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Differences of hemiarthroplasty and total hip replacement in orthogeriatric treated elderly patients: a retrospective analysis of the Registry for Geriatric Trauma DGU®

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Abstract

Purpose

Medial femoral neck fractures are typically managed with hemiarthroplasty (HA) or total hip arthroplasty (THA) in elderly patients. There is a debate as to which treatment predominates. The literatures have reported better outcomes for those patients with proximal femur fracture who were treated in an orthogeriatric centres compared to standard orthopaedic hospitals. Therefore, we have analysed the differences of outcome between HA and THA on patients, exclusively treated in orthogeriatric co-management and compared the results with the available literature.

Methods

We conducted a retrospective registry analysis of the Registry for Geriatric Trauma DGU®. Between 2016 and 2018, data for 16,236 patients from 78 different hospitals were available: they were analysed univariably, and differences between HA and THA were examined using propensity score matching, according to the American Society of Anesthesiologists (ASA) grade, Identification-of-Seniors-At-Risk (ISAR) Score, anticoagulation level, sex, age, and walking ability prefracture.

Results

There were 4,662 patients treated with HA and 892 with THA, meeting inclusion criteria. Patients in the HA group were older (84 years (IQR 80–89) vs. 79 years (IQR 75–83); p < 0.001), with more severe preexisting conditions, with an ASA grade ≥ 3 in 79% vs. 57% in the THA group (p < 0.001). After matching, the mortality rate, in-house revision rate, and quality of life (QoL) 7 days postoperatively were not significantly different by group. After 120 days, the HA group presented a lower rate of surgical complications (4% vs. 10%; p = 0.006), while the THA group had a higher rate of independent walking (18% vs. 28%; p = 0.001) and a higher QoL, measured by the EQ-5D-3L (0.81 (IQR 0.7–1.0) vs. 0.9 (IQR 0.72–1.0); p = 0.01).

Conclusions

Due to better walking ability and QoL, THA might be the better choice in healthier and more mobile patients, while HA would be better for multimorbid patients to avoid additional complication-associated treatments. Not the age of the patient but the preoperative condition might be important for the choice between THA and HA.

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Funding

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Authors and Affiliations

  1. Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany

    Bastian Pass, Lukas Nowak, Sven Lendemans & Carsten Schoeneberg

  2. Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany

    Daphne Eschbach, Tom Knauf & Ludwig Oberkircher

  3. AUC, Academy for Trauma Surgery GmbH, Munich, Germany

    Ruth Volland

  4. Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland

    Matthias Knobe

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Contributions

BP: prepared the manuscript, analysed the data, and designed the study. LN: prepared the manuscript, collected and analysed the data. DE: analysed the data and reviewed the manuscript. RV: collected and analysed the data, and reviewed the manuscript. TK: analysed the data and reviewed the manuscript. MK: analysed the data and reviewed the manuscript. LO: analysed the data and reviewed the manuscript. SL: analysed the data and reviewed the manuscript. CS: designed the study, analysed the data and prepared the manuscript. All the authors read and approved the final manuscript. Registry for Geriatric Trauma DGU: Host of the German Geriatric Trauma Register. It is no natural person. According to the publication guideline it is desired, the Registry for Geriatric Trauma DGU should list as a co-author. According to the guideline it should be written as "… and the Registry for Geriatric Trauma DGU" or "… on behalf of the Registry for Geriatric Trauma DGU". It is not the senior author of this manuscript, this is CS.

Corresponding author

Correspondence to Carsten Schoeneberg.

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All the authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics

Written patient consent was obtained by participating hospitals. The data from the ATR-DGU received full approval from the Ethics Committee of the medical faculty of the Philipps-University, Marburg, Germany (AZ 46/16).

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Pass, B., Nowak, L., Eschbach, D. et al. Differences of hemiarthroplasty and total hip replacement in orthogeriatric treated elderly patients: a retrospective analysis of the Registry for Geriatric Trauma DGU®. Eur J Trauma Emerg Surg 48, 1841–1850 (2022). https://doi.org/10.1007/s00068-020-01559-y

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