Clinical Orthopaedics and Related Research

, Volume 466, Issue 12, pp 3116–3122 | Cite as

Trends in Surgical Management of Femoral Neck Fractures in the United States

  • Nitin B. JainEmail author
  • Elena Losina
  • Daniel M. Ward
  • Mitchel B. Harris
  • Jeffrey N. Katz
Original Article


We examined trends in utilization of open reduction and internal fixation (ORIF), THA, and hemiarthroplasty (HA) for femoral neck fractures. Closed femoral neck fractures managed with ORIF or hip arthroplasty (n = 162,257) were extracted from 1990 to 2001 Nationwide Inpatient Samples. Trends were examined during three periods (1990–1993 [Period I], 1994–1997 [Period II], and 1998–2001 [Period III]). Utilization of HA increased from 67.8% in Period I to 75.3% in Period III. In the same period, utilization of THA decreased from 11.6% to 6.6%. The trend of decreased use of THA was consistent regardless of age, hospital, or surgeon volume. In Period III, 28.7% of patients were managed at urban teaching hospitals as compared with 19.6% in Period I. Increased utilization of HA conforms with recent evidence that arthroplasty has better outcomes than ORIF. However, the decrease in THA is contrary to what was expected, and its impact on patient outcomes needs to be evaluated. The increase in the proportion of femoral fractures managed at urban teaching hospitals may reflect a change in the organization of trauma systems during the last decade.

Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.


Internal Fixation Femoral Neck Fracture Hospital Volume Nationwide Inpatient Sample Displace Femoral Neck Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Agency for Healthcare Research and Quality. Available at: Accessed June 1, 2008.
  2. 2.
    Agency for Healthcare Research and Quality. HCUP Quality Control Procedures. Available at: Accessed June 1, 2008.
  3. 3.
    Battaglia TC, Mulhall KJ, Brown TE, Saleh KJ. Increased surgical volume is associated with lower THA dislocation rates. Clin Orthop Relat Res. 2006;447:28–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P 3rd, Obremskey W, Koval KJ, Nork S, Sprague S, Schemitsch EH, Guyatt GH. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck: a meta-analysis. J Bone Joint Surg Am. 2003;85:1673–1681.PubMedGoogle Scholar
  5. 5.
    Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH. Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg Am. 2005;87:2122–2130.PubMedCrossRefGoogle Scholar
  6. 6.
    Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007;89:160–165.PubMedCrossRefGoogle Scholar
  7. 7.
    Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures: randomized, controlled trial performed at four years. J Bone Joint Surg Am. 2005;87:1680–1688.PubMedCrossRefGoogle Scholar
  8. 8.
    Healy WL, Iorio R. Total hip arthroplasty: optimal treatment for displaced femoral neck fractures in elderly patients. Clin Orthop Relat Res. 2004;429:43–48.PubMedCrossRefGoogle Scholar
  9. 9.
    Jain N, Pietrobon R, Hocker S, Guller U, Shankar A, Higgins LD. The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004;86:496–505.PubMedCrossRefGoogle Scholar
  10. 10.
    Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlstrom O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthop Scand. 2000;71:597–602.PubMedCrossRefGoogle Scholar
  11. 11.
    Jonsson B, Sernbo I, Carlsson A, Fredin H, Johnell O. Social function after cervical hip fracture: a comparison of hook-pins and total hip replacement in 47 patients. Acta Orthop Scand. 1996;67:431–434.PubMedCrossRefGoogle Scholar
  12. 12.
    Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2001;83:1622–1629.PubMedCrossRefGoogle Scholar
  13. 13.
    Katz JN, Phillips CB, Baron JA, Fossel AH, Mahomed NN, Barrett J, Lingard EA, Harris WH, Poss R, Lew RA, Guadagnoli E, Wright EA, Losina E. Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum. 2003;48:560–568.PubMedCrossRefGoogle Scholar
  14. 14.
    Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty: treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am. 2006;88:249–260.PubMedCrossRefGoogle Scholar
  15. 15.
    Laursen JO. Treatment of intracapsular fractures of the femoral neck in Denmark: trends in indications over the past decade. Acta Orthop Belg. 1999;65:478–484.PubMedGoogle Scholar
  16. 16.
    Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2003;85:27–32.PubMedGoogle Scholar
  17. 17.
    Puolakka TJ, Laine HJ, Tarvainen T, Aho H. Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years: a prospective randomized study with two-year follow-up. Ann Chir Gynaecol. 2001;90:225–228.PubMedGoogle Scholar
  18. 18.
    Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur: 13 year results of a prospective randomised study. Injury. 2000;31:793–797.PubMedCrossRefGoogle Scholar
  19. 19.
    Ray NF, Chan JK, Thamer M, Melton LJ 3rd. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12:24–35.PubMedCrossRefGoogle Scholar
  20. 20.
    Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur: functional outcome for 450 patients at two years. J Bone Joint Surg Br. 2002;84:183–188.PubMedCrossRefGoogle Scholar
  21. 21.
    Soreide O, Molster A, Raugstad TS. Internal fixation versus primary prosthetic replacement in acute femoral neck fractures: a prospective, randomized clinical study. Br J Surg. 1979;66:56–60.PubMedCrossRefGoogle Scholar
  22. 22.
    Tidermark J, Ponzer S, Svensson O, Soderqvist A, Tornkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly: a randomised, controlled trial. J Bone Joint Surg Br. 2003;85:380–388.PubMedCrossRefGoogle Scholar
  23. 23.
    Whalen D, Houchens R, Elixhauser A. Final 2000 NIS Comparison Report. HCUP Methods Series Report #2003-1. Agency for Healthcare Research and Quality. Available at: Accessed June 1, 2008.

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Nitin B. Jain
    • 1
    • 2
    • 3
    Email author
  • Elena Losina
    • 4
    • 5
    • 6
  • Daniel M. Ward
    • 1
  • Mitchel B. Harris
    • 5
  • Jeffrey N. Katz
    • 4
    • 5
  1. 1.Department of Orthopedic SurgeryNew England Baptist HospitalBostonUSA
  2. 2.Department of Physical Medicine and RehabilitationSpaulding Rehabilitation Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of MedicineNewton-Wellesley HospitalNewtonUSA
  4. 4.Section of Clinical Sciences, Division of Rheumatology, Immunology, and AllergyBrigham and Women’s HospitalBostonUSA
  5. 5.Department of Orthopedic SurgeryBrigham and Women’s HospitalBostonUSA
  6. 6.Department of BiostatisticsBoston University School of Public HealthBostonUSA

Personalised recommendations