# When would orthopaedic surgeons perform arthroplasty for a femoral neck fracture in an older adult?

## TL;DR

This study explores when orthopaedic surgeons choose arthroplasty over traditional surgery for femoral neck fractures in older adults.

## Contribution

The paper identifies specific fracture and patient characteristics that influence surgeons' treatment choices for femoral neck fractures.

## Key findings

- Over one-third of surgeons perform arthroplasty for minimally displaced femoral neck fractures.
- Posterior tilt, varus angulation, and age significantly influence surgeons' preference for arthroplasty.
- 79% of surgeons believe a randomized trial is needed to determine the best treatment approach.

## Abstract

Minimally displaced femoral neck fractures (FNFs) in older adults have traditionally been managed with internal fixation (IF). However, emerging evidence suggests arthroplasty may provide better outcomes. We sought to determine surgeons’ current practice patterns and determine which patient and fracture characteristics lead them to prefer arthroplasty.

We developed a survey to assess the influence of fracture and patient characteristics on orthopaedic surgeons’ choice to treat FNFs in older adults with arthroplasty. We electronically distributed the survey to members of professional associations and our research network.

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° (69%) or 30° (94%), varus angulation (88%), or a neck-shaft angle > 160° (70%). Age (83%), mobility (76%), and osteoporosis (62%) influenced surgeons’ treatment preferences. Preference for arthroplasty was significantly associated with annual volume of minimally displaced FNFs (p = 0.033), but not years in practice (p = 0.065). Seventy-nine per cent agreed that a randomized trial is needed to determine the best clinical practice for minimally displaced FNFs.

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’s current practices demonstrates the need for a high-quality randomized trial.

The online version contains supplementary material available at 10.1007/s00590-025-04412-3.