Surgzon

Objectives

To evaluate the impact of estrogen hormone therapy on venous thrombotic events for femoral neck fractures treated with either total hip arthroplasty (THA) or hemiarthroplasty (HA).

Design

Retrospective cohort analysis.

Setting

TriNetX Health Research Network.

Patient selection criteria

Patients who sustained a femoral neck fracture (OTA/AO 31B) between 2005 and 2025 who were treated with either THA or HA were categorized into groups based on whether they were prescribed systemic estrogen hormone therapy (EHT) within 3 months before or after their fracture.

Outcome measures and comparisons

The primary outcomes were deep vein thrombosis (DVT) or pulmonary embolism (PE) within 3 months after their fracture. A matched cohort was created after a 1:1 propensity match for demographics, diabetes, obesity, and tobacco use. Measures of association models were used to determine odds ratios.

Results

A total of 39,631 patients with femoral neck fractures treated with either a THA or HA were identified. Of these, 330 (0.8%) patients with femoral neck fractures were prescribed estrogen within 3 months before or after their fracture. After a matched cohort comparison, there were no statistically significant differences in rates of PE (odds ratio [OR] = 1.31; 95% confidence interval [CI], 0.56-3.03; = 0.525) or for DVT (OR = 1.67; 95% CI, 0.78-3.61; = 0.184).

Conclusion

Systemic EHT was not associated with a significantly increased risk of DVT or PE after operatively treated femoral neck fractures with THA or HA.

Level of evidence

Level III, Prognostic.

Keywords

deep vein thrombosis, estrogen, femoral neck fracture, hemiarthroplasty, pulmonary embolism, total hip arthroplasty

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Estrogen hormonal therapy is not associated with increased risk of venous thrombosis in total hip arthroplasty or hemiarthroplasty for femoral neck fractures.