Patient-reported outcome after displaced femoral neck fracture: a national survey of 4467 patients.
BACKGROUND
Arthroplasty appears to be superior to internal fixation, with regard to complication rates, as a treatment for displaced femoral neck fractures. Less is known about the result as perceived by the patient. The aims of this prospective observational study were (1) to determine whether patient-reported outcomes after a displaced femoral neck fracture can be evaluated on a nationwide basis by means of a mailed survey, and (2) to evaluate differences among treatment methods with respect to patient-reported pain, health-related quality of life, and satisfaction with the surgical result.


METHODS
Through collaboration between the Swedish Hip Arthroplasty Register and the Swedish National Hip Fracture Register, 5902 patients (median age, eighty-four years; range, eighteen to 103 years) treated with internal fixation, total hip arthroplasty, or hemiarthroplasty for a displaced femoral neck fracture were identified. A composite questionnaire, including the EQ-5D and visual analog scales for pain and for satisfaction with the surgical result, was mailed to the 4467 patients who remained alive (median follow-up, fourteen months; range, seven to twenty-two months).


RESULTS
The total response rate was 79% (n = 3513); 72% to 75% of the patients completed each of the questionnaire sections. Both patients below and patients above seventy years of age treated with total hip arthroplasty reported less pain and were more satisfied compared with those treated with internal fixation or hemiarthroplasty (although the differences between total hip arthroplasty and hemiarthroplasty in patients below seventy years of age did not reach significance).


CONCLUSIONS
A mailed patient-reported outcomes questionnaire is a feasible method for national follow-up of hip fractures, with an acceptable response rate. The study also suggests that total hip arthroplasty as a treatment for femoral neck fracture is associated with less pain and greater satisfaction at short-term follow-up compared with internal fixation and hemiarthroplasty, both in patients younger and older than seventy years.
Swedish Hip Arthroplasty Register (O.L., C.R.), Institution for Clinical Sciences (K.Å.), Department of Orthopedics, Lund University, Skåne University Hospital/Malmö, 205 02 Malmö, Sweden. E-mail address for O. Leonardsson: o.leonardsson@gmail.com.
Olof
O
Leonardsson
Ola
O
Rolfson
Ami
A
Hommel
Göran
G
Garellick
Kristina
K
Åkesson
Cecilia
C
Rogmark
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D003625:Data Collection; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult