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Title: Practice variation in total hip arthroplasty versus hemiarthroplasty for treatment of fractured neck of femur in Australia.
Epworth Authors: de Steiger, Richard
Other Authors: Harris, Ian
Cuthbert, Alana
Lewis, Peter
Graves, Stephen
Keywords: Displaced Femoral Neck Fracture
Femoral Neck Fracture
Total Hip Arthroplasty
Community-Ambulant Patients
Hip Fractures
Trochanteric Fractures
Internal Fixation
Femoral Head Arthroplasty
Public Hospitals
Private Hospitals
Practice Variation
Australian Orthopaedic Association National Joint Replacement Registry
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Jan-2019
Publisher: The British Editorial Society of Bone & Joint Surgery
Citation: Bone Joint J, 101(1), 92-95.
Abstract: 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.
DOI: 10.1302/0301-620X.101B1.BJJ-2018-0666.R1.
PubMed URL:
ISSN: 2049-4408
Journal Title: The Bone & Joint Journal
Type: Journal Article
Affiliated Organisations: Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia.
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Musculoskeletal

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