Dr. Summers is a resident in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Grau is a resident in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Mr. Massel is a medical student in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Ong is Assistant Professor in the Rothman Institute Department of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Orozco is Assistant Professor in the Rothman Institute Department of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Rosas is a research fellow in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Hernandez is Assistant Professor in the Department of Orthopedic Surgery, University of Miami, Miami, Florida.
Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Address correspondence to: Victor Hugo Hernandez, MD, MS, Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Ave, Miami, FL 33136 (tel, 305-243-3000; fax: 305-689-4979; email, vhh1@med.miami.edu).
Am J Orthop. 2018;47(12). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.
Spencer Summers MD Luis Carlos Grau Dustin Massel BS Alvin Ong Fabio Orozco Samuel Rosas Victor Hernandez MD MSc . Trends in Utilization of Total Hip Arthroplasty for Femoral Neck Fractures in the United States. Am J Orthop. December 7, 2018
References
Femoral neck fractures are a common occurrence in the United States. A recent study estimated an incidence of >63 per 100,000 population.1-8 Although the incidence appears to have decreased over recent decades, there is a projected exponential increase in the incidence of hip fractures over the next 30 years in the baby boomer population.8,9 Given that these fractures have a significant impact on patient morbidity, mortality, and quality of life, research efforts have been directed toward optimizing the treatment of affected patients and improving the outcomes.4,9-24
The treatment of choice for femoral neck fractures and the use of total hip arthroplasty (THA)11 have been a topic of debate.4,9,10,15-17,22,25 Total hip arthroplasty has been advocated for younger, more active patients, whereas hemiarthroplasty (HA) has been reserved for patients who are older and less active. Although several studies have demonstrated that arthroplasty outperforms open reduction and internal fixation (ORIF) in the elderly population with displaced femoral neck fractures, ORIF is still commonly performed in the United States for nondisplaced fractures and in patients aged <50 years.26-29
In an attempt to quantify the use of THA in the treatment of femoral neck fractures and demonstrate the national trends, Miller and colleagues5 pooled the American Board of Orthopaedic Surgery (ABOS) database and analyzed the treatment trends of surgeons taking part II of the ABOS examination from 1999 to 2011. The authors found an increased utilization of THA by recently graduated orthopedic surgeons. In contrast, Jain and colleagues30 found different national trends when they analyzed data from the National Inpatient Sample containing data between 1990 and 2001 and further found decreased utilization of THA procedures by orthopedic surgeons of all levels of training nationwide. However, neither of these studies reported about the trends in demographics, comorbidities, risk factors, or outcomes in this patient population following surgery.
The purpose of this study was to help clarify the findings of these authors using the largest dataset to date and also report on the perioperative complications associated with each mode of fixation in patients who undergo operative treatment for femoral neck fractures in the United States. Our hypotheses were that the femoral neck fracture patient population has become older and has more medical comorbidities. We also hypothesized that there has been a trend toward performing fewer THA procedures in the United States and that THA is associated with increased perioperative complications compared to those with HA and ORIF.
MATERIALS AND METHODS
We conducted a retrospective epidemiological study using the National Hospital Discharge Survey (NHDS) on surgical trends in the management of femoral neck fractures. The NHDS is a publicly available survey that is conducted annually to provide data of nonfederal, short-stay hospitals to the public. The sample data are weighted to provide nationwide estimates of annual inpatient care. The NHDS includes up to 7 medical diagnoses and 4 procedural codes per case, which are categorized using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes, that were collected along with patient demographic information, length of stay (LOS), and discharge disposition. The diagnostic and procedural codes used for this study are presented in the Appendix. The year 2007 was chosen as the endpoint of this study due to the fact that the relative standard error of the NHDS doubled in 2008 as a result of a decrease in its survey size. As this is a publicly available database, our study was exempt from institutional review board approval.
