Racial Disparities in Surgical Treatment Choice for Displaced Femoral Neck Fractures

Femoral neck fractures (AO-OTA 31B) (FNFs) are prevalent among the elderly, and the choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) remains debated. Given previous evidence of treatment disparities in FNFs, we investigated racial differences in THA utilization.

Using the National Inpatient Sample (NIS) database, a representative sample of inpatient admissions, we identified patients aged ≥65 years who underwent HA or THA for FNFs from 2000 to 2020. Records were extracted using ICD9/ICD10 codes for intracapsular FNFs, excluding basicervical and peritrochanteric fractures, and procedure codes for THA and HA were used to create the cohorts. The primary outcome was treatment with either HA or THA. Covariates include hospital characteristics, demographics, socioeconomic factors, and medical comorbidities. Logistic regression analysis evaluated the relationship between race and treatment with THA or HA.

Bivariate analyses showed similar rates of HA across races and no statistically significant differences (Hispanic 89.6%, Asian 89.4%, Black 89.4%, White 88.7%; p = 0.056). Patient factors, including age, sex, and insurance, influenced treatment choice (all p < 0.0001), as did hospital-related factors such as location, region, and bed size (all p < 0.0001). Statistically significant comorbidities included acquired immune deficiency syndrome (AIDS), solid tumor without metastasis, alcohol abuse, metastatic cancer, depression, diabetes, hypertension, chronic obstructive pulmonary disease (COPD), obesity, hypothyroidism, and peripheral vascular disease (all p < 0.05).When controlling for patient- and hospital-related variables and significant comorbidities in our multivariable logistic regression model predicting THA, Black (OR 0.83, 95% CI 0.75-0.93; p = 0.001) and Hispanic (OR 0.76, 95% CI 0.67-0.86; p < 0.001) patients had significantly lower odds of undergoing THA compared with patients, whereas differences for Asian/Pacific Islander patients were not statistically significant.

Variations in patient age, insurance status, and hospital-related variables influenced HA versus THA treatment. Racial disparities persisted after controlling these factors, underscoring the need to closely evaluate potential inequities to ensure equitable access to appropriate care.

Level III, prognostic. See Instructions for Authors for a complete description of levels of evidence.