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Life sciences · Journal article
Archives of Orthopaedic and Trauma Surgery · August 10, 2026
Reinforces what was already believed, rather than introducing something new.
This nationwide retrospective cohort of 99,084 older adults with femoral neck fracture treated surgically describes patient factors associated with selection of total hip arthroplasty versus hemiarthroplasty. THA was more common in younger patients (76.6 vs 81.9 years) and those without frailty or cognitive conditions, but the study documents selection patterns rather than establishing clinical benefit or appropriate use.
Retrospective cohort study. Adults ≥65 years hospitalized with displaced femoral neck fracture, treated surgically with hemiarthroplasty or total hip arthroplasty. Internal fixation and non-arthroplasty cases excluded.. Intervention: Total hip arthroplasty. Compared with: Hemiarthroplasty. n = 99,084. United States (Nationwide Readmissions Database).
81.8% of eligible cases received hemiarthroplasty; 18.2% received THA THA patients were younger (76.6 vs 81.9 years) and had shorter length of stay (6.06 vs 7.24 days) THA patients more frequently discharged home (17.5% vs 6.2%)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This study documents that THA selection in clinical practice is associated with younger age and fewer frailty markers, consistent with guideline recommendations. However, it does not establish whether these selection patterns result in better outcomes, and clinicians cannot use this observational data alone to guide treatment decisions—outcomes research comparing THA and hemiarthroplasty in well-defined cohorts is needed.
A large retrospective cohort study describing real-world selection patterns for THA versus hemiarthroplasty that align with clinical expectations (younger age, better cognition, fewer frailty markers favour THA), but does not establish clinical benefit or causation.
As stated by the source record.
Quoted from the source exactly as published.
This study documents that THA selection in clinical practice is associated with younger age and fewer frailty markers, consistent with guideline recommendations. However, it does not establish whether these selection patterns result in better outcomes, and clinicians cannot use this observational data alone to guide treatment decisions—outcomes research comparing THA and hemiarthroplasty in well-defined cohorts is needed.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background Surgical management of displaced femoral neck fractures in older adults typically involves hemiarthroplasty or total hip arthroplasty (THA). Although clinical guidelines suggest that THA may be considered in selected healthier and cognitively intact patients, real-world procedure selection varies widely. This study evaluated patient factors associated with selection of THA versus hemiarthroplasty in a contemporary U.S. dataset. Methods A retrospective cohort study was conducted using the 2022 Nationwide Readmissions Database (NRD). Patients ≥ 65 years hospitalized with femoral neck fracture were identified using ICD-10-CM codes. Those treated with internal fixation or non-arthroplasty procedures were excluded. Weighted analyses characterized demographics, comorbidities, and hospital utilization between THA and hemiarthroplasty groups. A multivariable logistic regression model identified factors independently associated with receiving THA. All analyses accounted for NRD survey design. Results Among 142,013 operative cases, 99,084 met inclusion criteria (81.8% hemiarthroplasty; 18.2% THA). Patients receiving THA were younger (76.6 vs. 81.9 years), had shorter length of stay (6.06 vs. 7.24 days), and were more frequently discharged home (17.5% vs. 6.2%). Metabolic conditions were associated with increased odds of THA, including obesity (OR 1.17) and sleep apnea (OR 1.12). Frailty-related conditions were associated with markedly reduced THA likelihood, including Alzheimer’s disease (OR 0.48), Parkinson disease (OR 0.55), chronic kidney disease (OR 0.78), chronic lung disease (OR 0.72), and congestive heart failure (OR 0.77). Each additional year of age decreased the odds of THA by approximately 9%. Conclusion In this nationwide cohort, selection of THA rather than hemiarthroplasty was associated with younger age and lower prevalence of frailty- and cognition-related comorbidities, while several metabolic comorbidities showed modest positive associations with THA use. These findings describe contemporary national selection patterns but do not establish treatment appropriateness, clinical benefit, or guideline concordance, as key factors such as pre-fracture mobility, functional independence, and living situation were not available in the dataset. Level of evidence Level III.
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