Association of treatment method with mortality and functional outcome in patients with displaced femoral neck fracture: a cohort study of 60–69-year-old patients from the Swedish Hip Fracture Register

Abstract

Background and purpose Optimal treatment for displaced femoral neck fractures (FNF) in patients aged 60–69 years remains controversial. We aimed to compare mortality and short-term clinical outcomes after total hip arthroplasty (THA), hemiarthroplasty (HA), or internal fixation (IF) after displaced FNF. Methods We included 3,325 patients aged 60–69 years with displaced FNF recorded in the Swedish Hip Fracture Register. 1-year mortality and 4-month functional outcomes (maintenance of independent living and outdoor walking ability) were analyzed. Analyses were stratified by American Society of Anesthesiologists (ASA) class (I–II vs III–IV). Results Overall, 1-year mortality was 8.3%. Adjusted analyses showed higher 1-year mortality after HA (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.7–3.6) and IF (OR 2.3, CI 1.6–3.3) compared with THA. Survival analyses demonstrated lower survival probabilities after HA and IF compared with THA in ASA III–IV but not in ASA I–II patients. THA was associated with higher odds of maintaining independent living (IF: OR 0.40, CI 0.20–0.86; HA: OR 0.09, CI 0.04–0.17) and maintaining outdoor walking ability (IF: OR 0.35, CI 0.24–0.50; HA: OR 0.26, CI 0.16–0.43) in ASA I–II patients. In ASA III–IV patients, estimates were closer to unity. Conclusion THA was associated with lower mortality in ASA III–IV and better functional outcomes in ASA I–II.