Article

Trends in Utilization of Total Hip Arthroplasty for Femoral Neck Fractures in the United States

Publish date: December 7, 2018

References

1. Bishop J, Yang A, Githens M, Sox AH. Evaluation of contemporary trends in femoral neck fracture management reveals discrepancies in treatment. Geriatr Orthop Surg Rehabil. 2016;7(3):135. doi:10.1177/2151458516658328.

2. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res Off J Am Soc Bone Miner Res. 2007;22(3):465. doi:10.1359/jbmr.061113.

3. Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M. Epidemiology of hip fractures. Bone. 1996;18(1 Suppl.):57s. doi:10.1016/8756-3282(95)00381-9.

4. Koval KJ, Zuckerman JD. Hip fractures: I. Overview and evaluation and treatment of femoral-neck fractures. J Am Acad Orthop Surg. 1994;2(3):141. doi:10.5435/00124635-199405000-00002.

5. Miller BJ, Callaghan JJ, Cram P, Karam M, Marsh JL, Noiseux NO. Changing trends in the treatment of femoral neck fractures: a review of the American Board of Orthopaedic Surgery database. J Bone Joint Surg. (American) 2014;96(17):e149. doi:10.2106/JBJS.M.01122.

6. Miller BJ, Lu X, Cram P. The trends in treatment of femoral neck fractures in the Medicare population from 1991 to 2008. J Bone Joint Surg. (American) 2013;95(18):e132. doi:10.2106/JBJS.L.01163.

7. Nwachukwu BU, McCormick F, Provencher MT, Roche M, Rubash HE. A comprehensive analysis of Medicare trends in utilization and hospital economics for total knee and hip arthroplasty from 2005 to 2011. J Arthroplast. 2015;30(1):15. doi:10.1016/j.arth.2014.08.025.

8. Su EP, Su SL. Femoral neck fractures: a changing paradigm. Bone Joint J. 2014;96-b(11) Supple A):43. doi:10.1302/0301-620X.96B11.34334.

9. Ahn J, Man LX, Park S, Sodl JF, Esterhai JL. Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures. Clin Orthop Relat Res. 2008;466(10):2513. doi:10.1007/s11999-008-0368-3.

10. Alolabi B, Bajammal S, Shirali J, Karanicolas PJ, Gafni A, Bhandari M. Treatment of displaced femoral neck fractures in the elderly: a cost-benefit analysis. J Orthop Trauma. 2009;23(6):442. doi:10.1097/BOT.0b013e31817614dd.

11. Bentler SE, Liu L, Obrizan M, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170(10):1290. doi:10.1093/aje/kwp266.

12. Brox WT, Chan PH, Cafri G, Inacio MC. Similar mortality with general or regional anesthesia in elderly hip fracture patients. Acta Orthop. 2016;87(2):152. doi:10.3109/17453674.2015.1128781.

13. Catal B, Sener M. Treatment and displacement affect the reoperation rate for femoral neck fracture. Clin Orthop Relat Res. 2013;471(12):4096. doi:10.1007/s11999-013-3295-x.

14. Dailiana Z, Papakostidou I, Varitimidis S, Michalitsis S, Veloni A, Malizos K. Surgical treatment of hip fractures: factors influencing mortality. Hippokratia. 2013;17(3):252.

15. Deangelis JP, Ademi A, Staff I, Lewis CG. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma. 2012;26(3):135. doi:10.1097/BOT.0b013e318238b7a5.

16. Hedbeck CJ, Inngul C, Blomfeldt R, Ponzer S, Tornkvist H, Enocson A. Internal fixation versus cemented hemiarthroplasty for displaced femoral neck fractures in patients with severe cognitive dysfunction: a randomized controlled trial. J Orthop Trauma. 2013;27(12):690. doi:10.1097/BOT.0b013e318291f544.

17. Jia Z, Ding F, Wu Y, et al. Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2015;10:8. doi:10.1186/s13018-015-0165-0.

18. Lapidus LJ, Charalampidis A, Rundgren J, Enocson A. Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. J Orthop Trauma. 2013;27(7):386. doi:10.1097/BOT.0b013e318281da6e.

19. Mariconda M, Costa GG, Cerbasi S, et al. Factors predicting mobility and the change in Activities of Daily Living After hip fracture: A 1-year prospective cohort study. J Orthop Trauma. 2016;30(2):71. doi:10.1097/BOT.0000000000000448.

20. Nyholm AM, Gromov K, Palm H, et al. Time to surgery is associated with thirty-day and ninety-day mortality After proximal femoral fracture: A retrospective observational study on prospectively collected data from the Danish Fracture Database Collaborators. J Bone Joint Surg. (American) 2015;97(16):1333. doi:10.2106/JBJS.O.00029.

21. Samuel AM, Russo GS, Lukasiewicz AM, et al. Surgical treatment of femoral neck fractures after 24 hours in patients between the ages of 18 and 49 is associated with poor inpatient outcomes: an analysis of 1361 patients in the National Trauma Data Bank. J Orthop Trauma. 2016;30(2):89. doi:10.1097/BOT.0000000000000456.

22. Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res. 2012;470(8):2235. doi:10.1007/s11999-012-2293-8.

23. Zi-Sheng A, You-Shui G, Zhi-Zhen J, Ting Y, Chang-Qing Z. Hemiarthroplasty vs primary total hip arthroplasty for displaced fractures of the femoral neck in the elderly: a meta-analysis. J Arthroplast. 2012;27(4):583. doi:10.1016/j.arth.2011.07.009.

24. Zielinski SM, Keijsers NL, Praet SF, et al. Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture. J Orthop Trauma. 2014;28(12):e273. doi:10.1097/BOT.0000000000000123.

25. Gu Q, Koenig L, Mather RC, 3rd, Tongue J. Surgery for hip fracture yields societal benefits that exceed the direct medical costs. Clin Orthop Relat Res. 2014;472(11):3536. doi:10.1007/s11999-014-3820-6.

26. Forsh DA, Ferguson TA. Contemporary management of femoral neck fractures: the young and the old. Curr Rev Musculoskelet Med. 2012;5(3):214. doi:10.1007/s12178-012-9127-x.

27. Macaulay W, Pagnotto MR, Iorio R, Mont MA, Saleh KJ. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg. 2006;14(5):287. doi:10.5435/00124635-200605000-00004.

28. Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. I: Femoral neck fractures. J Am Acad Orthop Surg. 2008;16(10):596. doi:10.5435/00124635-200810000-00005.

29. Probe R, Ward R. Internal fixation of femoral neck fractures. J Am Acad Orthop Surg. 2006;14(9):565. doi:10.5435/00124635-200609000-00006.

30. Jain NB, Losina E, Ward DM, Harris MB, Katz JN. Trends in surgical management of femoral neck fractures in the United States. Clin Orthop Relat Res. 2008;466(12):3116. doi:10.1007/s11999-008-0392-3.

31. Menendez ME, Neuhaus V, van Dijk CN, Ring D. The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res. 2014;472(9):2878. doi:10.1007/s11999-014-3686-7.

32. Van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser Comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47(6):626-633.

33. Best MJ, Buller LT, Falakassa J, Vecchione D. Risk factors for nonroutine discharge in patients undergoing spinal fusion for intervertebral disc disorders. Iowa Orthop J. 2015;35:147.

34. Schairer WW, Lane JM, Halsey DA, Iorio R, Padgett DE, McLawhorn AS. The Frank Stinchfield award: total hip arthroplasty for femoral neck fracture is not a typical DRG 470: A propensity-matched cohort study. Clin Orthop Relat Res. 2017;475(2):353-360. doi:10.1007/s11999-016-4868-2.

35. Nikkel LE, Fox EJ, Black KP, Davis C, Andersen L, Hollenbeak CS. Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am. 2012;94(1):9. doi:10.2106/JBJS.J.01077.

36. Bilezikian JP. Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis. Am J Med. 2009;122(2 Suppl.):S14. doi:10.1016/j.amjmed.2008.12.003.

37. Siris ES, Pasquale MK, Wang Y, Watts NB. Estimating bisphosphonate use and fracture reduction among US women aged 45 years and older, 2001-2008. J Bone Miner Res Off J Am Soc Bone Miner Res. 2011;26(1):3. doi:10.1002/jbmr.189.

Analysis of the preoperative comorbidities demonstrated significant differences among each surgical treatment group (P < .001 for all, Table 3). The most common comorbidities in patients who underwent HA were uncomplicated hypertension (33.2%), fluid/electrolyte disorders (17.4%), chronic pulmonary disease (14.9%), and congestive heart failure (13.7%). The most common comorbidities in the ORIF group were uncomplicated hypertension (30.8%), fluid/electrolyte disorders (14.5%), chronic pulmonary disease (14.0%), and uncomplicated diabetes (10.9%). Patients treated with THA had most commonly uncomplicated hypertension (30.1%), fluid/electrolyte disorders (17.2%), uncomplicated diabetes (15.5%), and chronic pulmonary disease (14.4%). The prevalence of comorbidities is displayed in Table 3.

DISCHARGE STATUS
Mortality varied significantly, being lowest in those who underwent ORIF (0.8%), followed those who underwent THA (1.8%), and HA (2.6%) (P < .001, Table 1).

The majority of patients in each group were discharged to long-term rehabilitation facilities, including 53.0% of those treated with HA, 40.4% of those treated with ORIF, and 44.3% of patients treated with THA. The second most common discharge location was home, which included 14.8% of patients who underwent HA, 32.2% of patients treated with ORIF, and 20.8% of those who underwent THA. Table 3 demonstrates the details of the discharge settings.

Mortality analysis over time demonstrated a significant decrease in each treatment group (P < .001). Mortality in the ORIF group decreased from 1.2% during 1990 to 1995 to 0.8% in 2002 to 2007. Mortality in the THA group also decreased significantly from 0.8% during 1990 to 1995 to 0.5% during the 2002 to 2007 time period. Patients who underwent HA also exhibited a decrease in mortality rate from 3.3% during 1990 to 1995 to 2.2% during 2002 to 2007 (P < .001, Table 4, Figure 2).

$Femoral neck fracture operative trends in outcomes$

GENERAL ADVERSE EVENTS
There was a significant difference (P < .001) in the percentage of adverse events experienced, the maximum being observed in the THA group (41.0%), followed by the HA group (37.9%) and trailed by the ORIF group (20.3%, (P < .001, Table 1). The prevalence of adverse events is detailed in Table 5.

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