Prospective Randomized Clinical Trial Comparing Hemiarthroplasty to Total Hip Arthroplasty in the Treatment of Displaced Femoral Neck Fractures

High Dislocation Cumulative Risk in THA versus Hemiarthroplasty for Fractures

“…This did not occur in our series, and the 30-day mortality in another series [20] of more than 7000 patients undergoing THAs for a hip fracture is 2.4%, consistent with our observation. Two randomized trials showed similar mortality rates with THA compared with other treatment options [9,18]. Therefore, it would seem that increasing age and medical comorbidities [16], rather than the magnitude of the surgical procedure, influence mortality.…”

“…In addition to these considerations, the initial experience with THA for intracapsular fractures suggest rates of dislocation ranging from 2% to 9% [3,4,10,15,23,26]. However, there is an accumulating body of evidence that supports the use of THA in suitable patients, and some studies [4,9,14,18,27] indicate function may be better than after other procedures, particularly hemiarthroplasty. To confirm or refute the reported higher rate of dislocation and recurrent dislocation in patients treated with THAs, we compared patients treated with hemiarthroplasty with patients treated with THA to determine the incidence of first-time dislocation, cumulative risk of dislocation, and influence of demographic factors.…”

“…First, we did not randomize the patients into the two groups. However, we believe it is reasonable to compare the two groups, as we could identify (Table 1) only five studies in which a hemiarthroplasty with cement was compared with a THA with cement [2,7,9,14,18]. Second, the surgeons performed the two procedures at two different times; however, the surgeons were the same and used the same approaches and perioperative treatments.…”

“…Several studies [2,4,18,19] suggest THA provides the best function for elderly patients after displaced femoral neck fractures. Although not all elderly patients with displaced femoral neck fractures are candidates for THA, active, mentally competent, independent patients achieve the most predictable and durable functional scores with THA.…”

Revision Surgery Occurs Frequently After Percutaneous Fixation of Stable Femoral Neck Fractures in Elderly Patients

“…Treatment options for femoral neck fractures have been well studied, and the standard treatment in elderly patients who are fit for surgery is early medical optimization, acute surgical intervention, and early mobilization to achieve an optimal functional outcome and avoid medical complications [21,22,34]. Although there is some debate regarding specific surgical techniques, there are areas of consensus [16,17,19,23].…”