Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa- and septuagenarians

Abstract

BackgroundThe optimal treatment of femoral neck fracture in the elderly patient is still under debate. In patients aged 60–80 years, the decision between internal fixation and arthroplasty remains controversial. The primary aim of the present study is to evaluate the functional outcome of patients aged 60–80 years with femoral neck fracture treated with total hip arthroplasty or closed reduction and internal fixation. The secondary aim is to evaluate the incidence of nonunion and avascular necrosis in femoral neck fracture in different age groups.Materials and MethodsWe studied 100 patients affected by displaced fracture of the femoral neck from May 2007 through June 2010. There were 60 men and 40 women with mean age of 66 years. Fifty patients were treated with closed reduction and internal fixation with cannulated screws (group A), and the other 50 patients with total hip arthroplasty (group B). Mean surgical time, blood loss, duration of hospital stay, Harris hip score, complications, and need for reoperation were recorded.ResultsHarris hip score was significantly higher in group B at 3-, 6-, 12-, and 18-month follow-up evaluation. The overall complication rate was 28 % in group A and 32 % in group B, which was not statistically significant. A statistically significant difference was found regarding patients who required reoperation in group A (20 %) compared with group B (no one). The average Harris hip score in the internal fixation group was 90.6 and in the total hip arthroplasty group was 93.7, which was statistically significant (p < 0.05). Our study showed an increased risk for intracapsular hip fracture developing nonunion with older age.ConclusionsPrimary total hip arthroplasty compared with internal fixation appears to be a reasonably safe method of treating displaced fracture of femoral neck in elderly patients. We also concluded that outcome regarding hip function is generally better after total hip arthroplasty compared with internal fixation.Level of evidenceLevel II-Prospective cohort study.

Clinical Outcomes of Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Patients 80 Years of Age and Older Selected by Clinical Frailty Score

“…Mild thigh pain was present in 4 patients. When compared to the approaches used by other investigators, our group had a lower dislocation rate and mortality rate (Table 2) [23][24][25][26][27][28][29][30][31][32] .…”

Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly

“…[2223242526272829] The primary reasons for exclusion were as follows: six were review articles,[113031323334] six reported data that did not pertain to intracapsular hip fractures,[31535363738] one was a correspondence letter,[39] and two studies were excluded because they were not RCTs. [4041] Details of the selection process are shown in Figure 1. The weighted kappa for the agreement on eligibility between the reviewers was 0.88 (95% CI [0.83–0.94]).…”

Recent advances in the treatment of hip fractures in the elderly

“…In this group of 146 hips in patients who were at least 75 years old, there was also no difference in mortality between the groups. Other studies have also found a higher risk of revision surgery after internal fixation and recommend arthroplasty for healthy, lucid elderly patients 30 – 33 . Although the rate of re-operation is lower, it should be recognized that arthroplasty introduces a distinct subset of complications, namely dislocation, aseptic loosening, infection, and wound complications.…”