Outcomes of hip hemiarthroplasty for neck of femur fractures in patients under 60 with a minimum 5 year follow up.

BACKGROUND

Hip fractures predominantly affect the elderly however a subset of younger patients sustain fragility intracapsular neck of femur fractures. While internal fixation or total hip arthroplasty (THA) are typically preferred in younger individuals, hemiarthroplasty (HHA) may represent a pragmatic alternative in medically complex and low-demand patients at higher risk of complications from THA. The risk of reoperation and poor functional outcomes is a particular concern in younger patients. This study evaluates revision rates and outcomes of HHA in patients under 60 years of age.

METHODS

A retrospective review was conducted of patients aged <60 years who underwent primary HHA for intracapsular neck of femur fracture between 2010 and 2020 at a high-volume regional trauma centre. Minimum follow-up was five years. Pathological fractures were excluded. All radiographs and electronic clinical records were reviewed. The primary outcome was revision surgery for any cause. Secondary outcomes included comorbidities, mortality, and discharge destination.

RESULTS

118 patients were identified (68; 57.6% female, 50; 42.4% male), with a median age of 55 years (IQR 51.8-57.7). Alcoholism (60; 50.8%) and neurological disorders (51; 43.2%) were the most common comorbidities. No deaths occurred at 30 days, 90-day mortality was 2.5% (N = 3), rising to 9.3% (N = 11) at one year. Ten patients (8.5%) required revision surgery, accounting for 22 returns to theatre. Infection was the leading cause (5.1%), followed by dislocation (2.5%) and acetabular erosion (0.8%). Median time to reoperation was 3 months. Six patients (5.0%) ultimately underwent excision arthroplasty. Most patients (68; 57.6%) were discharged to their usual residence.

CONCLUSION

Patient selection is key when considering HHA in patients under 60 years. For those with alcoholism, associated neurological conditions or systemic disease HHA is a safe and appropriate option with lower risk of revision when THA would provide limited benefit and considerably higher potential risk. Age alone should not preclude HHA.