Complication profile and surgical trends in hemiarthoplasty for femoral neck fractures: analysis from a national referral hospital in Ethiopia

Hemiarthroplasty is one of the standard treatment options for displaced femoral neck fractures in the elderly. While surgical approaches, implant choices, and complication profiles are well-documented in high-income countries, there is a critical lack of data from low-resource settings like Ethiopia, where system constraints and resource availability may significantly influence practice and outcomes. This study aimed to analyze the surgical trends, implant choices, and complication profiles of hemiarthroplasty at a major Ethiopian trauma center. A retrospective cross-sectional study was conducted on all patients who underwent hemiarthroplasty for a displaced femoral neck fracture at Addis Ababa Burn, Emergency and Trauma (AaBET) Hospital between September 2020 and September 2024. Data on surgical approach, implant type and brand, fixation method, and major complications (periprosthetic fracture, dislocation, infection, reoperation) were extracted from medical records. Descriptive statistics were used to summarize trends and complication rates. Subgroup analyses comparing complication rates between groups were performed using Fisher’s exact test and Mann-Whitney U test, with findings interpreted as exploratory due to the small number of events. Among 104 patients analyzed, the direct lateral surgical approach was used in most cases (97.1%). A cemented Thompson monopolar prosthesis was the most common implant (74.0% of cases). Cemented fixation was used in 91.3% of procedures. The overall major complication rate was 7.7%. The most frequent complication was periprosthetic fracture (3.8%), followed by deep infection and reoperation (1.9% each). Only 11.5% of patients underwent surgery within the first week of injury. Surgical practice at this center is highly standardized, favoring the direct lateral approach and cemented Thompson implants, choices reflecting local surgical training and implant availability. Despite prolonged waiting times for surgery, the overall complication rate of 7.7% falls within ranges reported in the literature. The findings establish crucial baseline data for Ethiopia and highlight two key areas for quality improvement: reducing system-related delays to surgery and implementing strategies to further minimize the risk of periprosthetic fracture.