No Difference Between Hemiarthroplasty and Total Hip Arthroplasty in the Treatment of Pathologic Femoral Neck Fractures

Brett L Hayden; Nathan H Varady; Ayesha Abdeen; Santiago A Lozano-Calderon; Antonia F Chen; John E Ready; Pathologic Fracture Study Group

doi:10.1016/j.arth.2021.06.015

No Difference Between Hemiarthroplasty and Total Hip Arthroplasty in the Treatment of Pathologic Femoral Neck Fractures

J Arthroplasty. 2021 Nov;36(11):3662-3666. doi: 10.1016/j.arth.2021.06.015. Epub 2021 Jul 29.

Authors

Brett L Hayden¹, Nathan H Varady², Ayesha Abdeen³, Santiago A Lozano-Calderon⁴, Antonia F Chen⁵, John E Ready⁵; Pathologic Fracture Study Group

Collaborators

Pathologic Fracture Study Group:
Brett L Hayden¹, Brielle Antonelli⁵, Nathan H Varady², Nelson Merchan⁴, Megan E Anderson³, Ayesha Abdeen³, Muzna Ali³, Santiago A Lozano-Calderon⁴, Antonia F Chen⁵, John E Ready⁵

Affiliations

¹ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
² Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA.
³ Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
⁴ Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA.
⁵ Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA.

PMID: 34419316
DOI: 10.1016/j.arth.2021.06.015

Abstract

Background: Hemiarthroplasty (HA) and total hip arthroplasty (THA) have been widely discussed as treatment options for displaced osteoporotic femoral neck fractures. Pathologic femoral neck fractures from primary or metastatic tumors are comparatively rare and poorly investigated. The purpose of this study was to compare outcomes, complications, and perioperative survival for HA and THA in the treatment of pathologic femoral neck fractures of neoplastic etiology.

Methods: A multicenter retrospective cohort study identified patients with pathologic femoral neck fractures treated with HA or THA from 2005 to 2018. Demographics, American Society of Anesthesiologists classification, Charlson comorbidity index, Dorr classification, histopathologic diagnosis, and surgical data were compared. The primary outcome was reoperation. Secondary outcomes included 90-day mortality, estimated blood loss, length of stay, periprosthetic fracture, periprosthetic joint infection, and Eastern Cooperative Oncology Group performance status.

Results: There were 116 patients with HA and 48 patients with THA, with no differences between groups with regard to American Society of Anesthesiologists classification, Charlson comorbidity index, or Dorr classification. There were no differences between HA and THA in the primary outcome of reoperation (5.2% vs 4.2%, P = 1.00) or secondary outcomes of perioperative 90-day overall mortality (30.2% vs 25.0%, P = .51), estimated blood loss, transfusion rates, length of stay, discharge location, periprosthetic joint infection, periprosthetic fracture, or preoperative or postoperative Eastern Cooperative Oncology Group performance status.

Conclusions: Both HA and THA are viable options for the treatment of patients with pathologic femoral neck fractures and demonstrated no differences in reoperations, complications, perioperative 90-day mortality, or functional outcome scores.

Level of evidence: Level III.

Keywords: hemiarthroplasty; pathologic femoral neck fracture; pathologic hip fracture; pathologic proximal femur fracture; total hip arthroplasty.

Publication types

Multicenter Study

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Femoral Neck Fractures* / surgery
Hemiarthroplasty* / adverse effects
Humans
Reoperation
Retrospective Studies
Treatment Outcome