Cited 11 times since 2020 (2.4 per year) source: EuropePMC Journal of orthopaedic trauma, Volume 34 Suppl 3, 1 1 2020, Pages S9-S14 Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study. Afaq S, OʼHara NN, Schemitsch EH, Bzovsky S, Sprague S, Poolman RW, Frihagen F, Heels-Ansdell D, Bhandari M, Swiontkowski M, Slobogean GP, FAITH Investigators, HEALTH Investigators
Objective
To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs).
Design
Retrospective cohort study.
Setting
Secondary data analysis of 2 multinational randomized controlled trials.
Participants
Patients aged 50 years or older with a FNF.
Intervention
Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF.
Main outcome measurement
The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life.
Results
The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44-0.72, P < 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32-0.55, P < 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6-3.8, P < 0.01).
Conclusions
Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial.
Level of evidence
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
