We performed a four-year follow-up of a randomized controlled trial involving 120 elderly patients with an acute displaced femoral neck fracture who were randomized to treatment with either a bipolar hemiarthroplasty or a total hip arthroplasty. The difference in hip function (as indicated by the Harris hip score) in favor of the total hip arthroplasty group that was previously reported at one year persisted and seemed to increase with time (mean score, 87 compared with 78 at twenty-four months [p < 0.001] and 89 compared with 75 at forty-eight months [p < 0.001]). The health-related quality of life (as indicated by the EuroQol [EQ-5D(index)] score) was better in the total hip arthroplasty group at the time of each follow-up, but the difference was significant only at forty-eight months (p < 0.039). These results confirm the better results in terms of hip function and quality of life after total hip arthroplasty as compared with hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck.

BackgroundHip fractures are a major worldwide public health problem and includes two main types of fractures: the intracapsular (cervical) and the extracapsular (trochanteric and subtrochanteric) fractures. The aim of this study on patients with trochanteric and subtrochanteric hip fractures was to describe the epidemiology, treatment and outcome in terms of mortality within the context of a large register study.MethodsA descriptive epidemiological register study including patients registered in the national Swedish Fracture Register from January 2014 to December 2016. Inclusion criteria were all primary surgically treated traumatic non-pathological trochanteric and subtrochanteric femoral fractures in patients aged 18 years and above. Individual patient data (age, gender, injury location, injury cause, fracture type, treatment and timing of surgery) were retrieved from the register database. Mortality data was obtained via linkage to the Swedish Death Register.ResultsA total of 10,548 consecutive patients were identified and included in the study. The mean (±SD) age for all patients was 82 ± 11 years and the majority of the patients were females (69%). Most of the fractures were caused by a fall at the same level (83%) at the patients’ accommodation (75%). Fractures were classified using the AO/OTA classification as 31-A1 in 29%, as 31-A2 in 49% and as 31-A3 in 22% of the cases. The most commonly used implant was a short antegrade intramedullary nail (42%), followed by a plate with sliding hip screw (37%). With increasing fracture complexity, the proportion of intramedullary nails was increasing, and also the use of long versus short nails. The majority of the patients were operated within 36 h (90%). There was a higher mortality at 30 days and 1 year for males, and for all those who were delayed to surgery > 36 h.ConclusionSafety measures to prevent fall at elderly patient’s accommodation might be a way to reduce the number of trochanteric and subtrochanteric hip fractures. Surgery as soon as possible without delay should be considered to reduce the mortality rate. The selection of surgical methods depends on the fracture complexity.