JOA - 2026-04-16 - Journal Article
The Impact of Arthroplasty Training on Outcomes Following Hemiarthroplasty: A Propensity-Score-Matched Analysis.
Swartz G, Katanbaf R, Misch M, Over D, Mont MA, Nace J, Delanois RE
Topics
Key Takeaway
Hemiarthroplasty performed by non-arthroplasty-trained surgeons carries significantly higher rates of periprosthetic fracture at 90 days, 1 year, and 2 years, and higher aseptic revision rates at 1 and 2 years compared to arthroplasty-fellowship-trained surgeons in a propensity-score-matched cohort of 21,612 patients.
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Summary
This study used a national all-payer database to compare complications following hemiarthroplasty for femoral neck fracture between arthroplasty-fellowship-trained and non-arthroplasty-trained surgeons after propensity-score matching for patient comorbidities. Non-arthroplasty-trained surgeons had higher rates of surgical site infection at 90 days, periprosthetic fracture at all three time points, and aseptic revision at 1 and 2 years. No differences were detected in dislocation, aseptic loosening, or PJI rates.
Key Limitation
Fellowship training was ascertained via web search without accounting for surgeon case volume, years in practice, or ongoing arthroplasty practice patterns, making the training variable a crude and potentially unreliable proxy for surgical expertise.
Original Abstract
BACKGROUND
Hip hemiarthroplasty is the most frequently performed treatment for femoral neck fractures, which are projected to rise in incidence over the next century with an aging population. This study sought to compare the incidences of complications, including periprosthetic joint infections, periprosthetic fractures, and dislocations, between patients who underwent hip hemiarthroplasty by an arthroplasty-trained surgeon versus a non-arthroplasty surgeon at 90 days, one year, and two years.
METHODS
We queried a national, all-payer database to identify patients who underwent hip hemiarthroplasty for femoral neck fracture. Physician reports were produced on these patients, which included surgeon information such as National Provider Identifier (NPI), name, and location. A web search was performed to determine the fellowship training of each surgeon. Patients were then separated into two equal cohorts based on the surgeon who performed their hemiarthroplasty: arthroplasty-trained (n = 10,806) and non-arthroplasty-trained (n = 10,806). A propensity score match was utilized to control for patient factors and comorbidities.
RESULTS
Patients who were treated by non-arthroplasty-trained surgeons experienced higher rates of surgical site infection at 90 days (P < 0.001) and periprosthetic fracture at 90 days (P = 0.015), one year (P = 0.004), and two years (P = 0.036). Additionally, patients treated by non-arthroplasty-trained surgeons experienced higher rates of aseptic revision at one year (P = 0.002) and two years (P < 0.001). There were no differences observed in dislocations, aseptic loosenings, or periprosthetic joint infections (all P > 0.05).
CONCLUSIONS
Patients treated by non-arthroplasty-trained surgeons experienced higher rates of periprosthetic fractures and aseptic revisions. This data may inform institutional resource allocation, such as dedicated operating room time, for arthroplasty surgeons to be able to provide urgent care for hip fracture patients.