Death after Total Hip Arthroplasty in Patients with Compensated Heart Failure: Retrospective Cohort Study

Total hip arthroplasty (THA) is the preferred treatment for femoral neck fracture when functional longevity is expected, but congestive heart failure (CHF) is a risk factor for mortality. The hypothesis of this study is that mortality risk increases with disease severity, influencing the choice between total and hemiarthroplasty. This study queried the National Surgical Quality Improvement database for patients treated for an acute, closed, intracapsular femoral neck fracture, identifying 4486 THA and 34 282 hemiarthroplasty recipients. Subjects were stratified by preoperative risk factors, New York Heart Association categories of mild, moderate, and severe CHF, and odds of death within 30 days. The 30-day postoperative mortality rates for total and hemiarthroplasty were 2.1% (n = 95) and 5.4% (n = 1857), respectively. The 30-day postoperative mortality of patients undergoing THA with mild CHF was 14.3%, and moderate CHF was 21.4%., and for patients undergoing hemiarthroplasty with mild CHF was 11.4%, moderate CHF was 13.9%, and severe CHF was 18.4%. Mild (adjusted odds ratio [AOR] 1.63, 95% Confidence Interval [CI] 1.24-2.14), moderate (AOR 2.21, CI 1.49-3.30), and severe (AOR 2.89, CI 1.41-5.93) CHF was associated with death within 30 days of hemiarthroplasty. Mild (AOR 5.37, 95% CI 2.16-13.38) and moderate (AOR 12.00, CI 3.42-42.17) CHF was associated with death within 30 days of THA. Patients with CHF had increased mortality after THA for acute femoral neck fracture, suggesting it is not a modifiable risk factor. Hemiarthroplasty is a reasonable choice with CHF given evidence of unfavorable survival.