Total Hip Replacement in Patients with Hip Fractures – Can We Do It?

Background:
There are several options for the operative treatment of femoral neck fractures in the elderly. In many institutions, the capabilities of the surgeon and supporting staff fluctuates throughout the week and consequently, the available operative options vary. In addition, the frequency of admitted femoral neck fractures changes, with predictable peaks throughout the week, and year. Organizing a staff capable of performing a total hip replacement (THR) within 48 hours is difficult, but will result in better outcomes. This study aims to quantify admission trends in order to help coordinate staff to achieve prompt and optimal surgical treatment.

Methods:
We collected retrospective data of a total of 475 patients from January 2017 to December 2018 who underwent one of the following operations for the treatment of femoral neck fractures: bipolar hip replacement, dynamic hip screw (DHS), intramedullary nail (IMN), screw or THR. Data collected included age at surgery, gender, month of arrival, weekday of hospital admission, weekday of and duration of hospitalization.

Results:
The average age of all femoral neck fractures was 81.92 years with no statistically significant difference in age when comparing surgical treatment. There was also no statistically significant difference in surgical treatment based on gender. In our medical center, roughly one third of femoral neck fractures were treated with THR regardless of age or gender. During the year, there was a peak of admissions during the months of March and August. The days of the week with the highest number of admissions of femoral neck fractures were Sunday, Tuesday, and Friday, with most surgical treatment occurring on Monday, Wednesday, and Saturday. Surgery was performed within 48 hours in 82.3%, with no statistically significant difference when comparing THR to other surgical treatment. Duration of hospitalization for THR was shorter significantly by one day compared to all other operations (6+1 days, 7+1 days and 6+1 days, respectively).

Conclusions:
THR in patients with hip fractures can be achieved within 48 hours of admission. The peaks during the week and weekend demand special effort to reach this time frame. Knowing the weekly trends, and peaks during March and August (summer vacation) requires planning and organizing of the medical staff. Given that the long-term outcomes of THR exceed those of hemiarthroplasty, medical staff should arrange staff to accommodate predictable trends in the admission of femoral neck fractures. We propose that having capable surgical staff available to perform THR will reduce duration of hospitalization.