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However, emerging evidence suggests arthroplasty may provide better outcomes. We sought to determine surgeons\u2019 current practice patterns and determine which patient and fracture characteristics lead them to prefer arthroplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a survey to assess the influence of fracture and patient characteristics on orthopaedic surgeons\u2019 choice to treat FNFs in older adults with arthroplasty. We electronically distributed the survey to members of professional associations and our research network.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 155 orthopaedic surgeons (response rate 25%), 74% agreed that deciding between IF and arthroplasty is difficult for certain minimally displaced FNFs cases and 36% reported performing arthroplasty for at least half of minimally displaced FNFs. Surgeons reported they would perform arthroplasty for a minimally displaced FNF with posterior tilt of 20\u00b0 (69%) or 30\u00b0 (94%), varus angulation (88%), or a neck-shaft angle\u2009&gt;\u2009160\u00b0 (70%). Age (83%), mobility (76%), and osteoporosis (62%) influenced surgeons\u2019 treatment preferences. Preference for arthroplasty was significantly associated with annual volume of minimally displaced FNFs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033), but not years in practice (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.065). Seventy-nine per cent agreed that a randomized trial is needed to determine the best clinical practice for minimally displaced FNFs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In contrast to existing guidelines and practice trends, over one-third of orthopaedic surgeons who responded to the questionnaire would routinely treat minimally displaced FNFs with arthroplasty. The variation between surgeon\u2019s current practices demonstrates the need for a high-quality randomized trial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-025-04412-3","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T17:39:56Z","timestamp":1752255596000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["When would orthopaedic surgeons perform arthroplasty for a femoral neck fracture in an older adult?"],"prefix":"10.1007","volume":"35","author":[{"given":"Jose Manuel","family":"De Maria Prieto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph T.","family":"Patterson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia Paige","family":"Szasz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Bzovsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Guerra-Farf\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Axelrod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soroush","family":"Shabani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"4412_CR1","volume":"3","author":"T Swenning","year":"2020","unstructured":"Swenning T, Leighton J, Nentwig M, Dart B (2020) Hip fracture care and national systems: The United States and Canada. 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GS reports consulting fees from Smith and Nephew and Zimmer, and editorial board membership with the Journal of Orthopaedic Trauma. SS reports consulting fees from Geistlich Pharma AG. The remaining authors report nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"301"}}