Revision risk of salvage compared with acute total hip arthroplasty following femoral neck fracture: an analysis from the Dutch Arthroplasty Register




Arthroplasty, Fractures, Hip, Salvage


Background and purpose: There is no consensus on the treatment of patients with femoral neck fractures between internal fixation (IF) or directly treated with a total hip arthroplasty (fracture-THA) in particular for the age group 60–70 years. Failure of IF is not uncommon, resulting in salvage total hip arthroplasty (salvage-THA). The aim of our study was to compare revision rates of salvage-THA with fracture-THA and osteoarthritis (OA)-THA.
Patients and methods: Revision rates and reasons for revision were compared. Data collected in the Dutch Arthroplasty Register (LROI) between 2007 and 2018 was used. The study included 4,310 salvage-THAs, 12,159 fracture-THAs, and 274,147 OA-THAs. We performed Kaplan–Meier survival analyses and Cox regression to evaluate THA survival.
Results: No statistically significant difference in revision rates between salvage-THAs and fracture-THAs was found (HR 1.0, 95% CI 0.7–1.3) whereas the revision rate was higher compared with OA-THAs (HR 1.3, CI 1.0–1.5). The 5-year revision rate was 5.0% (CI 4.4–5.8) in salvage-THAs, 4.5% (CI 4.1–5.0) in fracture-THAs, and 3.1% (CI 3.0–3.2) in OA-THAs. A higher revision rate for infection was found in salvage-THAs in comparison with fracture-THAs (HR 1.6, CI 1.0–2.3).
Conclusion: We found no difference in revision rates for salvage-THAs compared with fracture-THAs. The risk of revision for infection was higher for salvage-THA.


Download data is not yet available.


Bhandari M, Devereaux P J, Tornetta P 3rd, Swiontkowski M F, Berry D J, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg Am 2005; 87(9): 2122-30. doi:10.2106/jbjs.E.00535. DOI:

Bartels S, Gjertsen J E, Frihagen F, Rogmark C, Utvåg S E. High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years. Acta Orthop 2018; 89(1): 53-8. doi: 10.1080/17453674.2017.1376514. DOI:

Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop 2006; 77(3): 359-67. doi: 10.1080/17453670610046262. DOI:

Rogmark C, Kristensen M T, Viberg B, Rönnquist S S, Overgaard S, Palm H. Hip fractures in the non-elderly: who, why and whither? Injury 2018; 49(8): 1445-50. doi: 10.1016/j.injury.2018.06.028. DOI:

Slobogean G P, Sprague S A, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury 2015; 46(3): 484-91. doi: 10.1016/j.injury.2014.10.010. DOI:

Scholten R, Füssenich W, Somford M P, van Susante J L C. High incidence of early periprosthetic joint infection following total hip arthroplasty with concomitant or previous hardware removal. Arch Orthop Trauma Surg 2019; 139(8): 1051-6. doi: 10.1007/s00402-019-03149-z. DOI:

Mahmoud S S, Pearse E O, Smith T O, Hing C B. Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck: a systematic review and meta-analysis. Bone Joint J 2016; 98-b(4): 452-60. doi: 10.1302/0301-620x.98b4.36922. DOI:

McKinley J C, Robinson C M. Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. J Bone Joint Surg Am 2002; 84(11): 2010-15. doi: 10.2106/00004623-200211000-00016. DOI:

Leonardsson O, Rogmark C, Kärrholm J, Akesson K, Garellick G. Outcome after primary and secondary replacement for subcapital fracture of the hip in 10 264 patients. J Bone Joint Surg Br 2009; 91(5): 595-600. doi: 10.1302/0301-620x.91b5.22224. DOI:

van Steenbergen L N, Denissen G A, Spooren A, van Rooden S M, van Oosterhout F J, Morrenhof J W, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop 2015; 86(4): 498-505. doi: 10.3109/17453674.2015.1028307. DOI:

LROI. Online LROI annual report 2018.

Van Steenbergen L N, Mäkelä K T, Kärrholm J, Rolfson O, Overgaard S, Furnes O, et al. Total hip arthroplasties in the Dutch Arthroplasty Register (LROI) and the Nordic Arthroplasty Register Association (NARA): comparison of patient and procedure characteristics in 475,685 cases. Acta Orthop 2021; 92(1): 15-22. doi: 10.1080/17453674.2020.1843875. DOI:

von Elm E, Altman D G, Egger M, Pocock S J, Gøtzsche P C, Vandenbroucke J P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61(4): 344-9. doi: 10.1016/j.jclinepi.2007.11.008. DOI:

Schemper M, Smith T L. A note on quantifying follow-up in studies of failure time. Control Clin Trials 1996; 17(4): 343-6. doi: 10.1016/0197-2456(96)00075-x. DOI:

Dunkler D, Ploner M, Schemper M, Heinze G. Weighted Cox regression using the R Package coxphw. J Statistical Software 2018; 84(2): 1-26. doi: 10.18637/jss.v084.i02. DOI:

Schemper M, Wakounig S, Heinze G. The estimation of average hazard ratios by weighted Cox regression. Stat Med 2009; 28(19): 2473-89. doi: 10.1002/sim.3623. DOI:

Graham J W. Missing data analysis: making it work in the real world. Annu Rev Psychol 2009; 60: 549-76. doi: 10.1146/annurev.psych.58.110405.085530. DOI:

Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients. Acta Orthop 2006; 77(4): 638-43. doi: 10.1080/17453670610012728. DOI:

Gjertsen J E, Lie S A, Fevang J M, Havelin L I, Engesaeter L B, Vinje T, et al. Total hip replacement after femoral neck fractures in elderly patients: results of 8,577 fractures reported to the Norwegian Arthroplasty Register. Acta Orthop 2007; 78(4): 491-7. doi: 10.1080/17453670710014130. DOI:

de Jong L, Klem T, Kuijper T M, Roukema G R. Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. Bone Joint J 2017; 99-b(8): 1088-94. doi: 10.1302/0301-620x.99b8.Bjj-2016-1119.R1. DOI:

Dapunt U, Spranger O, Gantz S, Burckhardt I, Zimmermann S, Schmidmaier G, et al. Are atrophic long-bone nonunions associated with low-grade infections? Ther Clin Risk Manag 2015; 11: 1843-52. doi: 10.2147/tcrm.S91532. DOI:

Kuijpers M F L, Hannink G, van Steenbergen L N, Schreurs B W. Outcome of revision hip arthroplasty in patients younger than 55 years: an analysis of 1,037 revisions in the Dutch Arthroplasty Register. Acta Orthop 2020; 91(2): 165-70. doi: 10.1080/17453674.2019.1708655. DOI:

Kamp M C, Liu W Y, Goosen J H M, Rijnen W H C, van Steenbergen L N, van der Weegen W. Mismatch in capture of periprosthetic joint infections between the Dutch Arthroplasty Register (LROI) and a detailed regional periprosthetic joint infection registry. J Arthroplasty 2022; 37(1): 126-31. doi: 10.1016/j.arth.2021.09.001. DOI:



How to Cite

Schmitz, P. P., Hannink, G., Somford, M. P., Schreurs, B. W., & van Susante, J. L. C. (2023). Revision risk of salvage compared with acute total hip arthroplasty following femoral neck fracture: an analysis from the Dutch Arthroplasty Register. Acta Orthopaedica, 94, 399–403.

Most read articles by the same author(s)

1 2 3 > >>