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Femoral neck fractures in the elderly: from risk factors to pronostic features for survival.

Santiago Luis Iglesias, Luciano Gentile, Fernando Vanoli, Martin Marcelo Mangupli, Ignacio Pioli, Riikka EK Nomides, Bartolome Luis Allende

Introduction: Proximal femur fracture is one of the more serious health problems that affect patients of advanced age. Few studies have reported the risk factors associated with increased mortality after arthroplasty for a femoral neck fracture in the elderly. The purpose of this study was to identify preoperative prognostic factors associated with survival probability and increased length of survival after hemiarthroplasty or total hip arthroplasty (THA) in elderly patients for femoral neck fracture. A secondary objective of this study was to perform a riskbenefit analysis of arthroplasty type on complication rate and patient survival. Materials and Methods: A retrospective, observational and descriptive study. Data was gathered from the medical records of all patients aged 60 years and older who underwent hemiarthroplasty or THA for a femoral neck fracture at our institution from 2010-2015. Data was supplemented by telephone interviews when necessary. Results: The average survival time was 33.9 months for THA and 19.07 months for hemiarthroplasty. Nineteen percent of study patient were deceased at final follow-up, with no difference in gender. Risk of mortality increased by 25% with increased age. The risk of mortality was 7 times greater in the group that underwent hemiarthroplasty. The presence of comorbidities diminish the likelihood of survival in patients subjected to hip surgery. This decrease was significantly greater after hemiarthroplasty, even when adjusting for age of the patient. There was no association between prosthesis and functional characteristics and quality of life post-operatively. Conclusions: The mean survival of patients undergoing hip surgery was less than 3 years and is influenced by the presence of comorbidities. The risk of mortality was significantly greater when the type of prosthesis is a hemiarthroplasty, even when adjusting for patient age. The quality of life after surgery was not related with the type of surgical procedure.