Title : Reoperation rates after surgical treatment of femoral neck fractures in patients under 50: A retrospective cohort study comparing four operative strategies
Abstract:
Background: Femoral neck fractures in younger adults are relatively uncommon but carry important risks of fixation failure, nonunion, osteonecrosis, and secondary procedures. Surgical treatment options include percutaneous Pinning (PIN), Oopen Reduction and Internal FIxation (ORIF), Hemi Arthroplasty (HA), and Total Hip Arthroplasty (THA), yet comparative data on reoperation risk across these strategies in patients under 50 years remain limited.
Methods: We performed a retrospective cohort study of patients younger than 50 years who underwent operative treatment of femoral neck fractures using one of four strategies: PIN, ORIF, HA, or THA. The primary outcome was reoperation. Time-to-event methods were used to estimate cumulative reoperation rates over follow-up. Both unadjusted and overlap-weighted analyses were performed to compare reoperation patterns between cohorts, with additional landmark evaluation at 1, 2, and 5 years after index surgery.
Results: Across the four treatment groups, cumulative reoperation risk differed over time. In the unweighted analysis, ORIF demonstrated the highest cumulative reoperation rate throughout follow-up, reaching approximately 7% to 8% by 5 years, while THA had the lowest rate at approximately 1%. PIN and HA showed intermediate reoperation rates, both remaining below ORIF. In the overlap-weighted analysis, the separation between groups narrowed, but ORIF and HA continued to demonstrate higher cumulative reoperation rates than THA, while PIN remained intermediate. Overall, the findings suggest meaningful heterogeneity in reoperation risk by operative strategy, with arthroplasty, particularly THA, showing the lowest observed reoperation burden in this cohort.
Conclusions: Among patients younger than 50 years undergoing surgery for femoral neck fractures, reoperation rates varied by operative strategy. ORIF was associated with the highest cumulative reoperation risk, whereas THA demonstrated the lowest. These findings may help inform surgical decision-making in younger patients with femoral neck fractures and support further comparative research on procedure selection, survivorship, and long-term functional outcomes.
