title: Surgical preferences of patients at risk of hip fractures: hemiarthroplasty versus total hip arthroplasty.
abstract: BACKGROUND
  The optimal treatment of displaced femoral neck fractures in patients over 60 years is controversial. While much research has focused on the impact of total hip arthroplasty (THA) and hemiarthroplasty (HA) on surgical outcomes, little is known about patient preferences for either alternative. The purpose of this study was to elicit surgical preferences of patients at risk of sustaining hip fracture using a novel decision board.
  
  
  METHODS
  We developed a decision board for the surgical management of displaced femoral neck fractures presenting risks and outcomes of HA and THA. The decision board was presented to 81 elderly patients at risk for developing femoral neck fractures identified from an osteoporosis clinic. The participants were faced with the scenario of sustaining a displaced femoral neck fracture and were asked to state their treatment option preference and rationale for operative procedure.
  
  
  RESULTS
  Eighty-five percent (85%) of participants were between the age of 60 and 80 years; 89% were female; 88% were Caucasian; and 49% had some post-secondary education. Ninety-three percent (93%; 95% confidence interval [CI], 87-99%) of participants chose THA as their preferred operative choice. Participants identified several factors important to their decision, including the perception of greater walking distance (63%), less residual pain (29%), less reoperative risk (28%) and lower mortality risk (20%) with THA. Participants who preferred HA (7%; 95% CI, 1-13%) did so for perceived less invasiveness (50%), lower dislocation risk (33%), lower infection risk (33%), and shorter operative time (17%).
  
  
  CONCLUSIONS
  The overwhelming majority of patients preferred THA to HA for the treatment of a displaced femoral neck fracture when confronted with risks and outcomes of both procedures on a decision board.
authors.affiliation: Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada.
authors.forename: Noor
authors.initials: N
authors.lastname: Alolabi
authors.forename: Bashar
authors.initials: B
authors.lastname: Alolabi
authors.forename: Raman
authors.initials: R
authors.lastname: Mundi
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Karanicolas
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002755:Choice Behavior; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis; D057240:Patient Preference; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome