Quality of life and cost-utility analysis in patients with femoral neck fracture: a propensity score matching study comparing monopolar hemiarthroplasty and total hip arthroplasty

Introduction Femoral neck fracture impacts patients' quality of life. Patients treated with a total hip arthroplasty (THA) versus a hemiarthroplasty (HA) may have higher quality of life scores after the intervention. This work aims to analyze and compare quality of life among patients with femoral neck fracture treated with THA versus monopolar HA and to perform a cost-utility analysis (CUA) on the procedures. Materials and methods A prospective, comparative study was conducted on 424 patients with femoral neck fractures, 268 treated with monopolar HA and 156 with THA. To ensure comparability between the groups, Propensity Score Matching (PSM) was performed based on variables such as age and the Charlson Comorbidity Index. The index accounted for comorbidities including cardiovascular disease, diabetes, chronic pulmonary disease, renal disease, and malignancy. After PSM, 156 matched pairs were analyzed. Follow-up data, including quality of life (QoL) assessed via the EQ-5D scale, were collected at 1 year. Results Twelve months after the procedure, patients treated with THA had significantly higher EuroQol-5D (EQ-5D) index values than those treated with monopolar HA (0.83 vs. 0.68; p = 0.001), with a large effect size (Cohen's d = 0.92), however, both procedures presented similar results on the EQ-5D visual analog scale (VAS) (86.59 vs. 87.11; p = 0.255). THA led to a gain of 0.15 quality-adjusted life years (QALY) compared to monopolar HA (0.83 QALY vs. 0.68 QALY) and demonstrated greater cost-effectiveness, particularly in patients younger than 80 years and those with fewer comorbidities. Conclusions Patients with femoral neck fracture treated with THA may have higher quality of life levels than those treated with monopolar HA. Likewise, the greatest gain in QALY with THA versus monopolar HA was observed in patients younger than 80 years of age and those who had less comorbidity.