Cannulated Screws or Hemiarthroplasty for Femoral Neck Fractures: Is There a Mortality Difference?

Objectives: To determine the difference in mortality and reoperation rate between femoral neck fractures (FNFx) treated with cannulated screw fixation (CS) or hemiarthroplasty (HA).

Methods: Design: Retrospective study.

Setting: Institutional registry data from a single Level I trauma center.

Patient selection criteria: Inclusion criteria were patients ≥60 years old with a FNFx (AO/OTA 31-B) who underwent primary operative treatment with a HA or CS.

Outcome measures and comparisons: Mortality and reoperation rates following primary operative treatment between patients treated with either hemiarthroplasty or cannulated screws. Kaplan-Meier survival curves were generated. Comparisons in the primary outcomes were made between the hemiarthroplasty or cannulated screw cohorts using univariate and multivariate analysis where appropriate.

Results: A total of 2,211 patients were included in the study (1,721 HA and 490 CS) and followed for an average of 34.5 months. The average age was 82.3 years (60-106 years) and predominantly female (66.3%). 1-year mortality was higher for the HA group compared to CS with a HR of 1.37 (p=0.03), however over the lifetime of patient or to final follow up, survival was not statistically significant with a RR of 0.95 95% CI, 0.83-1.1, p=0.97) The rate of reoperation at one year was lower for HA (5.0%) than for CS (10.1%), (HR 3.0, 95% CI, 2.1-4.34, p<0.0001).

Conclusions: Patients with FNFx treated with hemiarthroplasty had the same risk of mortality as those patients treated with cannulated screws across lifetime of patients or until final follow up. There is no difference in mortality at the 30- and 90-day timepoint, but a significant difference in mortality at 1 year. Hemiarthroplasty treatment was associated with a significantly lower reoperation risk when compared to cannulated screws across the lifetime of the patient or until final follow up.

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