Arthroplasty Versus Fixation of Femoral Neck Fractures in Nongeriatric Patients

OBJECTIVES: To compare arthroplasty versus fixation of femoral neck fractures (FNFs) in nongeriatric patients. METHODS: Design: Retrospective. Setting: Level 1 trauma center. Patients Selection Criteria: Adults with FNFs (OTA/AO 31-B) aged younger than 65 years. Outcome Measures and Comparisons: Arthroplasty and fixation groups were compared in terms of major complications (nonunion, deep infection, etc.) and reoperations. Subgroup analysis of total hip arthroplasty (THA) versus fixation of displaced FNFs was performed using propensity score matching. Variables associated with complications after fixation were evaluated for. RESULTS: Ninety-four patients were included: 47 received arthroplasty and 47 received fixation. The arthroplasty group was older (59.0 vs. 40.0 years, P < 0.0001), had more low-energy mechanisms (76.6% vs. 29.8%, P < 0.0001), more displaced fractures (97.9% vs. 76.6%, P = 0.003), and did not differ in proportion of men (61.7% vs. 70.2%, P = 0.51), or follow-up duration (16.0 vs. 10.6 months, P = 0.08). The arthroplasty group was less likely to have a major complication (17.0% vs. 42.5%, P = 0.01) or reoperation (12.8% vs. 31.9%, P = 0.04). Patients treated with THA (n = 19), compared with those with displaced fractures that were fixed (n = 36), were older (61.0 vs. 37.5 years, P < 0.0001), more likely to have low-energy injuries (63.1% vs. 25.0%, P = 0.008), and less likely to have an American Society of Anesthesiology >2 (15.8% vs. 55.6%, P = 0.008). After matching for these differences, there were 10 patients per group. The complication rate was lower in the THA group (0.0% vs. 50.0%, P = 0.03), and the reoperation rate was similar (0.0% vs. 20.0%, P = 0.47). Patients who had a complication after fracture fixation were more likely to have fracture comminution (70.0% vs. 22.2%, P = 0.002), greater initial fracture displacement (14.5 vs. 6.7 mm; P = 0.0002), and buttress plate fixation (20.0% vs. 0.0%; P = 0.02). CONCLUSIONS: Arthroplasty, compared with fixation, resulted in fewer major complications and reoperations. Major complications after fixation were associated with initial fracture displacement and comminution. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.