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Updated: May 20, 2025
Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture
Published on: March 3, 2023
Does Orthopaedic Subspecialty Training Affect Treatment Decision-Making and Outcomes for Displaced Femoral Neck
Joshua Giordano1, Anthony Modica1, Jorge A Padilla1
1Northwell Orthopedics, New Hyde Park, New York; Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, New York; Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Background:
Approximately 1.3 to 2.2 million femoral neck fractures occur annually globally, with up to 80% being displaced, requiring hemiarthroplasty or total hip arthroplasty (THA). As the population ages, femoral neck fractures may surpass six million by 2050. Optimal treatment for displaced femoral neck fractures is debated with literature supporting both hemiarthroplasty and THA. Our objective was to determine if subspecialty training plays a role in the decision-making and outcomes of displaced femoral neck fractures.
Methods:
A retrospective analysis was performed for 386 patients who underwent hemiarthroplasty or THA for displaced femoral neck fracture at an academic health system from 2017 to 2023. To assess subspecialty training impact, patients were stratified based on training: adult reconstruction (AR) fellowship or other orthopaedic training (non-AR). Procedure duration, 90-day postoperative complications, length of stay, and discharge disposition were compared between cohorts. A subanalysis was performed to compare the procedures.
Results:
The AR surgeons performed THA 31.8% for femoral neck fractures compared to 10.5% for non-AR-trained surgeons (P < 0.001). Patients treated by AR-trained surgeons were on average younger (79 versus 82 years; P = 0.01). Procedure duration was shorter for hemiarthroplasty (80.4 versus 90.1 minutes; P = 0.01) and THA (94.9 versus 132.6 minutes; P = 0.01) when performed by AR surgeons (overall P = 0.01). The THA patients were more likely discharged home when treated by AR surgeons (55.3 versus 28%; P = 0.03). The AR-trained surgeons used cemented prostheses less compared to non-AR surgeons (16.9 versus 33.2%; P < 0.001).
Conclusions:
Subspecialty training plays a role in decision-making, procedure duration, and discharge disposition for femoral neck fractures. The AR-trained surgeons more often perform THA for femoral neck fractures compared to non-AR-trained surgeons. The AR-trained surgeons completed hemiarthroplasty and THA in significantly shorter time compared with non-AR-trained surgeons and more frequently discharged patients home.
