{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:42:14Z","timestamp":1784335334226,"version":"3.55.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>To compare the 24-month risk of mortality between arthroplasty and internal fixation for undisplaced femoral neck fractures (FNFs).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective cohort study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Secondary data analysis of 2 multinational randomized controlled trials.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Participants:<\/jats:title>\n            <jats:p>Patients aged 50 years or older with a FNF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>Arthroplasty (n = 1441), including total hip arthroplasty and hemiarthroplasty, performed for a displaced FNF versus internal fixation (n = 734), including sliding hip screw or multiple cancellous screws, performed for an undisplaced FNF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measurement:<\/jats:title>\n            <jats:p>The primary outcome was mortality within 24 months of injury. Secondary outcomes included reoperation and health-related quality of life.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The 24-month mortality rate was 15.0% (n = 327). Arthroplasty was associated with a significant reduction in the odds of mortality [adjusted odds ratio (aOR): 0.56, 95% confidence interval (CI): 0.44\u20130.72, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01] compared with treatment with internal fixation. 11.4% (n = 248) of the study patients required reoperation within 24 months of injury. The odds of reoperation were 59% lower with arthroplasty treatment than with internal fixation (aOR: 0.41, 95% CI: 0.32\u20130.55, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01). The 24-month SF-12 physical component scores were 2.7 points higher in arthroplasty patients compared with internal fixation patients (95% CI: 1.6\u20133.8, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our findings suggest arthroplasty for a FNF may reduce the risk of mortality and reoperation compared with internal fixation of undisplaced fractures. This finding is counter to many current surgical practices but consistent with a mounting body of evidence. Before widespread adoption of arthroplasty for undisplaced fractures, these results should be confirmed in a definitive comparative trial.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000001940","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T13:00:27Z","timestamp":1601989227000},"page":"S9-S14","source":"Crossref","is-referenced-by-count":15,"title":["Arthroplasty Versus Internal Fixation for the Treatment of Undisplaced Femoral Neck Fractures: A Retrospective Cohort Study"],"prefix":"10.1097","volume":"34","author":[{"given":"Shaikh","family":"Afaq","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan N.","family":"O'Hara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil H.","family":"Schemitsch","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Western Ontario, London, ON, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Bzovsky","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada;"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf W.","family":"Poolman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, OLVG, Amsterdam and Leiden University Medical Center, Leiden, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frede","family":"Frihagen","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Heels-Ansdell","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada;"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Swiontkowski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the FAITH and HEALTH Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.2106\/JBJS.E.00535","article-title":"Operative management of displaced femoral neck fractures in elderly patients. 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