J Korean Med Sci.  2021 Nov;36(45):e300. 10.3346/jkms.2021.36.e300.

Comparison of Mortality, Length of Hospital Stay and Transfusion between Hemiarthroplasty and Total Hip Arthroplasty in Octo- and Nonagenarian Patients with Femoral Neck Fracture: a Nationwide Study in Korea

• Yoo JI
• Jang SY
• Cha Y
• Choy WS
• Koo KH

• KMID: 2522550
• DOI: http://doi.org/10.3346/jkms.2021.36.e300

Abstract

Background
The purpose of this study was to compare the mortality rate between patients undergoing hemiarthroplasty (HA) and those undergoing total hip arthroplasty (THA) in two age groups: patients aged 65–79 years (non-octogenerian) and patients aged ≥ 80 years (octogenarian).
Methods
We identified elderly (aged ≥ 65 years) femoral neck fracture patients who underwent primary THA or HA from January 1, 2005 to December 31, 2015 in South Korea using the Health Insurance and Review and Assessment database; the nationwide medical claim system of South Korea. We separately compared the mortality rate between the HA group and THA group in two age groups. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to calculate the adjusted risk ratio (aRR) of death according to the type of surgery.
Results
The 3,015 HA patients and 213 THA patients in younger elderly group, and 2,989 HA patients and 96 THA patients in older elderly group were included. In the younger elderly group, the mortality rates were similar between the two groups. In older elderly group, the aRR of death in the THA group compared to the HA group was 2.16 (95% confidence interval [CI], 1.20–3.87; P = 0.010) within the in-hospital period, 3.57 (95% CI, 2.00–6.40; P < 0.001) within 30-days, and 1.96 (95% CI, 1.21–3.18; P = 0.006) within 60-days.
Conclusions
In patients older than 80 years, THA was associated with higher postoperative mortality compared to HA. We recommend the use of HA rather than THA in these patients.

Keyword

Femur Neck Fracture; Total Hip Arthroplasty; Hemiarthroplasty; Mortality

Figure

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  Fig. 1 Kaplan-Meier curve. Comparison of cumulative incidence of death between total hip arthroplasty group and hemiarthroplasty group in younger elderly group and older elderly group. P value for log-rank test was 0.746, 0.544, respectively.

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