When would orthopaedic surgeons perform arthroplasty for a femoral neck fracture in an older adult?

Abstract

Purpose Minimally displaced femoral neck fractures (FNFs) in older adults have traditionally been managed with internal fixation (IF). However, emerging evidence suggests arthroplasty may provide better outcomes. We sought to determine surgeons’ current practice patterns and determine which patient and fracture characteristics lead them to prefer arthroplasty. Methods We developed a survey to assess the influence of fracture and patient characteristics on orthopaedic surgeons’ choice to treat FNFs in older adults with arthroplasty. We electronically distributed the survey to members of professional associations and our research network. Results Among 155 orthopaedic surgeons (response rate 25%), 74% agreed that deciding between IF and arthroplasty is difficult for certain minimally displaced FNFs cases and 36% reported performing arthroplasty for at least half of minimally displaced FNFs. Surgeons reported they would perform arthroplasty for a minimally displaced FNF with posterior tilt of 20° (69%) or 30° (94%), varus angulation (88%), or a neck-shaft angle > 160° (70%). Age (83%), mobility (76%), and osteoporosis (62%) influenced surgeons’ treatment preferences. Preference for arthroplasty was significantly associated with annual volume of minimally displaced FNFs (p = 0.033), but not years in practice (p = 0.065). Seventy-nine per cent agreed that a randomized trial is needed to determine the best clinical practice for minimally displaced FNFs. Conclusions In contrast to existing guidelines and practice trends, over one-third of orthopaedic surgeons who responded to the questionnaire would routinely treat minimally displaced FNFs with arthroplasty. The variation between surgeon’s current practices demonstrates the need for a high-quality randomized trial.