The Correlation of Surgeon Subspecialty With Outcomes Following Surgery for Geriatric Femoral Neck Fracture

Geriatric femoral neck fractures are common and typically managed with hemiarthroplasty (HA), total hip arthroplasty (THA), or percutaneous pinning (PP) by an on-call physician. The current study assessed if perioperative or longer-term outcomes correlated with orthopaedic surgeon subspecialty.

The 2016 to 2022 PearlDiver M161 Ortho administrative data set was used to identify patients >65 years who underwent HA, THA, or PP for femoral neck fracture. The subspecialty of the treating surgeon was defined as arthroplasty, trauma, or nonarthroplasty/nontrauma. Exclusion criteria included polytrauma and concurrent neoplasms/infections. For each surgery type, 90-day perioperative adverse events were assessed between surgeon cohorts using multivariate logistic regression. Five-year revisions/dislocations were also assessed.

Overall, 150,728 surgeries were identified (140,850 by nontrauma/nonarthroplasty surgeons, 5,013 arthroplasty, and 4,865 trauma). Arthroplasty surgeons performed THA at higher rates than trauma or nonarthroplasty/nontrauma surgeons (28.1% versus 7.7% and 12.8%, respectively, P < 0.001). Ninety-day outcomes were more similar than different across surgeon specialties. For HA, 5-year dislocation rates were statistically different but within 1% between cohorts (nonarthroplasty/nontrauma 97.5%, arthroplasty 96.8%, trauma 97.8%). Five-year revision rates were also within 1% between the cohorts (nonarthroplasty/nontrauma 98.2%, arthroplasty 97.2%, trauma 97.8%). For THA, 5-year dislocation rates were not statistically different (nonarthroplasty/nontrauma 95.7%, arthroplasty 96.3%, trauma 96.9%), nor were five-year revision rates (nonarthroplasty/nontrauma 93.9%, arthroplasty 93.8%, trauma 95.0%). For PP, 5-year revision rates were not statistically different (nonarthroplasty/nontrauma 93.8%, arthroplasty 95.1%, trauma 95.2%).

Femoral neck fractures were predominantly treated by nonarthroplasty/nontrauma surgeons. Nonetheless, 90-day adverse outcomes and five-year rates of revision/dislocation were clinically quite similar. This can provide confidence that those who self-select to treat geriatric femoral neck fractures are performing comparably regardless of subspecialty.