Trends in Operative and Nonoperative Hip Fracture Management 1990–2014: A Longitudinal Analysis of Manitoba Administrative Data

Objectives: To evaluate longitudinal trends in the use of total hip arthroplasty (THA), hemiarthroplasty (HA), internal fixation (IF), and nonoperative management and to identify individual-level factors associated with nonoperative treatment of hip fracture (HF). Design: Longitudinal analysis of administrative data. Setting: Manitoba, Canada. Participants: All adults who experienced nontraumatic hip fractures between 1990 and 2014 (N = 19,626; mean age 80.6, 72.3% female). Measurements: Billing codes were used to identify surgical treatment, and trends in treatment over time were examined. Regression models were developed to identify individual factors associated with receiving nonoperative management. Results: Use of THA increased from 0.6% for all HFs in 1990–94 to 5.3% in 2010–14, use of HA increased from 19.3% to 29.7%, and use of IF declined from 71.8% to 59.9% (P <.001 for all); increase in THA and HA were largest in individuals with femoral neck fracture. Nonoperative management declined from 8.3% in 1990–94 to 5.1% in 2010–14 (P <.001). Factors associated with nonoperative management included aged 90 and older, male sex, residing in a care facility before fracture, and rural residence. Conclusion: HF is increasingly treated with THA and HA, whereas rates of nonoperative management and IF are declining. Future efforts should focus on ensuring that all individuals are optimally triaged to the best procedure for them, with nonoperative management considered for individuals with extremely poor prefracture health.