Abstract
The objective of this article is to review large database comparisons of total hip
arthroplasty (THA) to hemiarthroplasty (HA) for geriatric hip fracture patients. This
article followed a systematic review of the literature using published studies identified
via PubMed as the data source. A literature search was done iteratively with a systematic
use of variations of key search terms. The initial search identified 490 references.
Of the 490, 15 full-text papers were reviewed. Ultimately, nine papers were included
in the review. Five of the included studies utilized the National Surgical Quality
Improvement Program database, one utilized Hospital Episode Statistics, one utilized
The National Hospital Discharge Survey, one utilized Swedish Nation Hip Fracture/Arthroplasty
Register, and the last utilized the ENCLAVE system of the Centers for Medicare & Medicaid
Services. These all included data ranging from 2005 to 2013 and included at least
1,000 patients. Clinical postoperative outcomes of THA and HA were grouped and compared
among the nine studies. The studies used multivariable analysis to make comparisons,
and it is of note that HA is much more common than THA in this patient population.
Primary outcome variables evaluated included major/minor complications, mortality,
length of stay, postoperative transfusion, readmission, dislocation, and revision.
Overall, major and minor adverse events (or a combination of the two) were lower for
THA than for HA patients, and postoperative transfusions were more common for THA
patients. Mortality was significantly less for THA patients by 3% to 4%. Length of
stay was lower for THA patients. Dislocation rates were higher for THA patients at
30 days, 18 months, 24 months, and 4 years by odds ratios of three to five times.
One study found THA patients more likely to undergo reoperation. In select geriatric
patients with femoral neck fractures, THA and HA may be appropriately considered.
For those patients, studies suggest that THA may be associated with fewer postoperative
challenges than HA; however, postoperative transfusion and dislocation rates were
noted to be higher for THA patients.
Keywords
hip fracture - arthroplasty - geriatric - database
