Combining forces in dual certified centers of geriatric trauma/joint replacement according to the German trauma society (DGU)/endocert improves mobility and quality of life in elderly patients with femoral neck fractures: an analysis from the registry for geriatric trauma (ATR-DGU)

BACKGROUND: Femoral neck fractures represent a significant health challenge among elderly. Specialized geriatric trauma centers (ATZ) and endoprosthesis centers (EPZ) have been established to optimize outcomes through interdisciplinary care. This study investigates the impact of combining expertise of ATZ and EPZ on clinical outcomes of elderly patients with femoral neck fractures. METHODS: This retrospective cohort study analyzed data from 25,443 patients aged > 70 years with femoral neck fractures, who were surgically treated in certified ATZ in Germany between 2016 and 2022. Data was obtained from the Registry for Geriatric Trauma (ATR-DGU). Patients were categorized based on treatment at either certified ATZ alone or at combined ATZ with integrated EPZ. Multivariate analyses adjusted for age, gender, ASA score, pre-fracture walking ability, and anticoagulant use were conducted using linear and logistic regression models to assess postoperative outcomes. RESULTS: Patients treated in dual certified centers had a higher rate of total hip arthroplasty (19.21 vs. 14.18%, p < 0.001) and received tranexamic acid more frequently (6.20 vs. 1.56%, p < 0.001). Head-retaining procedures played only a minor role in both centers (8.33% vs. 8.61%, p = 0.452). Despite higher prevalences of severe systemic disease (ASA score > 3), treatment in dual certified centers demonstrated improved early mobilization under full weight-bearing (OR 1.4, 95% CI 1.23-1.6, p < 0.001) and better mobility at 120 days (OR 1.17, 95% CI 1.03-1.33, p = 0.018). CONCLUSION: Treatment in dual certified centers (EPZ/ATZ) is associated with improved postoperative mobility and quality of life in elderly patients with femoral neck fractures. The higher rate of total hip arthroplasty and the combination of geriatric and arthroplasty expertise contribute to these better outcomes.