Outcomes of delayed arthroplasty after failed nonoperative management of valgus-impacted femoral neck fractures are comparable with outcomes of acute arthroplasty.

Abstract

To compare surgical complication rates between delayed arthroplasty after failed nonoperative management and acute arthroplasty for valgus-impacted geriatric femoral neck fractures. Design: Retrospective review. Single academic Level I trauma center. Patients over 65 with valgus-impacted femoral neck fractures (AO/OTA 31-B1) from 2005-2024 treated with acute or delayed arthroplasty were retrospectively reviewed. Arthroplasty was considered delayed on or after day 7 of attempted nonoperative management.Outcome Measures and Comparisons: Postoperative complication rates, reoperations, and failure to return to baseline ambulatory status at final follow-up were assessed. Differences in patient demographics and outcomes between acute and delayed arthroplasty patients were assessed with chi-squared, Fisher's exact, and independent samples t-tests (α=0.05). There were 47 patients treated with acute arthroplasty [35 (74.5%) female, age 83.5± 2 years, CCI: 6.0, 40% independent weight-bearing, follow-up: 8.5 months] and 21 treated with delayed arthroplasty [16 (76.2%) female, age 82.1±4 years, CCI: 6.1, 60% independent weight-bearing, follow-up: 10.1 months]. Rates of medical [acute: 12 (25.5%), delayed: 3 (14.3%); p = 0.361] and surgical [acute: 5 (10.6%), delayed: 2 (9.5%); p = 0.999] complications did not differ between groups. The proportion of patients who did not return to baseline ambulatory status [acute: 14 (32.6%), delayed: 5 (26.3%); p = 0.847] and reoperation rates [acute: 2 (4.3%), delayed: 0 (0%); p = 0.999] were similar between groups. The postoperative mortality rate was 19.1% among the patients treated with acute arthroplasty and 19.0% among those treated with delayed arthroplasty, with no difference between groups (p = 0.999). There were no differences in postoperative complications, reoperations, failure of return to baseline ambulatory status, or mortality for geriatric patients who underwent delayed versus acute arthroplasty for valgus-impacted femoral neck fractures. There was no evidence of increased surgical morbidity in geriatric valgus-impacted femoral neck fractures after failed nonoperative management compared to patients treated with acute arthroplasty. Level III.