Cannulated Screws or Hemiarthroplasty for Femoral Neck Fractures: Is There a Mortality Difference?

Abstract

To determine the difference in mortality and reoperation rate between femoral neck fractures (FNFx) treated with cannulated screw (CS) fixation or hemiarthroplasty (HA). Retrospective study. Institutional registry data from a single Level I trauma center. Inclusion criteria were patients older than 60 years with FNFx (OTA/AO 31-B) who underwent primary operative treatment with a HA or CS. Mortality and reoperation rates following primary operative treatment between patients treated with either HA or CS. Kaplan-Meier survival curves were generated. Comparisons in the primary outcomes were made between the HA and CS cohorts using univariate and multivariate analyses where appropriate. A total of 2211 patients were included in the study (1721 HA and 490 CS) and followed for an average of 34.5 months. The average age was 82.3 years (60-106 years), and patients were predominantly female (66.3%). One-year mortality was higher for the HA group compared with the CS group with a hazard ratio of 1.37 ( P = 0.03); however, over the lifetime of a patient or to the final follow-up, survival was not statistically significant (Relative Risk 0.95, 95% confidence interval, 0.83-1.1, P = 0.97). The rate of reoperation at 1 year was lower for HA (5.0%) than for CS (10.1%) (hazard ratio 3.0, 95% confidence interval, 2.1-4.34, P < 0.0001). Patients with FNFx treated with HA had the same risk of mortality as those treated with CS across the lifetime of patients or until the final follow-up. There is no difference in mortality at the 30-day and 90-day time point, but there is a significant difference in mortality at 1 year. HA treatment was associated with a significantly lower reoperation risk when compared with CS across the lifetime of the patient or until the final follow-up. Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.