Key result
Hemiarthroplasty did not significantly reduce 30-day postoperative mortality compared to pins/screws in patients with dementia and displaced femoral neck fractures.
Why the study?
Dementia is linked to increased postoperative mortality after hip fracture, and the optimal surgical intervention for displaced femoral neck fractures in this population remains debated.
Does hemiarthroplasty reduce mortality compared to pins/screws in patients with dementia and displaced femoral neck fractures?
Cohort (n=9,394)
Yes
Does hemiarthroplasty reduce mortality compared to pins/screws in patients with dementia and displaced femoral neck fractures?
Relative Risk: 0.89 (95% CI 0.74–1.09)
Absolute Event Rate: 14.7% vs 15.8%
p-value: p=0.286
In patients with dementia and displaced femoral neck fractures, hemiarthroplasty is associated with a lower risk of 1-year mortality compared to pins/screws, with no difference in 30-day mortality.
No short-term mortality difference supports individualized choice; leaves open whether hemiarthroplasty offers longer-term survival benefit in this observational cohort.
INTRODUCTION: Dementia is common in patients with hip fractures and is strongly associated with increased postoperative mortality. The choice of surgical intervention for displaced femoral neck fractures (dFNF) in patients with dementia has been a matter of debate. This study aims to investigate how short- and long-term mortality differs between those who have been operated with hemiarthroplasty or pins/screws. METHODS: All patients with dementia and dFNF, i.e., Garden III and IV, who underwent primary emergency hip fracture surgery, with either hemiarthroplasty or pins/screws, in Sweden between Jan 1, 2008 and Dec 31, 2017 were eligible for inclusion in the current study. Patients were divided into two groups based on the surgical intervention: hemiarthroplasty and pins/screws. The primary outcome of interest was 30-day postoperative mortality, and the secondary outcome was 1-year postoperative mortality. Poisson and Cox regression analyses were performed both before and after propensity score matching. RESULTS: A total of 9394 cases met the inclusion criteria; 84% received hemiarthroplasty and 16% received pins/screws. In the unmatched analysis, the adjusted incidence rate ratio (IRR) for 30-day postoperative mortality was not affected by the chosen surgical method (adj. IRR 0.96, CI 95% 0.83-1.12, p = 0.629). After propensity score matching, similar results were observed with no difference in 30-day postoperative mortality (adj. IRR 0.89, CI 95% 0.74-1.09, p = 0.286). There was a statistically significant decrease in the risk of 1-year postoperative mortality in the hemiarthroplasty group compared to the pins/screws group, both before and after propensity score matching. CONCLUSION: This study could not demonstrate any difference in 30-day mortality in patients with dementia and dFNFs when comparing hemiarthroplasty with pins/screws. Patients that received hemiarthroplasties did, however, have a lower risk of 1-year postoperative mortality.
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Ioannidis et al. (2021) conducted a cohort in Displaced femoral neck fractures in patients with dementia (n=9,394). Hemiarthroplasty vs. Pins/screws was evaluated on 30-day postoperative mortality (IRR 0.89, 95% CI 0.74-1.09, p=0.286). Hemiarthroplasty did not significantly reduce 30-day postoperative mortality compared to pins/screws in patients with dementia and displaced femoral neck fractures.
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