Who Is on Call? Trends in Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fractures Based on Subspecialty Training.

Abstract

As annual femoral neck fracture (FNF) incidence rises in an aging United States population, the choice between hemiarthroplasty and total hip arthroplasty (THA) has become increasingly relevant, influenced not only by patient factors such as age and activity level but also by the surgeon's subspecialty training. Traditionally, hemiarthroplasty is favored for older, less active patients, whereas THA is associated with better outcomes in younger, active patients. Recent trends suggest that some specialists may prefer THA even for older patients. This study examined trends in FNF treatment, focusing on the impact of surgeon subspecialty on the use of THA versus hemiarthroplasty. This study analyzed trends in FNF management from 2010 to 2022 using data from an administrative claims database. The FNF cases treated with either hemiarthroplasty or THA were identified and stratified by patient age (under and over 70 years) and surgeon subspecialty. Of 89,454 FNFs included, 71,521 received hemiarthroplasty, and 17,933 underwent THA. While hemiarthroplasty rates remained steady, THA cases more than doubled, especially among patients aged < 70 years, where the use of THA by adult reconstruction surgeons rose from 50 to 72%. Among patients aged > 70 years, trauma and sports surgeons increasingly adopted THA over hemiarthroplasty as well. The THA utilization has markedly increased for FNFs, particularly among adult reconstruction specialists and even in older patient groups. This shift reflects a growing emphasis on functional outcomes and mobility, with surgeon training appearing to influence treatment choice beyond traditional age-based guidelines. These findings underscore an evolving approach to FNF management that may create demand pressures on reconstruction and trauma specialists who are managing an expanding caseload of complex arthroplasties.