Purpose:Periprosthetic joint infections (PJIs) resulting from total hip arthroplasty (THA) pose significant challenges. Partial two-stage exchange arthroplasty (TSEA) retains either the femoral stem or acetabular cup by preserving bone stock and soft tissue and offers a potential alternative to total TSEA. Our meta-analysis evaluated the pooled success rate of partial TSEA in treating late chronic PJIs in THA. Our study also focused on the outcomes associated with retained prosthetic implant (stem or cup) and the type of prior surgery (primary vs. revision arthroplasty) performed. Materials and Methods:We analyzed data from 355 hips of patients with PJI following THA across 11 studies using a random-effects model to estimate the success rate of partial TSEA and spacer dislocation that occurs during the interval between the first and second stages of partial TSEA. The heterogeneity between the subgroups was also calculated. Results:The overall pooled success rate of partial TSEA in the study cohort was 87% (95% confidence interval [CI] 83-91). Lacking statistical significance (P=0.904), the success rates were 88% for stem-retained and 90% for cup-retained implant cases. The partial TSEA success rates were 88% for primary arthroplasty and 80% for revision arthroplasty, although this was not statistically significant (P=0.193). Spacer dislocation occurred in only 5% of the cases (95% CI 1-9). Conclusion:Partial TSEA achieves high success rates comparable to those of total TSEA. Although revision arthroplasty cases carry a high risk of recurrence, partial TSEA remains a viable, tailored treatment option with a low complication rate.
Purpose:In the existing literature, isolated femoral head and polyethylene liner exchange is commonly performed in revision total hip arthroplasty (THA) for a variety of indications with mixed outcomes. The purpose of this study is to investigate patient outcomes following head-liner exchange and risk factors associated with failure in THA. Materials and Methods:A retrospective chart review from May 2016 to November 2023 was conducted on patients who underwent isolated head-liner exchange at two institutions. Patients had minimum 1-year follow-up periods. For each patient, data such as indication for revision, surgical approach, revision head size, immediate and short-term complications, postoperative disposition, 90-day readmissions, and re-operations were recorded. Results:Out of 175 patients, there were 24 readmissions/emergency department visits within 90 postoperative days (13.7%), 21 subsequent revision surgeries (12.0%), 21 postoperative dislocations (12.0%), and 20 immediate postoperative complications (11.4%). A statistically significant association was demonstrated between indication for revision and postoperative instability (P=0.04). Patients operated upon for instability had higher rates of postoperative instability. Furthermore, patients with reported preoperative dislocation events had higher incidences of postoperative dislocations. Patients discharged to skilled nursing facilities (SNF) were associated with an increased number of hospital readmissions within 90 days of surgery, reoperation, and postoperative dislocation (P<0.05). No statistically significant associations were found between surgical approach and complications. Conclusion:This study suggests that, in the context of isolated head-liner exchanges, factors such as preoperative dislocation history, indication for revision, and discharge to SNF are associated with poorer outcomes and complications.
Femoroacetabular impingement syndrome (FAIS) is a risk factor for future hip osteoarthritis and is prevalent in both athletic and non-athletic populations. This bibliometric review aimed to understand the history of FAIS and provide detailed information for future FAIS research. The Clarivate Analytics Web of Science Core Collection was used to search and obtain all studies between 2020 and 2025 using bibliometrix (ver. 3.0.4) and R package software. Between 2020 and 2025, 1,486 articles were published on FAIS. There was an overall 41.3% downward trend in published research during this period. Furthermore, recent key terms include "physical impairments" and "muscle strength". Institutions and surgical authors across North America, Europe, and Australia published the highest volume of research papers. Across keywords, femoroacetabular impingement and osteoarthritis had the strongest relationship. FAIS research continues to be led by surgical authors within surgical journals. While surgical key terms have been historically prevalent within the existing literature, research aligning with more conservative management has started to emerge. Despite an increase in physiotherapy researchers, inter-disciplinary collaboration remains limited and concentrated in western countries.
Purpose:When managing femoral neck fractures, National Institute for Health and Care Excellence guidelines (2023) recommend total hip arthroplasty (THA) for patients who are expected to independently perform activities of daily living (ADLs) beyond two years. These attempt to clarify the indication for THA versus hemiarthroplasty (HA). Frailty assessment tools, such as the Rockwood Frailty Scale (RFS), may provide surgeons a more objective means to assess patient function. The aim of this study is to ascertain whether frailty assessments are predictive of mortality associated with THA thus helping determine arthroplasty suitability. Materials and Methods:Single-center data was collected retrospectively between 2014 and 2020. Three hundred thirty-three cases were eligible for review. For the RFS, Johns Hopkins Frailty Assessment (JHFA) and Nottingham Hip Fracture Score (NHFS), frailty scores were generated and 2-year mortality was calculated for 'frail' and 'non-frail' patient cohorts. Results:Overall 2-year mortality was 8.4%. Mortality within two postoperative years was 0.8% for RFS <4 compared to 12.7% for scores ≥4. This highlights an approximate 17-times greater mortality risk between these groups (odds ratio [OR] 17.27, 95% confidence interval [CI] 2.32-128.82, P=0.005). For the JHFA, the 2-year mortality rate for 'frail' patients was over 6-times greater than those 'not frail' (OR 6.91, 95% CI 3.04-15.72, P<0.0001). Positive findings were noted by the NHFS (P=0.054). Conclusion:This study demonstrates that following THA for femoral neck fractures, preoperative frailty scores are predictive of 2-year postoperative mortality. Frailty assessments could objectively guide surgical decision making with respect to offering THA versus HA.
Purpose:This study aimed to determine complication-free survival rates by assessing Barthel Index (BI) grades at discharge and to identify prognostic factors following hip hemiarthroplasty for femoral neck fractures. Materials and Methods:This retrospective study analyzed 404 patients. We collected data on BI scores following surgery and at discharge, BI improvement rate (BI speed), postoperative complications (dislocations, thrombosis, death, infection, and nerve disorder), and peri-hip fractures (contralateral and periprosthetic fractures). Results:Cluster analysis categorized patients into low (<35, n=92), moderate (40-80, n=199), and high (>85, n=113) BI groups. The moderate BI group showed an intermediate BI speed (1.97±1.31/day, P<0.001) and a peri-hip fracture incidence of 11.1% (P=0.015). Four-year complication-free survival rates were 47.5% in the low, 45.9% in the moderate, and 74.7% in the high BI groups (P<0.001). Multivariate analysis identified BI speed as a significant prognostic factor for complications (hazard ratio 0.746, 95% confidence interval 0.560-0.994, P<0.05). Conclusion:BI speed is a significant prognostic indicator for complications following hip hemiarthroplasty. Although it does not predict peri-hip fractures, the high fracture incidence in the moderate BI group suggests the need for targeted preventive interventions in this population.
Cemented and uncemented fixation are the two categories of fixation in hip arthroplasty (HA). While uncemented stems rely on biologic fixation, cemented HA uses PMMA (polymethylmethacrylate) to lend stability through an interlocking fit between the stem and the cancellous bone. The optimal choice of fixation in elderly patients is debatable. Although patients with poor bone quality have demonstrated good results with uncemented stems, recent improvements in cementing techniques have led to superior outcomes compared to those of older versions. We prefer fully cemented HA in elderly patients to achieve immediate stability that leads to early mobilization and minimal complications, such as intraoperative or postoperative periprosthetic femur fractures. This technical note describes cement fixation in HA.
Purpose:There is ongoing debate on the haemoglobin level at which red cell transfusion should be administered following surgery. This study aimed to evaluate the benefits of a restrictive blood transfusion strategy and assess potential adverse effects of anaemia in the immediate postoperative phase, determining whether a liberal transfusion approach still remains necessary. Materials and Methods:A randomized control trial compared two groups: Group 1, with a liberal blood transfusion strategy, and Group 2, with a restrictive blood transfusion protocol. Haemoglobin levels were measured on the 3rd and 12th postoperative days, and at 1-month follow-up. Clinical and functional evaluations were conducted at the 1-month follow-up. Results:There was no significant difference between the liberal and restrictive groups in 10 feet walking with support at 12 days and at 1 month. The restrictive group had a shorter hospital stay (17.57±4.66 days) compared to the liberal group (19.56±5.34 days). Incidence of surgical site infections were similar (4.0% in liberal, 2.0% in restrictive), and no mortalities were observed in either group at the 1-month follow-up. Conclusion:Both liberal and restrictive transfusion strategies were similarly effective in terms of early postoperative mortality and functional mobility. However, patients in the liberal transfusion group had a significantly longer length of stay compared to the restrictive group. Leading us to conclude that a restrictive strategy is effective and beneficial for patients and hospitals provided there are no signs of anaemia or a haemoglobin drop below 8 g/dL.
Purpose:The frequency of total hip arthroplasty (THA) has increased significantly. The morbidity and economic burden of periprosthetic hip fractures (PPHFx) following THA is high. The objective of this study is to identify predictors of in-hospital mortality, length of stay (LOS), and hospital costs associated with PPHFx. Materials and Methods:A retrospective analysis of the National Inpatient Sample (NIS) for all patients diagnosed with periprosthetic fracture around the internal prosthetic hip joint (International Classification of Disease, Tenth Revision, Clinical Modification [ICD-10-CM], M97.01XA, and M97.02XA) between 2016 and 2019 was conducted. Predictors of outcomes following PPHFx were assessed using univariable analyses; those with a P-value below 0.2 were included in the final multivariable models. Logistic regression was used to determine predictors of in-hospital mortality and linear regression for assessment of hospital cost and LOS predictors. Results:The study included 77,565 patient encounters. Significant predictors of in-hospital mortality included age, female sex, and comorbidities, such as metastatic cancer and liver disease. Predictors of increased LOS included black race, comorbidities, such as paralysis and fluid and electrolyte disorders, primary payment source, household income, hospital size, and type. Hospital costs showed an association with race, comorbidities, hospital type, and procedure. Conclusion:In the setting of PPHFx, higher comorbidity, particularly fluid and electrolyte, paralysis, and metastatic cancer, showed an association with all three outcome variables. In addition to comorbidity, advanced age, particularly nonagenarians, showed an association with in-hospital mortality, while cost was primarily driven by the procedure performed.
Purpose:The impact of altering a patient's hip offset during total hip arthroplasty (THA) on periprosthetic fracture risk is unknown. The purpose of this study was to compare periprosthetic fracture risk in patients where THA offset was "matched" to their contralateral native hip versus those where offset was mismatched. Materials and Methods:We reviewed 50 patients with Vancouver B periprosthetic fractures at a single academic institution between 2012 and 2019 and compared them with a matched cohort. By utilizing a validated technique, two reviewers calculated combined hip offset from anteroposterior pelvis radiographs. Offsets of the operative side and the native hip were measured and denoted as either as a "match" if values were within 5 mm of the contralateral, native hip, or a "mismatch" if the prosthetic horizontal hip offset differed more than 5 mm from the native side. Independent sample t-tests and chi square analyses were used for data comparison. Relative risk (RR) with a 95% confidence interval (CI) was then calculated. Results:Unmatched offset was associated with increased risk of periprosthetic fracture (P<0.001). This finding was true for cases where offset was increased relative to the native hip (P<0.001) and where implant offset was decreased relative to the native hip (RR=3.0, 95% CI 1.3-7.6, P=0.015). Conclusion:Failure to restore a patient's offset during THA is associated with increased rates of periprosthetic fracture. Although restoration of native hip anatomy is an important technical consideration of this procedure, alterations in the hip lever arm may predispose patients to periprosthetic fracture.
Purpose:Due to recent shifts in healthcare reimbursement models, more primary total hip arthroplasties (THAs) are now being performed in the outpatient setting. However, there is a lack of knowledge around the comparative outcomes of revision outpatient THA. Materials and Methods:Adults undergoing revision THA between 2010 and 2020 with 2-year follow-up data were identified on a large insurance claims database. Following stratification by inpatient versus outpatient revision THA, patients from both groups were matched 1:1 by demographics and revision characteristics. Ninety-day postoperative medical and 1- and 2-year postoperative surgical complications after matching were compared. Results:Among 67,570 patients, mean age was 65.3 years, 57.0% were female, and mean Charlson comorbidity index score was 1.72. Subsequent to 1:1 matching, 1,555 inpatient and outpatient revision THA patients were identified. Outpatient THA patients had significantly lower rates of blood transfusions (3.6% vs 5.1%, P=0.049), broken prosthesis (1 year: 0.1% vs. 0.6%, P=0.027; 2 years: 0.2% vs. 0.9%, P=0.015), and other postoperative mechanical complications (1 year: 4.9% vs. 7.1%, P=0.010; 2 years: 6.2% vs. 8.4%, P=0.023). Otherwise, the data for outpatient THA patients was not statistically different from inpatient THA patients across all studied complications. Conclusion:Outpatient revision THA may be a safe alternative to inpatient revision THA for carefully selected patients. Establishing patient- and case-specific parameters to optimize outcomes, satisfaction, safety, and value is critical.
Purpose:Reports remain sparse on the outcomes of quadratus femoris muscle pedicle bone grafting (QF-MPBG) for osteonecrosis of the femoral head (ONFH) in the existing literature. This study reports on the clinico-radiological outcomes of this procedure in early-stage non-traumatic ONFH using a quadriceps-coxae sparing (QCS) modified posterior approach. Materials and Methods:This prospective study included 22 symptomatic patients suffering from early-stage, non-traumatic ONFH. These patients underwent QF-MPBG surgery using a QCS modified posterior approach and were followed up for a minimum duration of 24 months. Results:The mean age of patients was 29 years (range, 20-47 years). As per the modified Kerboul's combined necrotic angle, the distribution of patients was as follows: grade 1 (n=5); grade 2 (n=9); grade 3 (n=4); and grade 4 (n=4). All four patients belonging to grade 4 and two belonging to grade 3 required total hip arthroplasty (THA) within 24 months. As per the modified Ficat's classification, 18 cases were in stage II and four in stage I. Six cases (out of the preoperative 18 cases classified as stage II) deteriorated to stage IV, and two deteriorated to stage III. The mean Harris hip score improved from 63 (range, 57-67) to 75 (range, 50-93) after surgery (P<0.05). Four out of six patients necessitating THA had steroid-induced ONFH. Conclusion:The QCS modified posterior approach provides sufficient exposure required for QF-MPBG. Steroid-induced ONFH and a modified Kerboul's combined necrotic angle of >250° may be considered as potential risk factors for progression of this disease.
Purpose:Primary cam and pincer type morphology of the hip can lead to femoroacetabular impingement and osteoarthritis. This study aimed to assess and compare magnetic resonance imaging (MRI)-based radiological parameters of hip morphology between young male semi-professional soccer players and non-athlete controls. Materials and Methods:This observational cross-sectional study included a retrospective review of MRI scans of young male soccer players and an age- and sex-matched control group obtained from a hospital radiology database. Lateral center edge angle, acetabular version, alpha angle, collodiaphyseal angle, and femoral head coverage ratio were recorded and compared between groups. Results:Bilateral hip MRI scans of 30 young male soccer players and 30 non-athletes were analyzed. The mean age of participants was 24.88±5.10 years (range, 15-34 years). In the non-athlete control group, anteversion was higher in both hips (P=0.02 for right hip and P=0.05 for left hip) and reached statistical significance for the right hip. The collodiaphyseal angle was higher in the soccer-player group (P=0.01 for the right hip and P=0.03 for the left hip). The femoral head coverage ratio was significantly higher in the control group (P=0.02 for the right hip and P=0.01 for the left hip). No significant difference was observed in lateral center edge angle or alpha angle between groups. Conclusion:Differences in collodiaphyseal angle, acetabular anteversion, and femoral head coverage ratio indicate partial variation in femoroacetabular morphology between groups; however, no evidence showed a higher incidence of cam or pincer morphology in soccer players.
For femoral reconstruction in revision total hip arthroplasty (rTHA), cementless, diaphyseal engaging femoral components are the most commonly-used implants. At present, there are no reviews that directly compare the design features of these implants. We performed a manual review of the designs of commercially available diaphyseal engaging femoral stems. We compiled and compared the design features of these implants. Clinical outcomes of modular and monoblock stems were also compared. We identified five modular and four monoblock stems in the manual review of commercial companies manufacturing these stems. Distal stem taper varied from 2° to 3.5°, and the number of splines varied from 8 to 16. The stems varied in their stem lengths, offsets, and surface finish. Although there are no clinically significant differences in the restoration of leg length between monoblock compared to modular stems. The modular stems appear to perform slightly better with respect to subsidence and restoration of leg length. A source of concern for modular stems are mechanical implant failures that occur almost exclusively at modular junctions. Current evidence does not support any difference in dislocation rate, intraoperative or postoperative fracture, aseptic loosening, re-revision rates, or clinical outcomes between monoblock and modular stems. With the knowledge of the distinct features of implants, surgeons must make choices associated with specific design characteristics that could be pivotal to the success of the operation. Our understanding of design differences will help us minimize chances of failure and choose patient-specific implants that will lead to a high rate of success.
Purpose:Hip fracture surgery is a high-stakes topic due to elevated mortality and high economic costs, making the identification of optimal treatment for displaced femoral neck fracture (FNF) pivotal. Our study aimed to evaluate and compare (1) surgery-associated parameters and (2) mortality rates following multiple screw fixation (MSF) or cementless bipolar hemiarthroplasty (BHA) in patients with displaced FNF using twenty years of data from a single tertiary referral center. Materials and Methods:Between January 2000 and January 2018, we analyzed 1,153 cases of displaced FNFs treated at our institution with either MSF or cementless BHA. We evaluated (1) surgery-associated parameters, (2) hospitalization duration, and (3) postoperative complications and mortality rates at one and five years following the surgical procedure. Results:MSF showed a reduced waiting period preceding surgery, a shortened duration of the surgical procedure, but an extended period of hospitalization. There was an increase of estimated blood loss and postoperative transfusion with cementless BHA compared to that with MSF. Both the procedures did not differ in postoperative complications. The one-year and five-year mortality rates were also similar in both groups. Conclusion:Since cementless BHA and MSF surgeries did not distinctly differ in mortality rates at one year and at five years, it is crucial that surgeons make personalized surgical decisions based on the individual characteristics of the patient. Surgeons should carefully weigh the advantages of MSF, which include shortened surgery time and low blood loss against the benefits (e.g., reduced hospitalization period) of cementless BHA.
Purpose:Hip arthroscopy is an increasingly common orthopedic procedure. Although the number of reported complications is low, emergency room visits in the early postoperative period do occur. This study aims to evaluate the impact of demographic, insurance, and clinical factors on the likelihood of postoperative emergency department (ED) visits following hip arthroscopy. Through the identification of key risk factors, including insurance status, comorbidities, and procedural specifics, the objective of this study is to inform clinical practices and enhance patient outcomes through targeted risk management. Materials and Methods:A retrospective review of a multi-center institutional database identified patients who underwent hip arthroscopy between 2014 and 2022. Medical records were analyzed for ED visits within the first 30 postoperative days. Diagnoses leading to ED visits were classified by pathology such as pain, musculoskeletal, or infection. Factors associated with increased odds of ED visits were assessed utilizing a multivariate regression analysis. Results:Of the 879 hip arthroscopies, 3.1% of patients had ED visits within 30 postoperative days. Medicaid patients were 2.88 times more likely to visit the ED (P=0.025). The presence of hypertension (P=0.013) or autoimmune conditions (P=0.041) further increased the odds. The use of a capsular closure technique during surgery reduced ED visits by 69.1% (P=0.026). Conclusion:Following hip arthroscopy, patients with Medicaid insurance, hypertension, and auto-immune disorders are more likely to require ED visits within 30 days. In contrast, the use of a capsular closure technique significantly reduces the likelihood of such visits.
Purpose:Internal fixation of undisplaced intracapsular hip fractures is typically achieved using either cannulated screws (CS) or a 2-hole dynamic hip screw (DHS). However, there is a lack of consensus on which of these is more effective clinically. Whilst several biomechanical analyses of cadaveric hips show a higher construct stability of DHS fixation, there is a paucity of large clinical studies investigating patient outcomes. Materials and Methods:Data from 2,705 patients at a single institution, including 322 internal fixations, were analysed retrospectively. Propensity scores were calculated to mitigate for the impact of covariates such as age, sex, Charlson comorbidity index and Nottingham Hip Fracture Score, producing an eligible group of 255 patients. Results:The CS group included 204 patients (mean age, 82.5±7.5 years; female, 90.7%), the DHS group included 51 patients (mean age, 82.4±8.0 years; female, 90.2%). There were no differences between groups after propensity matching. There were no significant differences in outcomes between CS and DHS groups for reoperation rate (CS 5.9% vs. DHS 5.9%, P>0.999), death <30 days (CS 5.9% vs. DHS 5.9%, P>0.999), length of stay (CS 11.5 days vs. DHS 14.0 days, P=0.294) and hours to surgery (CS 31:03 hours vs. DHS 29:23 hours, P=0.618). However, operation time was significantly shorter for CS (CS 39.0 minutes vs. DHS 44.0 minutes, P=0.013), an 11% reduction. Conclusion:There is no difference in clinical outcomes between CS and DHS fixation of intracapsular hip fractures. However, in this cohort the operating time was approximately 5 minutes shorter in CS fixation.
Purpose:The main aim of this study is to compare the functional and radiological outcomes of the acetabular distraction technique and the cup-cage construct technique in the management of chronic pelvic discontinuity. Materials and Methods:In this prospective interventional study, 36 patients with chronic pelvic discontinuity were initially split into two equal groups and underwent surgery utilizing either the acetabular distraction technique or the cup-cage construct technique. The patients were followed up for 2 years to assess the functional and radiological outcomes of the techniques. Six patients were lost during follow-up (two of them died, four discontinue follow-up). Results:The two groups did not differ significantly with regards to the clinical (Harris hip score) and radiological (stability of the construct, graft incorporation, and absence of loosening or migration) outcomes. Both the techniques displayed significant postsurgical improvements in both the Harris hip score and limb length discrepancy. Conclusion:Both acetabular distraction and the cup-cage construct techniques may be used to treat pelvic discontinuity without any significant difference in the clinical outcomes, as measured by Harris hip score, and in the radiological outcomes. Acetabular distraction appears to be more effective in treating discontinuity as a secondary outcome of neglected acetabular fracture.
Purpose:The alignment of the femoral with the acetabular components significantly influences the mechanics of the hip joint, especially in total hip arthroplasty (THA). Combined anteversion (CA) is a combination of femoral neck anteversion and acetabular anteversion (AA). CA is emerging as a significant factor that influences optimal THA outcomes. Our study aims to assess the impact of CA on postoperative functional outcomes in an Indian cohort where unique lifestyle demands may influence the anteversion characteristics. Materials and Methods:A retrospective study was conducted on 88 patients undergoing THA. Inclusion criteria included patients with unilateral THA due to femoral neck fractures or osteonecrosis of the femoral head. Computed tomography scans were used to identify and measure postoperative CA. We assessed the functional outcomes following THA at 7 days, 6 weeks, 3 months, 6 months, and 1 year, using the Harris hip score (HHS). Results:Our findings indicate that the CA values ranged from 25.5° to 93.9°, with a mean of 59.3°±15.7°. Patients with CA between 40° and 70° exhibited significantly improved functional outcomes, with an improvement in the mean HHS from 67.57 at day 7, to 94.26 at 3 months, to 97.50 at 1 year (P<0.001). In contrast, CA below 40° or above 70° was associated with poor outcomes, which includes a high risk of dislocation in the group with >70° CA. Conclusion:Our study concludes that achieving a CA within the range of 40° to 70° is pivotal for optimal functional outcomes and for minimum complications in THA.
Purpose:Osteochondroplasty and femoral neck osteotomy can be used in conjunction with surgical hip dislocation (SHD) for added benefit to patients with sequelae of Perthes disease. The aim of the current systematic review was to provide a critical analysis of the literature and present the outcomes of SHD with relative femoral neck lengthening in sequelae of Perthes disease. Materials and Methods:Electronic database searches with relevant keywords were conducted in PubMed and Embase. This review included studies which described relative femoral neck lengthening outcomes on sequelae of Perthes disease. A study required a minimum postoperative follow-up period of one year for inclusion in this review. Results:Seven retrospective studies with 244 patients were included in the review. Five studies reported objective improvement in functional scores. Approximately 9% (12/137) of patients reported complications and the overall pooled proportion of patients requiring subsequent total hip arthroplasty was 8% (95% confidence interval with a range of 4% to 11%). Conclusion:Used in conjunction with relative femoral neck lengthening SHD has opened a new treatment means for the correction of deformities resulting from sequelae of Perthes disease. Notable improvements in clinical and functional outcomes can be expected after this procedure. Low rates of postoperative complications and future conversions to total hip arthroplasty were also noted. The results of the review are limited by the non-uniform inclusion of study participants in terms of preoperative grading as well as any occurrence of prior, concomitant or subsequent surgical procedures.
Despite contradictory results of various published data on the subject, the complications of total hip arthroplasty (THA) in femoral neck fracture (FNF) compared to those in osteoarthritis (OA) are yet to be further elucidated. We queried PubMed, Cochrane, and Google Scholar from inception until October 2024 for studies that compared the surgical outcomes of THA in the management of FNF and OA. We evaluated the overall complications, such as dislocations, prosthetic joint infection (PJI), intraoperative fractures, periprosthetic fractures (PPFx), mechanical loosening, venous thromboembolism (VTE), hematoma, leg length discrepancy (LLD), and revisions. In addition, surgical parameters such as the duration of surgery and the length of stay (LOS) were also assessed. Eleven studies were included in our meta-analysis. The use of THA in FNF is associated with high risks of overall complications (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.00-2.49, P=0.05), dislocations (OR 2.12, 95% CI 1.07-4.21, P=0.03), PJI (OR 1.75, 95% CI 1.50-2.05, P<0.00001), PPFx (OR 1.62, 95% CI 1.18-2.22, P=0.003), and intraoperative fractures (OR 3.82, 95% CI 1.59-9.19, P=0.003) in comparison to those in the OA group treated with THA. FNF patients had a long LOS (mean difference=3.34, 95% CI 0.69-5.99, P=0.01). There was no statistically significant difference observed in the risk of VTE, hematoma, LLD, mechanical loosening, the number of revisions, and the duration of surgery between the FNF and OA groups, which were treated with THA. There is an increased risk of complications in patients undergoing THA for FNF than in patients undergoing THA for OA.
