Total Hip Arthroplasty for Acute Femoral Neck Fractures: Who Should Perform the Operation—Adult Reconstructive or Trauma Surgeons?

OBJECTIVETo compare the results and complications of a large consecutive series of total hip arthroplasty (THA) performed for acute femoral neck (FN) fracture by adult reconstructive (AR) and trauma (T) surgeons to determine if there is a difference in outcomes. DESIGNRetrospective chart review. SETTINGLevel 1 trauma center. PATIENTSOne hundred forty-nine consecutive patients who presented to our institution with displaced FN fractures treated by THA were included in this study. INTERVENTIONAll patients were treated with THA. MAIN OUTCOME MEASUREMENTSImplant survival, 90-day complications, 90-day readmission, 1-year complications. RESULTSFor the group as a whole, the major surgical complication rate (defined as dislocation, deep infection, loosening, fracture) was significantly higher for T surgeons (20%) than for AR surgeons (7%) (P = 0.021). AR surgeons had significantly less radiographic component malpositioning 12% versus 3% (P = 0.024). Mortality and readmission rates were similar between the 2 cohorts at all time points. Implant survivorship was significantly higher at 1 year for AR surgeons (P = 0.05). CONCLUSIONSTHA for acute FN fracture performed by AR surgeons demonstrated higher rates of accurate radiographic component positioning, significantly lower major complication rates at 90 days and 1 year, and greater implant survival at 1 year. LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.