Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture?

Abstract

Aims The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. Methods We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed. Results There were 143 patients included in the fittest cohort. Mean age was 66 years (SD 4.5) and 103 were female (72%). No clinically relevant differences were found between the treatment groups in the primary and sensitivity analyses. Conclusion This analysis found no differences in functional outcomes between HA and THA within two years of displaced low-energy FNF in a subgroup analysis of the fittest HEALTH patients. These findings suggest that very few patients above 50 years of age benefit in a clinically meaningful way from a THA versus a HA early after injury. Cite this article: Bone Jt Open 2022;3(8):611–617.

Infection after intracapsular femoral neck fracture – does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty?

“…34 In particular, the decisionmaking between THA and HA can be improved. 35 As risk factors for PJIs, older age, increased BMI, and a high number of (cardiovascular) comorbidities were evaluated recently. 36,37 This specific group of patients suffers from a modified or weakened immune system and reduced blood flow in the periphery, e.g.…”

Inter-departmental variation in surgical treatment of proximal femoral fractures: A nationwide observational cohort study

“…The HEALTH trial found no short-term benefit of THA over HA for patients >50 years with a displaced FNF after a 2-year follow-up [ 28 ]. Not even the youngest (50–70 years) and fittest (ASA grade I or II) patients benefit from a THA with a short-term follow-up of 2 years [ 15 ]. However, the potential benefit of THA is the avoidance of acetabular erosion and worsening hip function with time, which can come into play in younger and active patients with a longer life span.…”

“…In most patients current evidence cannot detect any differences of clinical importance between THA and HA approaches [ 15 ]. Notable is the high age cut-off (60 to 70 years) [ 16 , 17 ] in Scandinavia for using IF for displaced FNFs.…”

Total hip arthroplasty versus hemiarthroplasty for treatment of femoral neck fractures

“…However, evidence for the optimal treatment remains mixed. [2][3][4][5][6] There is considerable variation in practice patterns between healthcare systems, regions, institutions, and individual surgeons. [7][8][9][10] The purpose of this population-based cross-sectional study was to describe practice variation in the use of THA versus HA for patients aged 60 years and older with femoral neck fracture in Ontario, Canada, and to determine patient, surgeon, and institution factors that predicted treatment with THA.…”

“…However, evidence for the optimal treatment remains mixed. 2-6 There is considerable variation in practice patterns between healthcare systems, regions, institutions, and individual surgeons. 7-10…”