Hemiarthroplasty <I>versus</I> internal fixation for displaced intracapsular hip fractures in the elderly: A randomised trial of 455 patients

Abstract

A total of 455 patients aged over 70 years with a displaced intracapsular fracture of the proximal femur was randomised to be treated either by hemiarthroplasty or internal fixation. The preoperative characteristics of the patients in both groups were similar. Internal fixation has a shorter length of anaesthesia (36 minutes versus 57 minutes, p < 0.0001), lower operative blood loss (28 ml versus 177 ml, p < 0.0001) and lower transfusion requirements (0.04 units versus 0.39 units, p < 0.0001). In the internal fixation group 90 patients required 111 additional surgical procedures while only 15 additional operations on the hip were needed in 12 patients in the arthroplasty group. There was no statistically significant difference in mortality between the groups at one year (61/226 versus 63/229, p = 0.91), but there was a tendency for an improved survival in the older less mobile patients treated by internal fixation. For the survivors assessed at one, two and three years from injury there were no differences with regard to the outcome for pain and mobility. Limb shortening was more common after internal fixation (7.0 mm versus 3.6 mm, p = 0.004). We recommend that displaced intracapsular fractures in the elderly should generally be treated by arthroplasty but that internal fixation may be appropriate for those who are very frail.

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

“…The overall short life expectancy and the superior shortterm function in the hemiarthroplasty group reinforce bipolar hemiarthroplasty as the treatment of choice in elderly patients with a displaced intracapsular hip fracture [10,13,29,33]. The excess mortality compared with the background population is well demonstrated for the first year after fracture [20].…”

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…When comparing internal fixation and arthroplasty, fixation has been reported to induce more residual hip pain during the first post-fracture years (Gjertsen et al 2010, Lu-Yao et al 1994. Also shortening of limb length and limitations in limb range of motion are more common after fixation than after arthroplasty (Parker et al 2002). Femoral neck shortening after internal fixation induces walking asymmetry, decreased walking velocity and impaired physical functioning, leading to permanent physical limitations (Zielinski et al 2013).…”

“…The exact mechanisms underlying between musculoskeletal pain, type of surgical treatment, physical inactivity and mobility limitation are not known. The causes of pain after hip fracture might include restrictions in the range of motion of the hip joint, shortening of limb length and weight-bearing limitations in the affected leg, which have been reported to be more common after internal fixation than after arthroplasty (Parker et al 2002). These factors could further lead to muscle strength deficit and modifications in stance, standing posture and walking.…”

Treatment and Displacement Affect the Reoperation Rate for Femoral Neck Fracture

“…With this elderly population increase, the rate of hip fractures is expected to increase from less than 2 million in 1990 to more than 6 million by 2050 [28]. The increasing yearly prevalence and morbidity and mortality associated with FNFs have led to extensive research and multiple publications on which to base treatment decisions [1,4,5,9,19,25,26,31,33,36,38,42,45,[47][48][49]51].…”