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Patient-Reported Outcome After Displaced Femoral Neck FractureA National Survey of 4467 Patients
Olof Leonardsson, PhD1; Ola Rolfson, PhD2; Ami Hommel, PhD3; Göran Garellick, PhD2; Kristina Åkesson, PhD1; Cecilia Rogmark, PhD1
1 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
2 Swedish Hip Arthroplasty Register, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
3 Swedish National Hip Fracture Register–Rikshöft, Department of Orthopedics, Lund University, Skåne University Hospital/Lund, 221 85 Lund, Sweden
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  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopedic Surgery, Skåne University Hospital/Malmö, Malmö, the Swedish Hip Arthroplasty Register, Gothenburg, and the Swedish National Hip Fracture Register, Lund, Sweden

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Sep 18;95(18):1693-1699. doi: 10.2106/JBJS.L.00836
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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.


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).


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).


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.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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