Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, China.
Tibet Autonomous Region People's Hospital, Lhasa, China.
Bone Joint J. 2024 Dec 1;106-B(12):1477-1484. doi: 10.1302/0301-620X.106B12.BJJ-2024-0321.R1.
For displaced femoral neck fractures (FNFs) in geriatric patients, there remains uncertainty regarding the effect of total hip arthroplasty (THA) compared with hemiarthroplasty (HA) in the guidelines. We aimed to compare 90-day surgical readmission, in-hospital complications, and charges between THA and HA in these patients.
The Hospital Quality Monitoring System was queried from 1 January 2013 to 31 December 2019 for displaced FNFs in geriatric patients treated with THA or HA. After propensity score matching, which identified 33,849 paired patients, outcomes were compared between THA and HA using logistic and linear regression models.
The HA group had a lower incidence of 90-day surgical readmission than the THA group (odds ratio (OR) 0.75 (95% CI 0.68 to 0.83)). Meanwhile, the HA group had lower incidence of dislocation (OR 0.42 (95% CI 0.33 to 0.52)), aseptic loosening (OR 0.50 (95% CI 0.38 to 0.66)), and joint pain (OR 0.63 (95% CI 0.40 to 0.98)), but a higher incidence of periprosthetic fracture (OR 1.41 (95% CI 1.07 to 1.87)) for readmission, compared to the THA group. The incidence of in-hospital complications did not differ significantly between the two groups. Moreover, the HA group had lower mean charges than the THA group (47,578.29 Chinese Yuan (CNY) (SD 20,069.71) vs 57,641.00 CNY (SD 21,524.07)).
When considering 90-day surgical readmission rate, in-hospital complications, and mortality, HA resulted in a significantly lower surgical readmission rate within 90 days compared to THA, despite the patients being older and having a higher Charlson Comorbidity Index.
对于老年患者的股骨颈移位骨折（FNF），指南中对于全髋关节置换术（THA）与半髋关节置换术（HA）的效果仍存在不确定性。我们旨在比较这些患者中 THA 和 HA 之间 90 天内再次手术入院、住院并发症和费用。
从 2013 年 1 月 1 日至 2019 年 12 月 31 日，通过医院质量监测系统对接受 THA 或 HA 治疗的老年患者的股骨颈移位 FNF 进行了查询。通过倾向评分匹配后，确定了 33849 对配对患者，然后使用逻辑回归和线性回归模型比较了 THA 和 HA 之间的结果。
HA 组的 90 天内再次手术入院率低于 THA 组（优势比（OR）0.75（95%置信区间 0.68 至 0.83））。同时，HA 组脱位（OR 0.42（95%置信区间 0.33 至 0.52））、无菌性松动（OR 0.50（95%置信区间 0.38 至 0.66））和关节疼痛（OR 0.63（95%置信区间 0.40 至 0.98））的发生率低于 THA 组，但再次入院时假体周围骨折（OR 1.41（95%置信区间 1.07 至 1.87））的发生率较高。两组住院并发症的发生率无显著差异。此外，HA 组的平均费用低于 THA 组（47578.29 元人民币（SD 20069.71）比 57641.00 元人民币（SD 21524.07））。
考虑到 90 天内再次手术入院率、住院并发症和死亡率，HA 组在 90 天内再次手术入院率显著低于 THA 组，尽管患者年龄较大且 Charlson 合并症指数较高。
