Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2020; 11(1): 18-26
Published online Jan 18, 2020. doi: 10.5312/wjo.v11.i1.18
National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database
Anthony J Boniello, Alexander M Lieber, Kevin Denehy, Priscilla Cavanaugh, Yehuda E Kerbel, Andrew Star
Anthony J Boniello, Priscilla Cavanaugh, Andrew Star, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA 19107, United States
Alexander M Lieber, Drexel University College of Medicine, Philadelphia, PA 19123, United States
Kevin Denehy, Bluegrass Orthopaedics, Lexington, KY 40509, United States
Yehuda E Kerbel, Deparment of Orthopaedics, Hospital of University of Pennsylvania, Philadelphia, PA 19104, United States
Author contributions: Boniello AJ conceived the study concept and designed the research with Lieber AM, Denehy K and Star A, Lieber AM and Cavanaugh P performed data collection; Lieber AM and Kerbel YE performed statistical analysis; Boniello AJ, Lieber AM, Kerbel YE and Star A edited and revised the manuscript.
Institutional review board statement: HCUP databases such as the National Inpatient Sample (NIS) are considered limited data sets and therefore do not require IRB approval under HIPAA. See attached document of exemption.
Informed consent statement: HCUP databases such as the National Inpatient Sample (NIS) are considered limited data sets and therefore an informed consent statement is not relevant in this context.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: Statistical code available by contacting the corresponding author.
STROBE statement: STROBE checklist for the present study is available online.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Alexander M Lieber, BSc, Research Fellow, Department of Orthopedics, Jefferson University Hospital, 1025 Walnut Street, College Building, Suite 516, Philadelphia, PA 19107, United States. alex.m.lieber@gmail.com
Received: June 1, 2019
Peer-review started: June 4, 2019
First decision: September 21, 2019
Revised: September 25, 2019
Accepted: November 7, 2019
Article in press: November 7, 2019
Published online: January 18, 2020
Abstract
BACKGROUND

Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.

AIM

To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups.

METHODS

We queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition (ICD-9) codes were used to identify patients in our sample. Demographic variables, hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.

RESULTS

Of the total 502060 patients who were treated for femoral neck fracture, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay (LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly, private insurance was an independent predictor for treatment with THA.

CONLUSION

There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS.

Keywords: Hip fracture, Total hip arthroplasty, Hemiarthroplasty, Cost, Length of stay, National Inpatient Sample

Core tip: Total hip arthroplasty (THA) is increasingly being utilized as an alternative to hemiarthroplasty for the treatment of displaced femoral neck fractures especially in younger ambulatory patients. In an analysis of the National Inpatient Sample we found that the incidence of THA in the United States is increasing, particularly in urban areas. Furthermore, we found that THA was associated with increased hospital charges but shorter length of stay.