• BACKGROUND
    • Displaced femoral neck fractures in older adults are commonly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA), with the choice influenced by patient characteristics, surgeon training, and logistical factors. Prior international studies suggest THA is more often performed on weekdays and by arthroplasty-trained surgeons, but it is unclear whether similar patterns exist in the United States. This study examines whether weekend surgery affects the choice between HA and THA after adjusting for patient and surgeon-specific factors.
  • METHODS
    • Design : Retrospective cohort. Setting : Two Level 1 Trauma Centers. Patient Selection Criteria : Adult patients with displaced femoral neck fractures (2001-2023) treated with HA or THA. Outcome Measures and Comparisons : The primary outcome was the relative proportion of HA versus THA performed on weekends versus weekdays. Secondary outcomes included perioperative factors associated with weekend surgery.
  • RESULTS
    • Among 1947 cases, propensity matching yielded two well-balanced cohorts of 497 cases. Before matching, HA patients were older (80.4 vs. 70.9 years, p < 0.0001), had lower BMI (24.6 vs. 25.4 kg/m2, p = 0.002), and had a higher Elixhauser Comorbidity Index (25.5 vs. 15.3, p < 0.0001). Surgeon subspecialty training differed between the cohorts and more experienced surgeons were more likely to choose THA (15.1 years vs. 13.0 years, p = 0.0004). After matching, weekend surgery was associated with higher HA rates (24.7 % vs. 18.7 %, p = 0.021), despite appropriately balanced patient and surgeon characteristics.
  • CONCLUSIONS
    • Weekend surgery is associated with higher rates of HA over THA in displaced FNFs, independent of patient and surgeon characteristics. These findings suggest potential system-level factors influencing surgical decision-making and highlight the need for further investigation into resource allocation, cognitive biases, and perioperative workflows.
  • MESH TERMS
    • Arthroplasty, Replacement, Hip; Hip Fractures; Practice Patterns, Physician's; Propensity Score.
  • LEVEL OF EVIDENCE
    • Therapeutic Level IV.