Long-term surgical outcomes of hemiarthroplasty for patients with femoral neck fracture with metal versus ceramic head in Taiwan

Aims: Hip fractures are a significant health concern, especially in the elderly. Hemiarthroplasty has been the preferred treatment for displaced femoral neck fractures. The use of ceramic femoral heads has recently become popular due to their claimed durability. This study aimed to determine long-term outcomes associated with different implant choices in hemiarthroplasty. Methods: The study sample included patients aged 50 years and above, with an index femoral neck fracture admission and hip hemiarthroplasty identified from Taiwan's National Health Insurance (NHI) claims data (2009–2019). To compare two groups of users of different heads, we performed 1:2 matching of the ceramic group versus metal group according to age, gender, index year, and six major comorbidities. Cumulative incidence rates were assessed for revision, post-operative complications, and medical complications. Cause-Specific hazard Cox models were used to estimate the hazard ratios for the two different implants groups. Results: Among 47,158 patients, 2559 out of 2637 who received ceramic head hemiarthroplasty with co-payment, were successfully matched with 5118 receiving metal head prostheses fully covered by the NHI. Over a mean follow-up of 3.12 years, no significant differences were observed in revision rates between the ceramic and metal head groups. The ceramic head group demonstrated significantly lower risks of postoperative complications and medical complications within 90 days than the metal head group. Conclusions: This study found ceramic implant had lower postoperative complications and medical complication rates than metal head implant in hip hemiarthroplasty, but there was no difference in the revision rates between the two heads.