Sambe Hembashima Gabriel, Patel Urvish
Department of Pharmacy, University of Washington, Seattle, Washington, USA.
Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Adv Orthop. 2025 Feb 23;2025:3328450. doi: 10.1155/aort/3328450. eCollection 2025.
Femoral neck fractures (FNFs) in young adults are relatively uncommon but pose significant clinical and surgical challenges. Hip arthroplasty is rarely used as a treatment option in this population but has seen rising use over the previous decade. This study seeks to compare hip arthroplasty outcomes among young adult patients in the United States admitted with FNF by evaluating hip hemiarthroplasty (HHA) and total hip arthroplasty (THA). Using the National Inpatient Sample (NIS) data, adult patients less than 50 years old who underwent HHA or THA from 2016 to 2020 were analyzed. Both groups' postoperative length of stay (pLOS), total hospital charges, and prosthesis-related complications (PRCs), including mechanical loosening (ML), prosthesis dislocation (PD), and periprosthetic fracture (PPF), were analyzed and compared. Out of 174,776,205 hospitalizations between 2016 and 2020, 15,590 young adult patients had FNF, and 2970 patients (2.18%) underwent hip arthroplasty (1195 HHAs and 1775 THAs). After controlling for demographic, clinical and hospital characteristics, HHA was associated with a 22.4% longer pLOS compared to THA [rate ratio: 1.224, 95% CI: 1.183 to 1.266; < 0.001]. Patients in the HHA group also had higher odds of PPF (aOR: 9.06, 95% CI: 4.21, 19.48; < 0.001). Conversely, patients in the THA group had higher odds of PD (aOR: 6.00, 95% CI: 1.78, 20.24; =0.004). There was no statistically significant difference in total hospital charges between the groups [cost ratio: 1.03, 95% CI: 0.995 to 1.075; =0.092]. Among young adults with FNF undergoing hip arthroplasty, HHA is associated with a longer postoperative hospital stay and higher risk of PPF as a major early complication, while THA is associated with a higher risk of PD. Financial burden is comparable for both procedure groups. When hip arthroplasty is a preferred treatment for FNFs, individual patient factors are important considerations that should guide the choice of procedure.
年轻成年人的股骨颈骨折（FNFs）相对不常见，但带来了重大的临床和手术挑战。髋关节置换术在这一人群中很少作为治疗选择，但在过去十年中其使用呈上升趋势。本研究旨在通过评估髋关节半关节置换术（HHA）和全髋关节置换术（THA），比较美国因FNF入院的年轻成年患者的髋关节置换术结果。利用国家住院样本（NIS）数据，分析了2016年至2020年接受HHA或THA的年龄小于50岁的成年患者。分析并比较了两组的术后住院时间（pLOS）、总住院费用以及假体相关并发症（PRCs），包括机械松动（ML）、假体脱位（PD）和假体周围骨折（PPF）。在2016年至2020年的174,776,205次住院中，15,590名年轻成年患者发生了FNF，2970名患者（2.18%）接受了髋关节置换术（1195例HHA和1775例THA）。在控制了人口统计学、临床和医院特征后，与THA相比，HHA的pLOS长22.4%[率比：1.224，95%置信区间：1.183至1.266；P<0.001]。HHA组患者发生PPF的几率也更高（调整后比值比：9.06，95%置信区间：4.21，19.48；P<0.001）。相反，THA组患者发生PD的几率更高（调整后比值比：6.00，95%置信区间：1.78，20.24；P=0.004）。两组之间的总住院费用没有统计学上的显著差异[费用比：1.03，95%置信区间：0.995至1.075；P=0.092]。在接受髋关节置换术的FNF年轻成年人中，HHA与术后住院时间延长以及作为主要早期并发症的PPF风险较高相关，而THA与PD风险较高相关。两个手术组的经济负担相当。当髋关节置换术是FNF的首选治疗方法时，个体患者因素是指导手术选择的重要考虑因素。
