Does Surgeon Fellowship Training Influence Outcomes in Hemiarthroplasty for Femoral Neck Fracture?

Academic Article

Abstract

  • © 2019 Elsevier Inc. Background: The aim of this study is to compare the outcomes (90 days and 1 year) of patients with femoral neck fracture undergoing hemiarthroplasty by surgeons with different fellowship training: trauma, arthroplasty, and general orthopedics. Methods: This study is a retrospective review of consecutive patients undergoing hip hemiarthroplasty for femoral neck fracture from 2010 to 2018. Comorbidities, perioperative details, demographics, injury variables, and time-to-surgery were compared between the fellowship training cohorts, in addition to outcomes including dislocation, periprosthetic joint infection, and mortality at 90 days and 1 year. Results: A total of 298 hips with an average age of 77.8 years underwent hemiarthroplasty for femoral neck fracture. Arthroplasty surgeons had a significantly shorter operative duration (82 minutes, P =.0014) and utilized the anterior approach more frequently (P <.0001). The general orthopedists had a significantly increased total surgical complication risk compared to both the arthroplasty and trauma fellowship-trained cohorts at both 90 days (11.8% vs 1.6% vs 3.9%, P =.015) and 1 year (18.2% vs 4.9% vs 7.1%, P =.008). The overall mortality risk was 11.7% at 90 days and 22.8% at 1 year. When adjusted for covariates, including comorbidities, gender, age, and preoperative walking capacity, both the arthroplasty fellowship-trained cohort (odds ratio 0.381, 95% confidence interval 0.159-0.912, P =.030) and the general orthopedist cohort (odds ratio 0.495; 95% confidence interval 0.258-0.952, P =.035) had reduced risk of 1-year mortality compared to the trauma fellowship-trained cohort. Conclusion: Hemiarthroplasty performed for femoral neck fractures may result in fewer complications when performed by arthroplasty fellowship-trained surgeons. An arthroplasty weekly on-call schedule and adjusted institutional protocols may be utilized to improve outcomes and reduce complications. Level of Evidence: Level II, retrospective cohort.
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    Digital Object Identifier (doi)

    Author List

  • Mabry SE; Cichos KH; McMurtrie JT; Pearson JM; McGwin G; Ghanem ES
  • Start Page

  • 1980
  • End Page

  • 1986
  • Volume

  • 34
  • Issue

  • 9