Comparison of patient demographics and implant complications in patients with multiple sclerosis undergoing total hip arthroplasty versus hemiarthroplasty for femoral neck fractures.

Abstract

Multiple sclerosis (MS) is a chronic neurological condition characterized by muscle spasticity, which may influence the outcomes of hip arthroplasty procedures, particularly in patients undergoing total hip arthroplasty (THA) or hemiarthroplasty for femoral neck fractures. It is unclear whether implant complications and revision rates differ between these two surgical approaches in patients with MS. The aim of this study was to compare patient demographics and 2-year implant complications in patients with MS undergoing THA versus hemiarthroplasty for femoral neck fractures. A retrospective analysis was performed using a nationwide claims database (2010-2022). MS patients who did not have dementia who underwent THA or hemiarthroplasty for femoral neck fractures were identified. Two-year implant complications, including hip dislocations, aseptic loosenings, periprosthetic joint infections (PJIs), periprosthetic fractures, and all-cause revisions, were compared between the two groups using multivariable logistic regressions while controlling for age, sex, comorbidities, and overall Elixhauser Comorbidity Index (ECI). A total of 2018 patients with MS (604 THA and 1414 hemiarthroplasty) were included. Patients had no difference in overall comorbidity burden (ECI 7.47 vs. 6.93, p = 0.015). At 2 years, THA was associated with significantly higher rates of aseptic loosenings (OR: 4.17, p = 0.001) and all-cause revisions (OR: 3.04, p < 0.0001). Patients undergoing THA also showed trends toward higher rates of hip dislocations (OR: 1.53, p = 0.087) and PJIs (OR: 1.73, p = 0.059) compared to hemiarthroplasty. Patients with MS undergoing THA for femoral neck fractures are associated with a higher risk for implant complications, including aseptic loosening and all-cause revisions, compared to those undergoing hemiarthroplasty. Surgeons should consider these outcomes when selecting the appropriate surgical option for patients with MS who do not have dementia with femoral neck fractures.