OTA 2013 Posters

Scientific Poster #17 Geriatric OTA 2013

Hemiarthroplasty Versus Osteosynthesis for Undisplaced and Stable Femoral Neck Fractures

Kaan S. Irgit, MD; Raveesh D. Richard, MD; Andrew L. Cornelius, MD;
Thomas R. Bowen, MD; Cassondra Andreychik; Daniel S. Horwitz, MD;
Geisinger Health System, Danville, Pennsylvania, USA

Purpose: The incidence of hip fractures in the United States and Europe is high and continues to increase. The best treatment for femoral neck fractures is still under debate. The purpose of the study was to compare the complication, reoperation, and mortality rates of hemiarthroplasty and osteosynthesis in patients with impacted/stable osteoporotic femoral neck fractures.

Methods: We retrospectively compared the complication, reoperation, and mortality rates between two groups that were matched in age, gender, BMI (body mass index) and ASA (American Society of Anesthesiologists) scores. All included patients sustained Garden I or II femur neck fractures. Either hemiarthroplasty or osteosynthesis was performed based on surgeon preference. Osteosynthesis was performed with 3 parallel cannulated screws. The minimum follow-up was 24 months. All patients were over 60 years old. The primary outcomes were complications of surgery and the need for revision surgery. A secondary outcome of the study was the cost of the primary surgery.

Results: The mean age of the 98 patients in the osteosynthesis group was 82 years (range, 60-104) and 80 years (range, 60-90) in the 38 patients treated with hemiarthroplasty. Mean follow-up was 44 ± 1.4 months (range, 24-92 months). Overall complication, reoperation, and 1-year mortality rates were similar in both groups. Infection was significantly higher in the hemiarthroplasty group. In a logistic regression model analysis, the complication, reoperation, and 1-year mortality rates were similar between patients over and under 80 years old, in both the hemiarthroplasty and osteosynthesis groups. Intraoperative blood loss and length of stay were significantly lower in the osteosynthesis group. The hemiarthroplasty group had a much higher cost of surgery.

Conclusion: Hemiarthroplasty has no benefit in decreasing complications and reoperations for stable femoral neck fractures in the elderly. The costs of surgery and infection rates are higher with hemiarthroplasty as compared to osteosynthesis for these stable fracture patterns.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.