The Correlation of Surgeon Subspecialty With Outcomes Following Surgery for Geriatric Femoral Neck Fracture

Introduction: Geriatric femoral neck fractures are common and typically managed with hemiarthroplasty (HA), total hip arthroplasty (THA), or percutaneous pinning (PP) by an on-call physician. The current study assessed if perioperative or longer-term outcomes correlated with orthopaedic surgeon subspecialty. Methods: The 2016 to 2022 PearlDiver M161 Ortho administrative data set was used to identify patients >65 years who underwent HA, THA, or PP for femoral neck fracture. The subspecialty of the treating surgeon was defined as arthroplasty, trauma, or nonarthroplasty/nontrauma. Exclusion criteria included polytrauma and concurrent neoplasms/infections. For each surgery type, 90-day perioperative adverse events were assessed between surgeon cohorts using multivariate logistic regression. Five-year revisions/dislocations were also assessed. Results: Overall, 150,728 surgeries were identified (140,850 by nontrauma/nonarthroplasty surgeons, 5,013 arthroplasty, and 4,865 trauma). Arthroplasty surgeons performed THA at higher rates than trauma or nonarthroplasty/nontrauma surgeons (28.1% versus 7.7% and 12.8%, respectively, P < 0.001). Ninety-day outcomes were more similar than different across surgeon specialties. For HA, 5-year dislocation rates were statistically different but within 1% between cohorts (nonarthroplasty/nontrauma 97.5%, arthroplasty 96.8%, trauma 97.8%). Five-year revision rates were also within 1% between the cohorts (nonarthroplasty/nontrauma 98.2%, arthroplasty 97.2%, trauma 97.8%). For THA, 5-year dislocation rates were not statistically different (nonarthroplasty/nontrauma 95.7%, arthroplasty 96.3%, trauma 96.9%), nor were five-year revision rates (nonarthroplasty/nontrauma 93.9%, arthroplasty 93.8%, trauma 95.0%). For PP, 5-year revision rates were not statistically different (nonarthroplasty/nontrauma 93.8%, arthroplasty 95.1%, trauma 95.2%). Conclusion: Femoral neck fractures were predominantly treated by nonarthroplasty/nontrauma surgeons. Nonetheless, 90-day adverse outcomes and five-year rates of revision/dislocation were clinically quite similar. This can provide confidence that those who self-select to treat geriatric femoral neck fractures are performing comparably regardless of subspecialty.