Hemiarthroplasty vs. Total Hip Arthroplasty for Femoral Neck Fractures: 2010-2017 Trends in Complication Rates

Abstract Introduction Optimal treatment of femoral neck fractures (FNF) remains debated. Recent data suggests total hip arthroplasty (THA) confers improved functional outcomes compared to hemiarthroplasty (HA) in active patients. However, temporal trends in complication rates between these treatments lacks study. Methods The National Surgical Quality Improvement Program database was retrospectively queried to compare differences between HA and THA over time (2010-2012, 2013-2015, and 2016-2017) in blood transfusions, operation time, major complications, minor complications, and 30-day readmission, among FNF patients aged ≥50 years. Analyses adjusted for age, sex, anesthesia type, smoking, body mass index, hypertension, bleeding disorder, steroid use, and American Society of Anesthesiologists classification. Results 16,213 patients were identified. THA was associated with higher transfusion rates in 2010-2012 (mean=0.34 vs. 0.28, p=0.001) and 2013-2015 (mean=0.21 vs. 0.19, p=0.002), but not in 2016-2017 (mean=0.13 vs. 0.14, p=0.146). Operation time was significantly higher for THA across all periods (p’s Conclusion THA was associated with less major and minor complications in recent time periods compared to HA for the treatment of FNF, controlling for comorbidities. THA trends in transfusions and operation time have improved over time compared to HA.