National trends in the surgical management of femoral neck fractures (FNFs) from 2008 to 2017 by age group


Introduction: Recent data supports improved functional outcomes following total hip arthroplasty (THA) treatment for FNF. Published estimates examining U.S. trends in surgical management of FNFs beyond 2013 are lacking. The purpose of this study was to examine national trends in surgical treatment of FNFs from 2008-2017, stratified by treatment-relevant age groups.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was retrospectively queried in conjunction with International Classification of Diseases and Current Procedural Terminology codes to identify patients receiving either internal fixation (IF), hemiarthroplasty (HA), or THA for the treatment of closed FNFs from 2008-2017. Annual percentages and trends in these treatments were analyzed by age groups: 50-64, 65-79, and ≥80 years.

Results: We identified 14,300 patients who underwent surgical treatment for FNF. Table 1 presents trend estimates. THA use significantly increased over time (all p ’s <0.001), but this rate was variable between age groups: largest increase was seen in patients aged 50-64 years (440.9%, from 11.5% in 2008 to 62.2% in 2017), and lesser increases in patients aged 65-79 (132.5%, from 16.9% in 2008 to 39.3% in 2017) and ≥80 (106.7%, from 9.0% in 2008 to 18.6% in 2017) years. HA use remained stable in patients aged 50-79 years yet increased in patients aged ≥80 years (24.8%, from 64.1% in 2008 to 80.0% in 2017). IF use decreased at a rate >90% to <2% use across all age groups in 2017.

Conclusion: Across all age groups, THA has become increasingly utilized for FNF treatment. The largest increase was observed in patients aged 50-64 years. These findings support the emerging consensus for THA treatment of FNF among active patients. HA remains the preferred treatment for patients of older age groups.

Publication Date


Presented At:

14th Annual BHSF Research Conference

Content Type

Poster Presentation

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