Aims The aim of this study was to compare the early postoperative mortality and morbidity in older patients with a fracture of the femoral neck, between those who underwent total hip arthroplasty (THA) and those who underwent hemiarthroplasty. Methods This nationwide, retrospective cohort study used data from the Japanese Diagnosis Procedure Combination database. We included older patients (aged ≥ 60 years) who underwent THA or hemiarthroplasty after a femoral neck fracture, between July 2010 and March 2022. A total of 165,123 patients were included. The THA group was younger (mean age 72.6 (SD 8.0) vs 80.7 years (SD 8.1)) and had fewer comorbidities than the hemiarthroplasty group. Patients with dementia or malignancy were excluded because they seldom undergo THA. The primary outcome measures were mortality and complications while in hospital, and secondary outcomes were readmission and reoperation within one and two years after discharge, and the costs of hospitalization. We conducted an instrumental variable analysis (IVA) using differential distance as a variable. Results The IVA analysis showed that the THA group had a significantly higher rate of complications while in hospital (risk difference 6.3% (95% CI 2.0 to 10.6); p = 0.004) than the hemiarthroplasty group, but there was no significant difference in the rate of mortality while in hospital (risk difference 0.3% (95% CI -1.7 to 2.2); p = 0.774). There was no significant difference in the rate of readmission (within one year: risk difference 1.3% (95% CI -1.9 to 4.5); p = 0.443; within two years: risk difference 0.1% (95% CI -3.2 to 3.4); p = 0.950) and reoperation (within one year: risk difference 0.3% (95% CI -0.6 to 1.1); p = 0.557; within two years: risk difference 0.1% (95% CI -0.4 to 0.7); p = 0.632) after discharge. The costs of hospitalization were significantly higher in the THA group than in the hemiarthroplasty group (difference $2,634 (95% CI $2,496 to $2,772); p < 0.001). Conclusion Among older patients undergoing surgery for a femoral neck fracture, the risk of early complications was higher after THA than after hemiarthroplasty. Our findings should aid in clinical decision-making in these patients.

中文翻译：

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与股骨颈骨折老年人的半髋关节置换术相比，全髋关节置换术后早期并发症增加。


目的 本研究的目的是比较老年股骨颈骨折患者接受全髋关节置换术 (THA) 和半髋关节置换术的术后早期死亡率和发病率。方法 这项全国性回顾性队列研究使用了日本诊断程序组合数据库的数据。我们纳入了 2010 年 7 月至 2022 年 3 月期间股骨颈骨折后接受 THA 或股骨头置换术的老年患者（年龄≥60 岁）。总共纳入了 165,123 名患者。与半关节置换术组相比，THA 组更年轻（平均年龄 72.6 (SD 8.0) vs 80.7 岁 (SD 8.1)）并且合并症更少。患有痴呆症或恶性肿瘤的患者被排除在外，因为他们很少接受全髋关节置换术。主要结局指标是住院期间的死亡率和并发症，次要结局指标是出院后一年和两年内的再次入院和再次手术，以及住院费用。我们使用差分距离作为变量进行了工具变量分析（IVA）。结果 IVA 分析显示，THA 组住院期间并发症发生率显着高于半髋关节置换组（风险差异 6.3%（95% CI 2.0 至 10.6）；p = 0.004），但术后并发症发生率无显着差异。住院期间的死亡率（风险差异 0.3%（95% CI -1.7 至 2.2）；p = 0.774）。再入院率无显着差异（一年内：风险差异 1.3%（95% CI -1.9 至 4.5）；p = 0.443；两年内：风险差异 0.1%（95% CI -3.2 至 3.4） ；p = 0.950）和再次手术（一年内：风险差异 0.3%（95% CI -0.6 至 1.1）；p = 0.557；两年内：风险差异 0.1%（95% CI -0.4 至 0.7）；p = 0。632）出院后。 THA 组的住院费用显着高于半关节置换术组（差异 2,634 美元（95% CI 2,496 至 2,772 美元）；p < 0.001）。结论 在接受股骨颈骨折手术的老年患者中，全髋关节置换术后早期并发症的风险高于半髋关节置换术后。我们的研究结果应该有助于这些患者的临床决策。