture: A Medicare Cohort Study
Zhong Wang, PhD, MPH and Timothy Bhattacharyya, MDHip
Objectives
For patients with femoral neck fractures, total hip arthroplasty demonstrates superior outcomes compared to hemiarthroplasty. However hemiarthroplasty remains a common treatment for femoral neck fractures and the conversion rates are unknown. We compared the results of the two procedures utilizing a Medicare database.
Methods
We assembled a cohort of 70,242 patients age 65 to 90 with an ICD9 diagnosis and matching Current Procedure terminology (CPT) code for femoral neck fracture between 2008 and 2012. Patients were followed forward for two years minimum. Incidences of dislocation and mortality were measured. Reoperation for revision of total hip arthroplasty or conversion of hemiarthroplasty to total hip arthroplasty was assessed by CPT code. Groups were compared via proportional hazard models controlling for age, race, sex and comorbidity index.
Results
Hemiarthroplasty represented 95% of the patients treated using arthroplasty for femoral neck fracture. The proportional hazard of reoperation and dislocation were significantly lower for hemiarthroplasty than total hip arthroplasty (p<0.0001 for both). At two years, fewer than 2% of hemiarthroplasty patients underwent conversion to total hip replacement. Patients treated with total hip arthroplasty were more likely to be alive at two years (adjusted hazard ratio=1.67, 95% Confidence Interval: 1.59 to 1.92).
Conclusion
Patients treated with hemiarthroplasty following femoral neck fractures had significantly lower proportional hazard of reoperation than those treated with total hip arthroplasty. Total hip arthroplasty may be associated with lower mortality.
Level of Evidence
Therapeutic, Level III.(1)
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