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Assessing the Value of Routine Pathologic Examination of Resected Femoral Head Specimens After Femoral Neck Fracture

Davis, Jason A. MD; Rohlfing, Geoffrey DO; Sagouspe, Kenan BS; Brambila, Maximino MD, MBA

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: July 15, 2019 - Volume 27 - Issue 14 - p e664–e668
doi: 10.5435/JAAOS-D-17-00901
Research Article

Introduction: The purpose of this study was to evaluate the efficacy of routine pathologic examination (PE) of femoral head (FH) specimens after arthroplasty for acute femoral neck fractures and to determine the cost.

Methods: This was a retrospective chart review of 850 acute femoral neck fractures treated with hemiarthroplasty or total hip arthroplasty These were evaluated to determine whether the FH was sent for PE, the resultant findings, alterations in medical treatment, and cost.

Results: A total of 466 FH specimens (54.8%) were sent to pathology. Four (0.9%) were positive for a neoplastic process. All four had a known history of cancer, antecedent hip pain, or an inappropriate injury mechanism. None of the findings resulted in an alteration in medical treatment. The average cost of PE was $195 USD.

Discussion: The routine PE of FH specimens after arthroplasty for femoral neck fractures is not warranted and uneconomic. Sending the FH for PE, only when clinically indicated, rather than routine, will result in notable savings for the healthcare system.

Level of Evidence: Level IV

From the Department of Orthopaedic Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, CA.

Correspondence to Dr. Davis:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Davis, Dr. Rohlfing, Mr. Sagouspe, and Dr. Brambila.

© 2019 by American Academy of Orthopaedic Surgeons
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