{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:59:27Z","timestamp":1790103567436,"version":"4.0.1"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Femoral neck fractures (AO-OTA 31B) (FNFs) are prevalent among the elderly, and the choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) remains debated. Given previous evidence of treatment disparities in FNFs, we investigated racial differences in THA utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Using the National Inpatient Sample (NIS) database, a representative sample of inpatient admissions, we identified patients aged \u226565 years who underwent HA or THA for FNFs from 2000 to 2020. Records were extracted using ICD9\/ICD10 codes for intracapsular FNFs, excluding basicervical and peritrochanteric fractures, and procedure codes for THA and HA were used to create the cohorts. The primary outcome was treatment with either HA or THA. Covariates include hospital characteristics, demographics, socioeconomic factors, and medical comorbidities. Logistic regression analysis evaluated the relationship between race and treatment with THA or HA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Bivariate analyses showed similar rates of HA across races and no statistically significant differences (Hispanic 89.6%, Asian 89.4%, Black 89.4%, White 88.7%; p = 0.056). Patient factors, including age, sex, and insurance, influenced treatment choice (all p &lt; 0.0001), as did hospital-related factors such as location, region, and bed size (all p &lt; 0.0001). Statistically significant comorbidities included acquired immune deficiency syndrome (AIDS), solid tumor without metastasis, alcohol abuse, metastatic cancer, depression, diabetes, hypertension, chronic obstructive pulmonary disease (COPD), obesity, hypothyroidism, and peripheral vascular disease (all p &lt; 0.05).When controlling for patient- and hospital-related variables and significant comorbidities in our multivariable logistic regression model predicting THA, Black (OR 0.83, 95% CI 0.75-0.93; p = 0.001) and Hispanic (OR 0.76, 95% CI 0.67-0.86; p &lt; 0.001) patients had significantly lower odds of undergoing THA compared with patients, whereas differences for Asian\/Pacific Islander patients were not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Variations in patient age, insurance status, and hospital-related variables influenced HA versus THA treatment. Racial disparities persisted after controlling these factors, underscoring the need to closely evaluate potential inequities to ensure equitable access to appropriate care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/jats:underline>\n                      , prognostic. See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.25.00040","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:00:21Z","timestamp":1790100021000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Racial Disparities in Surgical Treatment Choice for Displaced Femoral Neck Fractures"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9525-5262","authenticated-orcid":false,"given":"Monica","family":"Guirgus","sequence":"first","affiliation":[{"name":"Research Department, California University of Science and Medicine, Colton, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7951-4019","authenticated-orcid":false,"given":"Yoyo","family":"Ocho","sequence":"additional","affiliation":[{"name":"Research Department, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Ewing","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Cedar Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-323X","authenticated-orcid":false,"given":"Carol","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Cedar Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"issue":"8","key":"R1-20260922","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1016\/j.arth.2019.03.070","article-title":"Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis","volume":"34","author":"Lewis","year":"2019","journal-title":"J Arthroplasty"},{"issue":"18","key":"R2-20260922","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.2106\/JBJS.20.00226","article-title":"Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fracture: a systematic review and meta-analysis of randomized controlled trials","volume":"102","author":"Ekhtiari","year":"2020","journal-title":"J Bone Jt Surg."},{"issue":"6 suppl 1","key":"R3-20260922","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.arth.2008.05.013","article-title":"A prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award","volume":"23","author":"Macaulay","year":"2008","journal-title":"J Arthroplasty"},{"issue":"8","key":"R4-20260922","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1007\/s00264-012-1569-7","article-title":"Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials","volume":"36","author":"Burgers","year":"2012","journal-title":"Int Orthop"},{"issue":"21","key":"R5-20260922","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.2106\/JBJS.23.00247","article-title":"Hemiarthroplasty versus total hip arthroplasty for femoral neck fracture in elderly patients: twelve-month risk of revision and dislocation in an instrumental variable analysis of Medicare data","volume":"105","author":"Edelstein","year":"2023","journal-title":"J Bone Jt Surg."},{"issue":"8","key":"R6-20260922","doi-asserted-by":"crossref","first-page":"591","DOI":"10.2106\/JBJS.22.01193","article-title":"Comparative effectiveness of total hip arthroplasty and hemiarthroplasty for femoral neck fracture: a propensity-score-matched cohort study","volume":"105","author":"Tohidi","year":"2023","journal-title":"J Bone Jt Surg."},{"issue":"23","key":"R7-20260922","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1056\/NEJMoa1906190","article-title":"Total hip arthroplasty or hemiarthroplasty for hip fracture","volume":"381","author":"Einhorn","year":"2019","journal-title":"N Engl J Med"},{"issue":"1","key":"R8-20260922","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/s13018-020-01725-3","article-title":"Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomized controlled trials","volume":"15","author":"Liu","year":"2020","journal-title":"J Orthop Surg Res"},{"issue":"2","key":"R9-20260922","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.arth.2011.04.043","article-title":"Long-term trends in hip arthroplasty use and volume","volume":"27","author":"Cram","year":"2012","journal-title":"J Arthroplasty"},{"issue":"3","key":"R10-20260922","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1177\/2151458517720991","article-title":"Disparities in total hip arthroplasty versus hemiarthroplasty in the management of geriatric femoral neck fractures","volume":"8","author":"Dangelmajer","year":"2017","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"7","key":"R11-20260922","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s00402-012-1485-8","article-title":"A meta-analysis of total hip 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in the elderly","volume":"97","author":"Brox","year":"2015","journal-title":"J Bone Jt Surg Am"},{"issue":"jun21 3","key":"R17-20260922","doi-asserted-by":"crossref","first-page":"d3304","DOI":"10.1136\/bmj.d3304","article-title":"Management of hip fracture in adults: summary of NICE guidance","volume":"342","author":"Ftouh","year":"2011","journal-title":"BMJ"},{"issue":"1","key":"R18-20260922","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1186\/s13018-020-02122-6","article-title":"The comparison between total hip arthroplasty and hemiarthroplasty in patients with femoral neck fractures: a systematic review and meta-analysis based on 25 randomized controlled trials","volume":"15","author":"Tang","year":"2020","journal-title":"J Orthop Surg Res"},{"issue":"23","key":"R19-20260922","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1056\/NEJMoa1906190","article-title":"Total hip arthroplasty or hemiarthroplasty for hip fracture","volume":"381","author":"Bhandari","year":"2019","journal-title":"N Engl J Med"},{"issue":"6","key":"R20-20260922","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s12178-021-09718-3","article-title":"Racial disparities in total joint arthroplasty","volume":"14","author":"Chun","year":"2021","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"2","key":"R21-20260922","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5435\/JAAOS-D-21-00137","article-title":"Racial and ethnic disparities in hip fracture surgery care in the United States from 2006 to 2015: a nationwide trends study","volume":"30","author":"Amen","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"issue":"4","key":"R22-20260922","doi-asserted-by":"crossref","first-page":"103575","DOI":"10.1016\/j.otsr.2023.103575","article-title":"Total hip arthroplasty reduces the risk of dislocation after femoral neck 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Trends in hemiarthroplasty versus total hip arthroplasty for femoral neck fractures based on subspecialty training","volume":"41","author":"Tate","year":"2025","journal-title":"J Arthroplasty"},{"issue":"9","key":"R24-20260922","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.arth.2024.02.052","article-title":"The financial burden of patient comorbidities on total hip arthroplasties: a matched cohort analysis of high comorbidity burden and non-high comorbidity burden patients","volume":"39","author":"Ashkenazi","year":"2024","journal-title":"J Arthroplasty"},{"issue":"2","key":"R25-20260922","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1177\/2151458514528951","article-title":"Preoperative factors and early complications associated with hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures","volume":"5","author":"Miller","year":"2014","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"12","key":"R26-20260922","doi-asserted-by":"crossref","first-page":"e22667","DOI":"10.1016\/j.heliyon.2023.e22667","article-title":"Patient\u2013physician communication in intercultural settings: an integrative review","volume":"9","author":"Alkhamees","year":"2023","journal-title":"Heliyon"},{"issue":"3","key":"R28-20260922","doi-asserted-by":"crossref","first-page":"E232","DOI":"10.1001\/amajethics.2019.232","article-title":"Medical students as certified interpreters","volume":"21","author":"Aitken","year":"2019","journal-title":"AMA J Ethics"},{"key":"R29-20260922","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.socscimed.2017.05.009","article-title":"A decade of studying implicit racial\/ethnic bias in healthcare providers using the implicit association test","volume":"199","author":"Maina","year":"2018","journal-title":"Soc Sci Med"},{"issue":"8","key":"R30-20260922","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1161\/CIRCULATIONAHA.117.031650","article-title":"Sex differences in the presentation and perception of symptoms among young patients with myocardial infarction: evidence from the VIRGO Study (Variation in recovery: role of gender on outcomes of young AMI patients)","volume":"137","author":"Lichtman","year":"2018","journal-title":"Circulation"},{"issue":"7","key":"R31-20260922","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/BPO.0000000000002170","article-title":"Implicit racial bias in pediatric orthopedic surgery","volume":"42","author":"Guzek","year":"2022","journal-title":"J Pediatr Orthop"},{"issue":"8","key":"R32-20260922","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1161\/CIRCULATIONAHA.117.031650","article-title":"Sex differences in the presentation and perception of symptoms among young patients with myocardial infarction: evidence from the VIRGO study (variation in recovery: role of gender on outcomes of young AMI patients)","volume":"137","author":"Lichtman","year":"2018","journal-title":"Circulation"},{"issue":"24","key":"R33-20260922","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1097\/BRS.0000000000002251","article-title":"Examining healthcare segregation among racial and ethnic minorities receiving spine surgical procedures in the state of Florida","volume":"42","author":"Schoenfeld","year":"2017","journal-title":"Spine (Phila Pa 1976)"},{"issue":"14","key":"R34-20260922","doi-asserted-by":"crossref","first-page":"e989","DOI":"10.5435\/JAAOS-D-21-01017","article-title":"Gender, racial, and ethnic differences in the utilization of cervical disk replacement for cervical radiculopathy","volume":"30","author":"Wick","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"issue":"6","key":"R35-20260922","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/BSD.0000000000001383","article-title":"Racial disparities in spine surgery: a systemic review","volume":"36","author":"Mo","year":"2023","journal-title":"Clin Spine Surg."}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:00:26Z","timestamp":1790100026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.25.00040","relation":{},"ISSN":["2472-7245","2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"},{"value":"2472-7245","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}