Hemiarthroplasty vs Total Hip Arthroplasty for the Management of Displaced Neck of Femur Fractures: A Systematic Review and Meta-Analysis

Lewis, Daniel; Wæver, Daniel; Thorninger, Rikke; Donnelly, William J.

doi:10.1016/j.arth.2019.03.070

Cited by 139 publications

(171 citation statements)

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“…5 Although limited comparative data are available, total hip arthroplasty has consistently been associated with better function and quality of life than hemiarthroplasty in previous studies. [4][5][6] Our findings showed slightly but significantly lower WOMAC scores (indicating better function) in the total hip arthroplasty group, as well as trends that favored total hip arthroplasty in EQ-5D, SF-12 scores, and TUG test times. However, the differences in WOMAC scores were deemed clinically unimportant on the basis of the thresholds for the minimal clinically important difference.…”

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confidence: 49%

“…[4][5][6] Our inclusion of patients who could ambulate independently before the fracture occurred (i.e., patients who did not require the assistance of another person to ambulate) is consistent with previous trials. 6 Although the use of assistive devices was balanced between the treatment groups, we did not record the type of assistive device or the specific ambulatory capacity of the patients. Data on 17,985 femoral neck fractures over a period of 16 years from the Australian Joint Registry suggest that modern hemiarthroplasty and total hip arthroplasty have similar incidences of revision over 10 years (hazard ratio, 1.13; 95% CI, 0.95 to 1.33; P = 0.16).…”

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confidence: 53%

“…1 Meta-analyses of studies involving patients with a displaced hip fracture have suggested that total hip arthroplasty results in fewer reoperations and substantially better function than hemiarthroplasty. [4][5][6] We performed the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemi-Arthroplasty (HEALTH) trial, an expertisebased randomized, controlled trial involving patients with a displaced femoral neck hip fracture, to examine the effect that total hip arthroplasty, as compared with hemiarthroplasty, has on the risk of a secondary hip procedure.…”

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confidence: 99%

“…Our results differ from those of published meta-analyses reporting that the risk of reoperation associated with total hip arthroplasty is 34 to 43% lower than with hemiarthroplasty. [4][5][6] This difference may, in part, be the consequence of longer follow-up periods in these meta-analyses (ranging from 1 to 13 years) or potential differences in our eligibility criteria. [4][5][6] Our inclusion of patients who could ambulate independently before the fracture occurred (i.e., patients who did not require the assistance of another person to ambulate) is consistent with previous trials.…”

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confidence: 99%

“…[4][5][6] This difference may, in part, be the consequence of longer follow-up periods in these meta-analyses (ranging from 1 to 13 years) or potential differences in our eligibility criteria. [4][5][6] Our inclusion of patients who could ambulate independently before the fracture occurred (i.e., patients who did not require the assistance of another person to ambulate) is consistent with previous trials. 6 Although the use of assistive devices was balanced between the treatment groups, we did not record the type of assistive device or the specific ambulatory capacity of the patients.…”

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confidence: 99%

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Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

et al. 2019

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BACKGROUND Globally, hip fractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty. METHODS We randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. All enrolled patients had been able to ambulate without the assistance of another person before the fracture occurred. The trial was conducted in 80 centers in 10 countries. The primary end point was a secondary hip procedure within 24 months of follow-up. Secondary end points included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health end points. RESULTS The primary end point occurred in 57 of 718 patients (7.9%) who were randomly assigned to total hip arthroplasty and 60 of 723 patients (8.3%) who were randomly assigned to hemiarthroplasty (hazard ratio, 0.95; 95% confidence interval [CI], 0.64 to 1.40; P = 0.79). Hip instability or dislocation occurred in 34 patients (4.7%) assigned to total hip arthroplasty and 17 patients (2.4%) assigned to hemiarthroplasty (hazard ratio, 2.00; 99% CI, 0.97 to 4.09). Function, as measured with the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, pain score, stiffness score, and function score, modestly favored total hip arthroplasty over hemiarthroplasty. Mortality was similar in the two treatment groups (14.3% among the patients assigned to total hip arthroplasty and 13.1% among those assigned to hemiarthroplasty, P = 0.48). Serious adverse events occurred in 300 patients (41.8%) assigned to total hip arthroplasty and in 265 patients (36.7%) assigned to hemiarthroplasty. CONCLUSIONS Among independently ambulating patients with displaced femoral neck fractures, the incidence of secondary procedures did not differ significantly between patients who were randomly assigned to undergo total hip arthroplasty and those who were assigned to undergo hemiarthroplasty, and total hip arthroplasty provided a clinically unimportant improvement over hemiarthroplasty in function and quality of life over 24 months. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov number, NCT00556842.

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