JOA - 2026-06-19 - Journal Article
Time-Dependent Revision Risk and Failure Modes After Total Hip Arthroplasty and Hemiarthroplasty for Displaced Femoral Neck Fracture in Patients Younger Than 70 Years: A Multicenter Analysis of 1,176 Consecutive Cases.
Won SH, Lee SH, Bahk JH, Jo WL, Lim YW, Huddleston JI, Kim SC
Topics
Key Takeaway
At mean 6.1-year follow-up, THA and HA revision rates were equivalent, but cumulative revision curves diverged in favor of THA at 5.5 years, driven by late HA failures from periprosthetic femoral fracture (27.8%) and acetabular erosion (16.7%).
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Summary
This multicenter retrospective cohort compared revision risk, failure modes, and clinical outcomes of THA versus HA for displaced femoral neck fracture in patients under 70 years. Cumulative revision incidence was equivalent between groups overall but diverged at 5.5 years favoring THA, with late HA failures attributable to PFF and acetabular erosion. THA demonstrated lower mortality, lower PJI, and lower postoperative PFF rates, but higher dislocation rates (P=0.001); comorbidity—not age or procedure type—was the only independent predictor of revision.
Key Limitation
Retrospective design with no standardization of implant selection, surgical approach, or bearing surface across eight institutions precludes controlling for variables that independently affect dislocation and erosion rates.
Original Abstract
BACKGROUND
Although total hip arthroplasty (THA) and hemiarthroplasty (HA) are widely used for femoral neck fractures (FNFs) in younger adults, outcome data in this population are limited. We analyzed revision risks, failure patterns, and clinical outcomes of THA or HA in FNF patients younger than 70 years across eight institutions.
METHODS
We analyzed 1,176 patients (645 THAs; 531 HAs; mean follow-up, 6.1 years). The primary outcome was the cumulative incidence of revision and the time point at which the cumulative incidence diverged. The secondary outcomes included revision incidence by age subgroup, risk factors for revision, modes of failure, mortality, surgical complications, 30-day readmissions, and emergency department visits.
RESULTS
In overall and subgroup analyses, the cumulative incidence of revision did not differ between THA and HA, but from 5.5 years, the curves diverged in favor of THA. Comorbidity was independently associated with revision, whereas age and procedure were not associated. In THA, dislocation was the most common mode of failure (66.7%), predominantly within one year. In HA, periprosthetic joint infection (PJI; 44.4%) predominated within one year, whereas periprosthetic femoral fracture (PFF; 27.8%) and acetabular erosion (16.7%) were the leading failure modes after five years. The THA group showed lower mortality (P < 0.001), PJI (P = 0.002), and postoperative PFF (P = 0.006) rates and higher dislocation rates (P = 0.001). The 30-day readmission and emergency department visits were similar.
CONCLUSIONS
The revision rates did not differ between THA and HA at a mean follow-up of 6.1 years. However, from 5.5 years postoperatively, cumulative revision incidence diverged in favor of THA, reflecting late HA revisions due to PFF and acetabular erosion. Revision risk was associated with patient comorbidity. Preventing early dislocation (THA) and PJI (HA) may improve outcomes; HA warrants closer surveillance after five years owing to a late rise in revision risk.