Key result
In patients older than 80 years with femoral neck fractures, total hip arthroplasty was associated with a significantly higher risk of 30-day mortality compared to hemiarthroplasty (aRR 3.57).
Why the study?
The study was conducted to compare mortality rates between hemiarthroplasty and total hip arthroplasty across two age groups: patients aged 65-79 years and patients aged 80 years or older with femoral neck fracture.
Does total hip arthroplasty compared to hemiarthroplasty affect mortality in elderly patients with femoral neck fracture?
Cohort (n=6,222)
Yes
Does total hip arthroplasty compared to hemiarthroplasty affect mortality in elderly patients with femoral neck fracture?
Relative Risk: 3.57 (95% CI 2–6.4)
Absolute Event Rate: 11.46% vs 3.28%
p-value: p=<0.001
In patients older than 80 years with femoral neck fractures, total hip arthroplasty is associated with higher postoperative mortality compared to hemiarthroplasty.
The purpose of this study was to compare the mortality rate between patients undergoing hemiarthroplasty (HA) and those undergoing total hip arthroplasty (THA) in two age groups: patients aged 65-79 years (non-octogenerian) and patients aged 80 years (octogenarian). Methods: We identified elderly (aged 65 years) femoral neck fracture patients who underwent primary THA or HA from January 1, 2005 to December 31, 2015 in South Korea using the Health Insurance and Review and Assessment database; the nationwide medical claim system of South Korea. We separately compared the mortality rate between the HA group and THA group in two age groups. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to calculate the adjusted risk ratio (aRR) of death according to the type of surgery. Results: The 3,015 HA patients and 213 THA patients in younger elderly group, and 2,989 HA patients and 96 THA patients in older elderly group were included. In the younger elderly group, the mortality rates were similar between the two groups. In older elderly group, the aRR of death in the THA group compared to the HA group was 2.16 (95% confidence interval [CI], 1.20-3.87; P = 0.010) within the in-hospital period, 3.57 (95% CI, 2.00-6.40; P < 0.001) within 30-days, and 1.96 (95% CI, 1.21-3.18; P = 0.006) within 60-days. Conclusions: In patients older than 80 years, THA was associated with higher postoperative mortality compared to HA. We recommend the use of HA rather than THA in these patients.
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Yoo et al. (2021) conducted a cohort in Femoral neck fracture (n=6,222). Total hip arthroplasty vs. Hemiarthroplasty was evaluated on 30-day mortality in patients aged 80-99 years (aRR 3.57, 95% CI 2.00-6.40, p=<0.001). In patients older than 80 years with femoral neck fractures, total hip arthroplasty was associated with a significantly higher risk of 30-day mortality compared to hemiarthroplasty (aRR 3.57).
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