Association of treatment method with mortality and functional outcome in patients with displaced femoral neck fracture: a cohort study of 60-69-year-old patients from the Swedish Hip Fracture Register.

BACKGROUND AND PURPOSE: Optimal treatment for displaced femoral neck fractures (FNF) in patients aged 60-69 years remains controversial. We aimed to compare mortality and short-term clinical outcomes after total hip arthroplasty (THA), hemiarthroplasty (HA), or internal fixation (IF) after displaced FNF. METHODS: We included 3,325 patients aged 60-69 years with displaced FNF recorded in the Swedish Hip Fracture Register. 1-year mortality and 4-month functional outcomes (maintenance of independent living and outdoor walking ability) were analyzed. Analyses were stratified by American Society of Anesthesiologists (ASA) class (I-II vs III-IV). RESULTS: Overall, 1-year mortality was 8.3%. Adjusted analyses showed higher 1-year mortality after HA (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.7-3.6) and IF (OR 2.3, CI 1.6-3.3) compared with THA. Survival analyses demonstrated lower survival probabilities after HA and IF compared with THA in ASA III-IV but not in ASA I-II patients. THA was associated with higher odds of maintaining independent living (IF: OR 0.40, CI 0.20-0.86; HA: OR 0.09, CI 0.04-0.17) and maintaining outdoor walking ability (IF: OR 0.35, CI 0.24-0.50; HA: OR 0.26, CI 0.16-0.43) in ASA I-II patients. In ASA III-IV patients, estimates were closer to unity. CONCLUSION: THA was associated with lower mortality in ASA III-IV and better functional outcomes in ASA I-II.