Background: 

When arthroplasty is indicated for a femoral neck fracture (FNF), it is unclear whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is best. This study compares data from the Australian Orthopaedic Association National Joint Replacement Registry using contemporary surgical options.

Methods: 

Patients from 60 to 85 years old who were treated with arthroplasty for FNF, between September 1999 and December 2019, were included if the femoral stems were cemented. Only THAs with femoral heads of ≥36 mm or dual-mobility articulations were included. Patients who had monoblock HA were excluded. Rates of revision for all aseptic failures and dislocation were compared. Competing risks of revision and death were considered using the cumulative incidence function. Subdistribution hazard ratios (HRs) for revision or death from a Fine-Gray regression model were used to compare THA and HA. Interactions of procedure with age group and sex were considered. Secondary analysis adjusting for body mass index (BMI) and American Society of Anesthesiologists (ASA) classification was also considered.

Results: 

There were 4,551 THA and 29,714 HA procedures included. The rate of revision for THA was lower for women from 60 to 69 years old (HR = 0.58 [95% confidence interval (CI), 0.39 to 0.85]) and from 70 to 74 years old (HR = 0.65 [95% CI, 0.43 to 0.98]) compared with HA. However, women from 80 to 85 years old (HR = 1.56 [95% CI, 1.03 to 2.35]) and men from 75 to 79 years old (HR = 1.61 [95% CI, 1.05 to 2.46]) and 80 to 85 years old (HR = 2.73 [95% CI, 1.89 to 3.95]) had an increased rate of revision when THA was undertaken compared with HA. There was no difference in the rate of revision for dislocation between THA and HA for either sex or age categories.

Conclusions: 

When contemporary surgical options for FNF are used, there is a benefit with respect to revision outcomes for THA in women who are <75 years old and a benefit for HA in women who are ≥80 years old and men who are ≥75 years old. There is no difference in dislocation rates.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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全髋关节置换术的股骨颈骨折翻修率是否低于股骨头置换术？：当代手术选择的注册数据比较

背景： 

当关节置换术适用于股骨颈骨折 (FNF) 时，尚不清楚全髋关节置换术 (THA) 还是股骨头置换术 (HA) 是最好的。本研究比较了澳大利亚骨科协会全国关节置换登记处使用当代手术方案的数据。

方法： 

在 1999 年 9 月至 2019 年 12 月期间接受 FNF 关节成形术治疗的 60 至 85 岁患者被纳入，如果股骨柄是骨水泥型的话。仅包括股骨头≥36 mm 或双活动关节的 THA。具有单块 HA 的患者被排除在外。比较了所有无菌性失败和脱位的翻修率。使用累积发生率函数考虑翻修和死亡的竞争风险。Fine-Gray 回归模型的翻修或死亡的子分布风险比 (HR) 用于比较 THA 和 HA。考虑了程序与年龄组和性别的相互作用。还考虑了调整体重指数 (BMI) 和美国麻醉医师协会 (ASA) 分类的二次分析。

结果： 

包括 4,551 个 THA 和 29,714 个 HA 程序。60 至 69 岁女性 (HR = 0.58 [95% 置信区间 (CI)，0.39 至 0.85]) 和 70 至 74 岁女性 (HR = 0.65 [95% CI， 0.43 至 0.98]) 与 HA 相比。然而，80 至 85 岁的女性（HR = 1.56 [95% CI，1.03 至 2.35]）和 75 至 79 岁的男性（HR = 1.61 [95% CI，1.05 至 2.46]）和 80 至 85 岁与 HA 相比，old (HR = 2.73 [95% CI, 1.89 to 3.95]) 在进行 THA 时翻修率增加。无论是性别还是年龄组，THA 和 HA 的脱位翻修率都没有差异。

结论： 

当使用 FNF 的现代手术方案时，<75 岁女性的 THA 翻修结果有益，≥80 岁女性和 ≥75 岁男性的 HA 翻修结局有益。错位率没有差异。

证据等级： 

治疗三级。有关证据等级的完整描述，请参阅作者须知。