Total Hip Arthroplasty and Hemiarthroplasty in Mobile, Independent Patients With a Displaced Intracapsular Fracture of the Femoral Neck

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

“…Despite hemiarthroplasty being the treatment of choice in an unsorted population, the healthiest patients with long life expectancy might have a better result with THA [1]. This is the conclusion in a Cochrane review in which THA in a majority of relatively young and healthy patients had significantly less residual pain and better function at 1, 2, and 4 years after fracture at the cost of increased risk of dislocation and increased surgical time [28], also shown by Hedbeck et al [16].…”

High Dislocation Cumulative Risk in THA versus Hemiarthroplasty for Fractures

“…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.…”

“…We defined loosening of the socket as cup migration exceeding 5 mm, angular rotation exceeding 58, and a continuous radiolucent line wider than 2 mm [6]. To assess cartilage wear we used the criteria of Baker et al [2]. Cup position was assessed according to the acetabular position angle [22].…”

“…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. THA conferred superior short-term clinical functional scores and fewer complications when compared with hemiarthroplasty in a prospectively, randomized study [2] of mobile, independent patients with a displaced fracture of the femoral neck. Although patients with displaced femoral neck fractures who underwent hemiarthroplasties and THAs experienced reduced function 3 years later compared with preoperative levels [2], patients in the THA group had less deterioration and maintained preoperative walking distances better than patients with hemiarthroplasties [2].…”

“…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.…”