Increased Risk of 10-Year Revision Following Total Hip Arthroplasty for Femoral Neck Fracture

Authors

Amy Y. Zhao, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: zhaoa@gwmail.gwu.edu.
Philip M. Parel, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: pmparel2018@gwmail.gwu.edu.
Amil R. Agarwal, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: aagarw31@jh.edu.
Alex Gu, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: algu@email.gwu.edu.
Rachel A. Ranson, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: rachelannranson@gmail.com.
Avilash Das, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: dasa@email.gwu.edu.
Gregory J. Golladay, Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA. Electronic address: gregorygolladay@gmail.com.
Savyasachi C. Thakkar, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: savyasachithakkar@gmail.com.

Document Type

Journal Article

Publication Date

9-14-2024

Journal

The Journal of arthroplasty

DOI

10.1016/j.arth.2024.09.012

Keywords

Etiology; Femoral neck fracture; Revision; Survival; Total hip arthroplasty

Abstract

INTRODUCTION: As the incidence of femoral neck fracture (FNF) increases with the aging population, understanding its impact on surgical outcomes is important to improving implant survival and patient satisfaction. Despite increasing use of total hip arthroplasty (THA) as management for FNF, few studies have examined long-term implant survivability. Thus, this study sought to determine the 10-year cumulative incidence of revision and indications for revision in patients undergoing THA for FNF in comparison to osteoarthritis. METHODS: Patients who underwent primary THA for FNF or osteoarthritis were identified using a national administrative claims database and propensity-score matched in a 1:2 ratio based on age, gender, the Charlson Comorbidity Index (CCI), smoking, obesity, and diabetes mellitus. Kaplan-Meier and Cox proportional hazards analyses were used to observe the cumulative incidence and risk of all-cause revision, periprosthetic joint infection (PJI), dislocation, mechanical loosening, and periprosthetic fracture (PPF) within 10 years of primary THA. In total, 19,735 patients who underwent THA for FNF and 39,383 patients who underwent THA for osteoarthritis were included. RESULTS: The 10-year cumulative incidences of all-cause revision (7.1 versus 4.9%), PJI (5.0 versus 3.3%), dislocation (6.8 versus 3.8%), mechanical loosening (3.1 versus 1.9%), and PPF (7.8 versus 4.0%) were significantly higher for those who underwent THA for FNF versus osteoarthritis. Femoral neck fractures were associated with higher risks of revision (hazard ratio [HR]: 1.6), PJI (HR: 1.7), dislocation (HR: 2.0), mechanical loosening (HR: 1.6), and PPF (HR: 2.2) (P < 0.001 for all). DISCUSSION: Despite the advantages of THA, femoral neck fractures remain a major risk factor for long-term complications. Tailored preoperative planning, surgical techniques, and postoperative bone health optimization in these patients may help minimize poor outcomes.

APA Citation

Zhao, Amy Y.; Parel, Philip M.; Agarwal, Amil R.; Gu, Alex; Ranson, Rachel A.; Das, Avilash; Golladay, Gregory J.; and Thakkar, Savyasachi C., "Increased Risk of 10-Year Revision Following Total Hip Arthroplasty for Femoral Neck Fracture" (2024). GW Authored Works. Paper 5640.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5640

Department

School of Medicine and Health Sciences Resident Works