Patient Factors Associated with 10-Year Survival After Arthroplasty for Hip Fracture: A Population-Based Study in Ontario, Canada.
Level 3 - non-randomized controlled study
Retrospective population-based prognostic cohort study
PubMed 39292763 · doi:10.2106/JBJS.24.00379
What was done
A retrospective cohort study analyzed 19,659 patients aged 60 years or older who underwent hemiarthroplasty or total hip arthroplasty for femoral neck fracture between 2002 and 2009 in Ontario, Canada. Investigators used validated administrative healthcare databases linked through ICES. Ten-year survival and its association with baseline patient variables were estimated using Poisson regression, and restricted cubic spline functions modeled survival probabilities by age.
What was found
Overall, 18% (3,564 of 19,659) of patients were alive at 10 years postoperatively. Factors associated with increased likelihood of 10-year survival included independent living status (risk ratio [RR] 2.68, 95% confidence interval [CI] 2.23 to 3.22), lower ASA class (ASA I or II versus IV or V: RR 1.96, 95% CI 1.76 to 2.19), female sex (RR 1.56, 95% CI 1.46 to 1.68), younger age, and fewer specific comorbidities. An age threshold of 73 years marked an inflection point after which 10-year survival decreased more rapidly in females. Estimated 10-year survival probabilities across patient groups ranged from 0.8% (95% CI 0.6% to 1.0%) to 79.0% (95% CI 75.5% to 82.5%).
Why it matters
This study establishes that approximately 1 in 6 older patients survive 10 years after arthroplasty for hip fracture. These baseline predictors help clinicians discuss long-term prognosis, anticipated outcomes, and natural history with patients and families.
Limits
The study is retrospective and observational, relying on administrative health databases that lack granular clinical metrics such as specific functional status, cognitive impairment severity, and intraoperative variables. The cohort was treated between 2002 and 2009, potentially limiting generalizability to contemporary perioperative care. Cause of death and patient-reported quality of life were not captured.
Cited by
- supports Breaking a hip drastically reduces an older adult's probability of surviving more than 10 years.