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Published on: September 7, 2022

Death after Total Hip Arthroplasty in Patients with Compensated Heart Failure: Retrospective Cohort Study

Raj Amin1, Wade Banta2, Ryan Guilbalt3

  • 1Orthopaedic Surgery University of California-Fresno.

Hawai'I Journal of Health & Social Welfare
|June 12, 2026
PubMed

Insights

Congestive heart failure (CHF) increases mortality risk in patients undergoing hip surgery for femoral neck fractures. Hemiarthroplasty may be a safer option than total hip arthroplasty for patients with moderate to severe CHF.

Area of Science:

  • Orthopedic Surgery
  • Cardiology
  • Public Health

Background:

  • Total hip arthroplasty (THA) is preferred for femoral neck fractures, but congestive heart failure (CHF) poses a significant mortality risk.
  • The impact of CHF severity on mortality following THA versus hemiarthroplasty for femoral neck fractures requires further investigation.

Purpose of the Study:

  • To evaluate the association between congestive heart failure (CHF) severity and 30-day postoperative mortality after total hip arthroplasty (THA) and hemiarthroplasty for acute femoral neck fractures.
  • To compare the mortality risks associated with THA and hemiarthroplasty in patients with varying degrees of CHF.

Main Methods:

  • Retrospective cohort study using the National Surgical Quality Improvement database.
  • Inclusion of patients treated for acute, closed, intracapsular femoral neck fractures.
  • Stratification of patients based on New York Heart Association (NYHA) CHF categories (mild, moderate, severe) and surgical procedure (THA vs. hemiarthroplasty).

Main Results:

  • Overall 30-day mortality was 2.1% for THA and 5.4% for hemiarthroplasty.
  • Mortality increased with CHF severity for both procedures.
  • Patients with mild and moderate CHF undergoing THA had significantly higher adjusted odds ratios for 30-day mortality compared to hemiarthroplasty.

Conclusions:

  • Congestive heart failure (CHF) is associated with increased 30-day mortality after total hip arthroplasty (THA) for femoral neck fractures, indicating CHF is not a modifiable risk factor in this context.
  • Hemiarthroplasty presents a potentially safer surgical option for patients with congestive heart failure (CHF) undergoing treatment for femoral neck fractures, given the observed mortality trends.

Keywords:
CHFComplications of THACongestive Heart FailureMortality after THATHATHA and mortalityTotal hip arthroplasty

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