Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 12, pp 1667–1671 | Cite as

Revision rates and cumulative financial burden in patients treated with hemiarthroplasty compared to cannulated screws after femoral neck fractures

Orthopaedic Surgery



This study compares re-operation rates and financial burden following the treatment of femoral neck fractures treated with hemiarthroplasty compared to non-displaced femoral neck fractures treated with cannulated screws.


Data was retrospectively analyzed from a prospective database at a university hospital setting on patients undergoing hemiarthroplasty after femoral neck fractures and those with non-displaced femoral neck fractures treated with cannulated screws over a 7-year period. Re-operation rates were determined and financial data was analyzed. Charges refer to amounts billed by the hospital to insurance carriers, while costs refer to financial burden carried by the hospital during treatment.


There were 491 femoral neck fractures (475 patients) that underwent hemiarthroplasty (HA) and 120 non-displaced fractures (119 patients) treated with cannulated screw (CannS) fixation. Both groups had similar age, sex, Charlson co-morbidity scores, pre-operative Parker mobility scores, and 12-month mortality. There were 29 (5.9 %) reoperations in the HA group and 16 (13.3 %) in the CannS group (P = 0.007). The majority of re-operations occurred within 12 months for both groups [21/29 (72 %) HA group; 15/16 (94 %) CannS group; P = 0.13]. Average hospital charges per patient for the index procedure were higher in the HA group ($17,880 ± 745) compared to the CannS group ($14,104 ± 5,047; P < 0.001). After accounting for additional procedures related to their initial surgical fixation, average hospital charges and costs remained higher in the HA group.


Patients treated with hemiarthroplasty for femoral neck fractures have lower re-operation rates than patients treated with cannulated screws for non-displaced femoral neck fractures, with 80 % of re-operations occurring in the first 12 months. Hospital charges and costs to the hospital for treating patients undergoing hemiarthroplasty were higher than patients treated with cannulated screws for the index procedure alone, and after accounting for re-operations.


Femoral neck fracture Hemiarthroplasty Cannulated screw fixation Re-operation Financial burden 


Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Brown CA, Starr AZ, Nunley JA (2012) Analysis of past secular trends of hip fractures and predicted number in the future 2010–2050. J Orthop Trauma 26:117–122PubMedCrossRefGoogle Scholar
  2. 2.
    US Interim Projections by Age, Sex, Race and HO. Washington (DC): US Census Bureau, Population Division, Populations Projection Branch 2010–2050 ndGoogle Scholar
  3. 3.
    Barrett M, Whalen D (2007) HCUP Nationwide Inpatient Sample Comparison Report. HCUP Methods Series Report# 2010-03 ndGoogle Scholar
  4. 4.
    Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL (2010) The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 1:6–14PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Bentley G (1980) Treatment of nondisplaced fractures of the femoral neck. Clin Orthop Relat Res 152:93–101PubMedGoogle Scholar
  6. 6.
    Hansen F (1994) Conservative vs. surgical treatment of impacted, subcapital fractures of the femoral neck. Acta Orthop Scand 256:9Google Scholar
  7. 7.
    Masson M, Parker MJ, Fleischer S (2003) Internal fixation vs. arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev 2:CD001708Google Scholar
  8. 8.
    Rödén M, Schön M, Fredin H (2003) Treatment of displaced femoral neck fractures: a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients. Acta Orthop Scand 74:42–44PubMedCrossRefGoogle Scholar
  9. 9.
    Parker MJ, Khan RJK, Crawford J, Pryor GA (2002) Hemiarthroplasty vs. internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients. J Bone Joint Surg Br 84:1150–1155PubMedCrossRefGoogle Scholar
  10. 10.
    Parker MJ, Pryor GA (2000) Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: a randomised controlled trial of 208 patients. Acta Orthop Scand 71:440–446PubMedCrossRefGoogle Scholar
  11. 11.
    Gjertsen J-E, Fevang JM, Matre K, Vinje T, Engesæter LB (2011) Clinical outcome after undisplaced femoral neck fractures. Acta Orthop 82:268–274PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Axon RN, Williams MV (2011) Hospital readmission as an accountability measure. JAMA 305:504–505PubMedCrossRefGoogle Scholar
  13. 13.
    Goodman D, Fisher E, Chang C (2011) After Hospitalization: a Dartmouth Atlas report on post-acute care for Medicare beneficiaries. Hanover, NH DartmouthGoogle Scholar
  14. 14.
    Cutler DM, Ghosh K (2012) The potential for cost savings through bundled episode payments. N Engl J Med 366:1075–1077PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Buecking B, Eschbach D, Koutras C, Kratz T, Balzer-Geldsetzer M, Dodel R et al (2013) Re-admission to level 2 unit after hip-fracture surgery: risk factors, reasons and outcome. Injury 44:1919–1925PubMedCrossRefGoogle Scholar
  16. 16.
    Boockvar KS, Halm EA, Litke A, Silberzweig SB, McLaughlin M, Penrod JD et al (2003) Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc 51:399–403PubMedCrossRefGoogle Scholar
  17. 17.
    Kates SL, Blake D, Bingham KW, Kates OS, Mendelson DA, Friedman SM (2010) Comparison of an organized geriatric fracture program to US government data. Geriatr Orthop Surg Rehabil 1:15–21PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.University of Rochester Medical CenterRochesterUSA

Personalised recommendations