Restoration of Hip Biomechanics after a Hemiarthroplasty for a Femoral Neck Fracture—Who Does It Better?

Introduction: The restoration of the preoperative biomechanics of the hip, in particular leg length and femoral offset, are critical in restoring normal function and diminishing the risk of dislocation following hip arthroplasty. This study compares the consistency of arthroplasty and non-arthroplasty orthopedic surgeons in restoring the normal biomechanics of the hip when performing a hemiarthroplasty for the treatment of a femoral neck fracture. Methods: We retrospectively reviewed the preoperative and postoperative digital radiographs of 175 hips that had a modular hemiarthroplasty for the treatment of a displaced femoral neck fracture at a Level 1 academic hospital. Fifty-two hips were treated by one of the three fellowship-trained arthroplasty surgeons (Group A), and 123 were treated by one of the nine non-arthroplasty fellowship-trained orthopedic surgeons (Group B). Results: Patients in Group A were more likely to have their femoral offset restored to normal than patients in Group B, both with respect to under correcting the offset (p = 0.031) and overcorrecting the offset (p = 0.010). Overall, there was no difference in restoration of leg lengths between the two groups (p = 0.869). Conclusions: Following a hemiarthroplasty for a displaced femoral neck fracture, the normal biomechanics of the hip are more likely to be restored by an arthroplasty-trained surgeon than by a non-arthroplasty-trained surgeon. Identifying the inconsistency of non-arthroplasty surgeons and, to a lesser degree, arthroplasty surgeons in restoring hip biomechanics is important for sensitizing surgeons to rectify this in the future with appropriate templating and femoral implant selection.