Racial disparities exist regarding hemiarthroplasty vs. THA for femoral neck fractures
Key takeaways:
- White patients were more likely to undergo total hip arthroplasty for displaced femoral neck fracture.
- Hemiarthroplasty was most common among Hispanic patients.
SAN DIEGO — Results showed white patients were more likely to undergo total hip arthroplasty for displaced femoral neck fracture compared with historically underrepresented groups, who were more likely to undergo hemiarthroplasty.
“We did find that, over the last decade, the rate of hemiarthroplasty for displaced femoral neck fractures seems to be falling and that the disparity between different patient groups by race also seems to be changing when you use white patients as a reference,” Carol A. Lin, MD, an orthopedic trauma surgeon at Cedars Sinai Medical Center, told Healio. “Asian patients seem to be getting a hemiarthroplasty at the same rate as white patients. However, Black and Hispanic patients, even when you control for all of the socioeconomic factors and access to different institutions, seem to be getting hemiarthroplasty at a higher rate for the same injury.”
Using the National Inpatient Sample database, Lin, Monica E. Guirgus and colleagues analyzed patient and hospital variables, as well as comorbidities, among 312,683 patients aged 65 years or older who underwent hemiarthroplasty or THA for displaced femoral neck fracture between 2000 and 2020.
“We did a multivariate regression analysis in order to see if there was an independent effect on the choice of the treatment,” Guirgus, a third-year medical student at Cedars Sinai Medical Center who presented the data at the American Academy of Orthopaedic Surgeons Annual Meeting, said. “The primary outcome was hemiarthroplasty vs. total hip arthroplasty.”
According to Guirgus, older patient age, female gender, having Medicaid or no insurance, rural location and nonteaching hospitals or smaller hospitals were associated with an increased rate of hemiarthroplasty.
“For our multivariate regression analysis, even after controlling all of these factors, we did find a significant independent effect of race on whether or not patients received hemiarthroplasty or total hip arthroplasty, with Hispanic [patients] having the greatest odds of receiving hemiarthroplasty relative to all other races,” Guirgus said.
She added that, while the rate of hemiarthroplasty was decreasing overall, the decrease was occurring at a slower rate for Hispanic and Black patients.
In the future, the elective arthroplasty literature may be used as a model to look at rates of access as well as “more qualitative research to understand better why certain patient groups do not seem to be able to access different types of care,” Lin said.
“Femoral neck fractures are a bit different because it is not elective and a procedure has to happen within, ideally, 24 hours,” Lin said. “But, even then, some qualitative research, patient interviews [and] a better assessment of the conversation between patient and surgeon preferences would help understand why some of these barriers exit.”
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Ewing B, et al. Paper 63. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.