Total Hip Arthroplasty versus Hemiarthroplasty for Femoral Neck Fracture: Propensity-Score Matched Cohort Study and Survey of Orthopaedic Surgeons in Ontario
Bibliographic record
Abstract
Background There is significant variation in treatment of displaced femoral neck fractures in older patients and ongoing controversy regarding optimal treatment. Methods This thesis examined surgical practice variation in the use of total hip arthroplasty (THA) versus hemiarthroplasty for femoral neck fracture and compared clinical outcomes across a matched group of patients who underwent either procedure. We linked healthcare databases at ICES to create a population-based cohort of 49,597 patients aged 60 years and older who underwent hemiarthroplasty or THA for femoral neck fracture between 2002 – 2017. We used multilevel logistic regression modeling to quantify the association between patient-, surgeon-, and institution-level variables and treatment with THA. We compared clinical outcomes in a subset of propensity-score matched patients using survival analysis. We developed, tested, and administered a survey to orthopaedic surgeons in Ontario to better understand the reasons underlying this treatment variation. We used a vignette-based experimental design and multilevel and multivariable linear regression modeling to determine factors associated with treatment recommendation. Results 9.4% of cohort patients (n=4,638) were treated with THA. Treating surgeon and institution accounted for most of the treatment variation. Patient factors associated with THA included: younger age, male sex, lower comorbidity burden, and rheumatoid arthritis. Long-term care residence, use of home care services, dementia, and marginalization were negatively associated with THA. Patients treated with THA had higher risk of hip dislocation at two years post-operation. Risk of revision was similar between treatment groups at 30 days, one year, and two years post-operation. Our survey response rate was 61.1% (n=302), and 60.3% of surgeons practiced in the community. Surgeon-level predictors of treatment with THA included: higher volume of THA for fracture, elective THA practice, and increasing years in practice. Pre-existing hip arthritis increased likelihood to recommend THA, while increasing patient age and comorbidity burden decreased likelihood to recommend THA. Conclusion There is significant treatment variation at the patient-, surgeon-, and institution-levels for patients undergoing arthroplasty for femoral neck fracture in Ontario. Shared decision making should involve discussion of increased risk of short-term hip dislocation with THA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".