Health Utility of Early Hemiarthroplasty Versus Delayed Total Hip Arthroplasty for Displaced Femoral Neck Fracture in Elderly Patients: A Markov Model

• Published in: The Journal of arthroplasty
• Main Authors: Uhler, Lauren, MPH, Schultz, W. Randall, MD, MS, Hill, Austin, MD, MPH, Koenig, Karl, MD, MS
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Orthopedics; femoral neck fracture; hip fracture; decision analysis; total hip replacement; hemiarthroplasty
• ISSN: 0883-5403
• DOI: 10.1016/j.arth.2016.11.051

Abstract Background Treatment for femoral neck fracture among patients age 65 or older varies, with many surgeons preferring hemiarthroplasty (HA) over total hip arthroplasty (THA). There is evidence that THA may lead to better functional outcomes although it also carries greater risk of mortality and dislocation. Methods We created a Markov decision model to examine the expected health utility for older patients with femoral neck fracture treated with early HA (done within 48 hours) versus delayed THA (done after 48 hours). Model inputs were derived from the literature. Health utilities were derived from previously fit patients over 60 years old. Sensitivity analyses on mortality and dislocation rates were conducted to examine the effect of uncertainty in the model parameters. Results In the base case, the average cumulative utility over two years was 0.895 for HA and 0.994 for THA. In sensitivity analyses, THA was preferred over HA until THA 30-day and 1-year mortality rates were increased to 1.3x the base case rates. THA was preferred over HA until the health utility for HA reached 98% that of THA. THA remained the preferred strategy when increasing the cumulative incidence of dislocation among THA patients from a base case of 4.4% up to 26.1%. Conclusion We found that delayed THA provides greater health utility than early HA for older patients with femoral neck fracture, despite the increased 30-day and 1-year mortality associated with delayed surgery. Future studies should examine the cost-effectiveness of THA for femoral neck fracture.