Practice variation in total hip arthroplasty versus hemiarthroplasty for treatment of fractured neck of femur in Australia.
AIMS
Displaced femoral neck fractures (FNF) may be treated with partial (hemiarthroplasty, HA) or total hip arthroplasty (THA), with recent recommendations advising that THA be used in community-ambulant patients. This study aims to determine the association between the proportion of FNF treated with THA and year of surgery, day of the week, surgeon practice, and private versus public hospitals, adjusting for known confounders.


PATIENTS AND METHODS
Data from 67 620 patients in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1999 to 2016 inclusive were used to generate unadjusted and adjusted analyses of the associations between patient, time, surgeon and institution factors, and the proportion of FNF treated with THA.


RESULTS
Overall, THA was used in 23.7% of patients. THA was more frequently used over time, in younger patients, in healthier patients, in cases performed on weekdays (adjusted odds ratio (OR) 1.27; 95% confidence interval (CI) 1.14 to 1.41), in private hospitals (adjusted OR 4.34; 95% CI 3.94 to 4.79) and by surgeons whose hip arthroplasty practice has a relatively higher proportion of elective patients (adjusted OR 1.65; 95% CI 1.49 to 1.83).


CONCLUSION
Practice variation exists in the proportion of FNF patients treated with THA due to variables other than patient factors. This may reflect variation in resources available and surgeon preference, and uncertainty regarding the relative indication.
['Harris|I A|IA|', 'Cuthbert|A|A|', 'de Steiger|R|R|', 'Lewis|P|P|', 'Graves|S E|SE|']
D000368:Aged D000369:Aged, 80 and over D019644:Arthroplasty, Replacement, Hip D001291:Attitude of Health Personnel D001315:Australia D005260:Female D005265:Femoral Neck Fractures D062785:Hemiarthroplasty D016304:Hospitals, Private D006779:Hospitals, Public D006801:Humans D008297:Male D008875:Middle Aged D000072161:Orthopedic Surgeons D010549:Personal Satisfaction D010818:Practice Patterns, Physicians' D000078337:Procedures and Techniques Utilization D013997:Time Factors
Total hip arthroplasty Hemiarthroplasty Femoral neck fractures