Differences in Total Hip Arthroplasty Utilization Across Subspecialties and Practice Environments for Geriatric Displaced Femoral Neck Fractures: Secondary Analysis of Bullet Health Analysis (BHA) I

Purpose: The growing geriatric population has led to a sharp rise in geriatric displaced femoral neck fractures (DFNF). Global reporting is pivotal in deciphering surgeons' decision-making, managing geriatric DFNF. This study aims to further analyze the nuanced utilization preferences and stratifies these across various subspecialities, practice environments, and countries. Methods: A longitudinal survey from 2020 to 2023 was conducted online via Orthobullets Case Studies, a global orthopaedic collaboration platform, to ascertain treatment preferences for geriatric DFNF. Standardized peer-reviewed polls were used to capture surgeon preferences for total hip arthroplasty (THA). A multivariable regression analysis assessed THA utilization odds across practice environments, subspecialities, and geographic factors, followed by a robust analysis to furnish precise estimates of THA preferences to represent the general population. Results: Among the 2606 respondents surveyed, 51.5% expressed a preference for THA. Subspecialty preferences were distributed as follows: Arthroplasty (63.4%), Trauma (53.4%), General orthopaedics (51.4%), and Sports (40.2%). Notably, hospitals exhibited a higher inclination towards THA (53.3%) compared to private practices (41.2%) (i.e. one additional THA for every seven fractures managed in a hospital setting). Regression analyses unveiled a significant 3-fold odds difference in THA rates across diverse practice environments and subspecialties. Academic arthroplasty surgeons displayed a 5.4 times higher inclination for THA (i.e. two additional THAs for every five fractures encountered). Conclusion: Practice environment profoundly influences THA utilization for geriatric DFNF. The study findings underscore the critical need for future trials, advocating for randomized evaluations across subspecialties, geographical regions, and varied practice settings to holistically inform best practices in orthopaedic care. Level of Evidence Level III Surgical Practice Survey (Global Practice Trends).