Rethinking Femoral Head Biopsies in Geriatric Hip Fractures: Financial Burden vs Clinical Outcomes.
Colin Shing Yat Yung1, Christian Fang1, Ho Ming Cheng2
1Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong S.A.R, China.
Geriatric Orthopaedic Surgery & Rehabilitation
|December 25, 2025
Summary
Femoral head biopsies in elderly fracture patients rarely yield positive results for malignancy. This practice has a low clinical impact and high cost, suggesting a need for more selective testing based on patient history and imaging.
Area of Science:
- Orthopedic Surgery
- Pathology
- Oncology
Background:
- Femoral head histopathology is common after geriatric femoral neck fractures, especially with a history of malignancy.
- The cost-effectiveness and clinical impact of this practice remain unclear.
Purpose of the Study:
- To evaluate the yield and clinical significance of femoral head histopathology in elderly patients with femoral neck fractures.
- To determine the cost-effectiveness of routine femoral head biopsies.
Main Methods:
- Retrospective review of 1431 femoral head specimens from 2003-2023 (patients <65 excluded).
- Analysis of demographics, clinical notes, and radiographic information for positive cases.
- Identification of changes in subsequent management and cost analysis.
Main Results:
- Only 3.14% of biopsies were positive for malignancy.
- 82.2% of positive cases showed radiological signs of malignancy, and 77.8% lacked a history of trauma.
- Management plans changed in only 1.8% of cases, with most managed palliatively.
- The average cost per positive case was $12,585.
Conclusions:
- Femoral head biopsies in this population have a low diagnostic yield and minimal impact on patient management.
- Clinical history and radiological findings should guide the decision for histopathology examination.
