Hemi-Versus Total Hip Arthroplasty in Femoral Neck Fractures? Predicting Failure on a 10-Year Data Analysis of the German Arthroplasty Registry (EPRD)

J. Clin. Med., 2025 · DOI: https://doi.org/10.3390/jcm14051457 · Published: February 21, 2025

Simple Explanation

This study used data from the German Arthroplasty Registry (EPRD) to analyze almost 100,000 femoral neck fractures recorded between 2013 and 2023. The goal was to determine survival rates and identify risk factors for failure in people who had these fractures. The researchers compared two types of hip replacement surgeries: hemiarthroplasty (HA) and total hip arthroplasty (THA). They used machine learning algorithms and statistical models to predict the odds of implant failure based on factors like the type of surgery, how the implant was fixed, and patient characteristics. The study found that longer hospital stays, being male, and having surgery on a weekend or holiday were linked to higher risks of failure. On the other hand, using cemented fixation (where the implant is glued in place) and choosing hemiarthroplasty were associated with better outcomes.

Study Duration

10 Years

Participants

97,410 cases from the German Arthroplasty Registry (EPRD)

Evidence Level

Not specified

Key Findings

1
The failure rate was 3.7% for hemiarthroplasties and 5.6% for total hip arthroplasties, with most failures occurring within six weeks after surgery.
2
Six risk factors for failure were identified: non-cemented stem fixation, undergoing THA instead of HA, longer time to discharge from the hospital, male sex, age, and having surgery on a weekend or holiday.
3
Longer hospital stays were significantly associated with an increased risk of failure, with an odds ratio of 1.006 (95% CI: 1.006–1.006).

Research Summary

This study analyzed data from the German Arthroplasty Registry (EPRD) on nearly 100,000 femoral neck fractures to identify survival rates and risk factors for failure following hemiarthroplasty (HA) and total hip arthroplasty (THA). Machine learning algorithms (MLAs) and statistical modeling were used to compare HA and THA. The analysis revealed a failure rate of 3.7% for HAs and 5.6% for THAs, with a peak in the first six weeks post-surgery. LASSO regression identified six significant risk factors: non-cemented stem fixation, THA versus HA, time to discharge, male sex, age, and surgery performed on a weekend or holiday. The study concludes that longer hospital stays, male sex, and surgeries on weekends/holidays are associated with higher failure risks, while cemented fixation and hemiarthroplasty show protective effects. These findings underscore the importance of considering various factors to improve outcomes in hip arthroplasty.

Practical Implications

Surgical Technique

Consider cemented fixation and HA for elderly patients to reduce failure rates.

Hospital Stay Optimization

Implement strategies to reduce hospital stay duration to decrease the risk of failure.

Scheduling Considerations

Allocate resources to ensure optimal surgical conditions and expertise availability, especially during weekends and holidays.

Study Limitations

1
Class imbalance due to a relatively low number of failure events compared to intact cases.
2
Potential bias due to the competing risk of death in older patients.
3
Inconsistent availability of certain parameters, such as height and weight data, throughout the study period.

Your Feedback

Was this summary helpful?

Back to Orthopedics