Decreasing incidence of femoral neck fractures in the Medicare population.

This study was designed to evaluate trends in incidence and treatment patterns for intracapsular hip fractures and to evaluate risk factors for complications and mortality. Patients with an intracapsular hip fracture who underwent internal fixation, hemiarthroplasty, or total hip arthroplasty (THA) were identified from a 5% nationwide sample of Medicare data (1998-2007). The authors identified 41,053 patients with intracapsular hip fractures between 1998 and 2007. The number of intracapsular hip fractures treated with internal fixation, hemiarthroplasty, or THA decreased by 21.8%, from 4602 in 1998 to 3601 in 2007. In 2007, 54.3% of patients with an intracapsular hip fracture were treated with hemiarthroplasty, compared with 41.2% who were treated with internal fixation and 4.5% who were treated with THA. Compared with internal fixation, hemiarthroplasty had higher adjusted risks of dislocation (+98%) and infection (+53%) at 90 days and higher rates of death (+8%) and reoperation (+33%) at 1 year. Patients who underwent THA had a higher risk of complications at 90 days compared with those who underwent hemiarthroplasty, with 114%, 39%, and 123% greater risk of dislocation, deep venous thrombosis, and mechanical complications, respectively. At 1 year, patients treated with THA had a 42% lower mortality risk and an 85% lower risk of reoperation compared with those who underwent internal fixation. Primary THA is performed more often in younger patients with fewer comorbidities. The incidence of intracapsular hip fracture decreased by 21.8% over the past decade. This decrease is likely the result of multiple factors, most significantly increased awareness and medical management of osteoporosis.