Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly

Abstract

Forty-three elderly patients with an intracapsular hip fracture were selected for a prospective randomised trial comparing osteosynthesis (DHS) versus primary hemiarthroplasty (HA) with a 3-year follow-up. The duration of the operation and the perioperative blood loss were significantly shorter in DHS, but inadequate reduction and/or fixation led to serious problems in this group. Clinical morbidity was lower after DHS. No difference could be demonstrated in the mortality rates, fracture- or operation-related complications or the need for secondary intervention. Reintervention could be carried out without additional risk in both groups and did not lead to poor end results. Comparable results were obtained with both methods up to 24 months. At the 36-month follow-up, a significantly worse outcome could be demonstrated in the HA group. We conclude that osteosynthesis is justified as the primary treatment of displaced intracapsular hip fractures in elderly patients. Endoprosthetic replacement can be safely used in cases where osteosynthesis has failed.

High Dislocation Cumulative Risk in THA versus Hemiarthroplasty for Fractures

“…Hemiarthroplasty, regardless of type, does not seem to fulfill the active, independent patient's functional demands. Van Vugt et al [28] concluded that their study group of independent living patients between 71 and 80 years old should not have a bipolar hemiarthroplasty owing to their higher risk of acetabular protrusion and loosening. Three studies [15,17,26] have longer-term followups and calculated 10-and 20-year survival of THAs after femoral neck fractures.…”

Arthroplasty or internal fixation for displaced femoral neck fractures: which is the optimal alternative for elderly patients? A meta-analysis

“…Table 1 provides a summary of the studies, author, year of publication, their location, sample size, follow-up period, interventions and age of patients. Internal fixation was mostly performed with multiple screws, but in five studies [4,11,19,27,31] a compression screw and plate were used.…”

“…However, whether arthroplasty or IF is more appropriate for displaced femoral neck fractures in elderly patients is still being debated [12,25,26]. IF preserves the femoral head; in addition, it has shorter operative time, less blood loss and operative trauma, while arthroplasty might increase operative mortality [14,16,31]. However, some authors favour arthroplasty because the replacement of the femoral neck can decrease the rate of revision surgery and the complications related to healing of the fracture [2,5,17,23].…”

Treatment and Displacement Affect the Reoperation Rate for Femoral Neck Fracture

“…These must be considered alongside surgeon preference and fracture variables that include displacement, fracture pattern, comminution, and bone quality [7,11,21,25,45,51]. Treatment options include nonsurgical management [13,35,36], internal fixation with multiple cannulated screws [11,22,24,31,40,47,51,52], hemiarthroplasty [3,8,18,24,54], or THA [3,5,10,12,42,50].…”