Arthroplasty boosts neck fracture survival, especially in women

Arthroplasty is an effective intervention for femoral neck fractures, improving short- and midterm survival in patients older than 90 years, and especially in women, a recent study has found.

Researchers conducted a retrospective cohort study of 104 femoral neck fracture patients (51.9 percent women) aged over 90 years. Outcomes were survival time and mortality rate, compared between patients who underwent arthroplasty and those who were treated nonoperatively. Sex differences in treatment effect were also explored.

Thirty-seven patients were treated with arthroplasty while 67 received nonoperative interventions. The sex distribution between groups did not significantly differ.

Twenty-one patients in the arthroplasty group died, yielding a mortality rate of 56.75 with a median survival time of 59 months. In comparison, 51 patients who received nonoperative intervention died, corresponding to a mortality rate and median survival time of 76.12 percent and 24 months, respectively. These between-group differences were statistically significant, according to log-rank test.

In particular, the 1-year mortality rate in the nonoperative group was more than twice as high as that in the arthroplasty arm (41.8 percent vs 18.9 percent). The survival advantage of arthroplasty persisted until 5 years.

Cox proportional hazard regression analysis revealed that the benefit of arthroplasty was much higher in women (hazard ratio [HR], 34.04, 95 percent confidence interval [CI], 8.68–133.47) than it was in men (HR, 1.24, 95 percent CI, 0.58–2.67).