Femoral Neck System Compared with 3 Cannulated Screws in the Treatment of Femoral Neck Fracture in Patients Aged 60 and Older

Background: While the Femoral Neck System (FNS) is increasingly utilized for the fixation of femoral neck fractures in elderly patients, studies comparing the device to the historical standard (that is, multiple cannulated screws) are lacking. The purpose of this study was to determine the risk of all-cause revision following fixation with the FNS device compared with multiple cannulated screws in patients ≥60 years of age with a femoral neck fracture. Methods: Patients ≥60 years of age who underwent fixation of a femoral neck fracture with the FNS or 3 cannulated screws (2017 to 2022) were identified using the Kaiser Permanente Hip Fracture Registry. Exclusion criteria were polytrauma, pathologic fracture, open fracture, additional surgeries at other sites during the same hospital stay, and prior procedures on the affected hip. The primary outcome measure was all-cause revision surgery, and the secondary outcome measures were mortality, emergency department visits, and readmissions. Multivariable Cox proportional hazards or logistic regression was performed, controlling for a wide range of potential confounders. Results: A total of 352 FNS and 1,686 cannulated-screw repairs were included. The overall incidence of revision at 2 years was 4.0% and 4.8% for the FNS and cannulated-screw constructs, respectively. Mortality at 2 years was 23.6% and 25.2%, respectively. In the adjusted analysis, no difference in all-cause revision risk was observed when comparing the FNS to cannulated screws (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.50 to 1.71; p = 0.79). A subgroup analysis of procedures performed by surgeons who used both devices also did not demonstrate a difference in revision rates (HR = 0.91; 95% CI = 0.39 to 2.17; p = 0.84). Conclusions: In this study of patients ≥60 years of age with a femoral neck fracture, the rates of all-cause revision and mortality were found to be similar between the FNS and multiple cannulated screws. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.