Femoral Neck Fracture Management in Elderly Patients: Surgeons' Practice Through a Registry Analysis

Femoral neck fractures (FNFs) in elderly patients are a growing concern given increased life expectancy and functional demands. Hemiarthroplasty is the standard treatment, but optimal fixation, approach, and perioperative management remain debated. This study aims to describe implant characteristics, perioperative details, survival, and complications of hemiarthroplasty in patients aged ≥75 years.

A descriptive retrospective analysis was performed using the Emilia Romagna arthroplasty registry (RIPO). All patients ≥ 75 years who underwent hemiarthroplasty for FNFs between 2000 and 2021 were included. Data on demographics, implant fixation, surgical approach, complications, and revisions were analyzed. Implant survival was assessed with Kaplan-Meier analysis.

A total of 43,657 procedures were identified; the mean age was 85.5 years, and 73.7% were female. Cemented stems were used in ~76% of cases. The lateral approach was most common (52.6%), followed by posterolateral (43.7%) and anterior (2.9%). Overall revision rate was <2% (853 cases). Dislocation was the leading cause of failure (46.9%), followed by periprosthetic fracture, acetabular wear, aseptic loosening, and infection. Heparins were used for thromboprophylaxis in >93% of cases. Ninety-day mortality reached 13.9%.

In this large registry study, cemented stems and the lateral approach were predominant. Despite low revision rates, dislocation remained the main cause of failure. High perioperative mortality highlights the vulnerability of this population and the importance of multidisciplinary care. Future high-quality studies, as prospective studies, will be necessary to determine the optimal solutions in this frail elderly population.