Total Hip Arthroplasty for Acute Femoral Neck Fractures: Who Should Perform the Operation-Adult Reconstructive or Trauma Surgeons?

OBJECTIVE

To compare the results and complications of a large consecutive series of total hip arthroplasty (THA) performed for acute femoral neck (FN) fracture by adult reconstructive (AR) and trauma (T) surgeons to determine if there is a difference in outcomes.

DESIGN

Retrospective chart review.

SETTING

Level 1 trauma center.

PATIENTS: One hundred forty-nine consecutive patients who presented to our institution with displaced FN fractures treated by THA were included in this study.

INTERVENTION: All patients were treated with THA.

MAIN OUTCOME MEASUREMENTS: Implant survival, 90-day complications, 90-day readmission, 1-year complications.

RESULTS

For the group as a whole, the major surgical complication rate (defined as dislocation, deep infection, loosening, fracture) was significantly higher for T surgeons (20%) than for AR surgeons (7%) (P = 0.021). AR surgeons had significantly less radiographic component malpositioning 12% versus 3% (P = 0.024). Mortality and readmission rates were similar between the 2 cohorts at all time points. Implant survivorship was significantly higher at 1 year for AR surgeons (P = 0.05).

CONCLUSIONS

THA for acute FN fracture performed by AR surgeons demonstrated higher rates of accurate radiographic component positioning, significantly lower major complication rates at 90 days and 1 year, and greater implant survival at 1 year.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.