Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck

Abstract

We reviewed the seven- to ten-year results of our previously reported prospective randomised controlled trial comparing total hip replacement and hemiarthroplasty for the treatment of displaced intracapsular fracture of the femoral neck. Of our original study group of 81 patients, 47 were still alive. After a mean follow up of nine years (7 to 10) overall mortality was 32.5% and 51.2% after total hip replacement and hemiarthroplasty, respectively (p = 0.09). At 100 months postoperatively a significantly greater proportion of hemiarthroplasty patients had died (p = 0.026). Three hips dislocated following total hip replacement and none after hemiarthroplasty. In both the total hip replacement and hemiarthroplasty groups a deterioration had occurred in walking distance (p = 0.02 and p < 0.001, respectively). One total hip replacement required revision compared with four hemiarthroplasties which were revised to total hip replacements. All surviving patients with a total hip replacement demonstrated wear of the cemented polyethylene component and all hemiarthroplasties had produced acetabular erosion. There was lower mortality (p = 0.013) and a trend towards superior function in patients with a total hip replacement in the medium term.

Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis

“…The mid-to long-term results of THA compared with hemiarthroplasty rarely were reported. Avery et al [1] reviewed the 7-to 10-year results of THA compared with hemiarthroplasty for fracture of the femoral neck and reported lower mortality and a trend toward superior function in patients with THA. Future studies comparing THA with hemiarthroplasty at long-term followup are needed to confirm these results.…”

Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures. A four-year follow-up of a randomised controlled trial

“…Recently published RSA data on 18 patients from Australia displayed a significant reduction of acetabular erosion in the bipolar group compared to the unipolar group at 24-months follow-up [18]. Furthermore, after a mean followup of nine years, Avery et al reported a rate of acetabular erosion of 100 % in the unipolar HA group, though only 13 of the original 41 patients were available for follow-up [23]. Of their 13 patients three (23 %) had enough symptoms due to acetabular erosion to justify revision surgery.…”

The provision of total hip replacement for displaced intracapsular hip fractures

“…In general, symptomatic acetabular erosion following hemiarthroplasty occurs late and is not common. 13,18 Younger patients have been found to be at a higher risk for requiring revision surgery for acetabular erosion or loosening of the hemiarthroplasty than patients aged 75 years or older. 19 There may be an underestimation of the number of older patients with symptomatic hemiarthroplasties as many will not be suitable for revision owing to frailty and a lack of fitness for anaesthesia or further surgery.…”

“…[5][6][7]13 Although patients may fit the criteria for THR as outlined by NICE, the selection of the right patients for THR remains difficult in clinical practice. For them to be strictly adhered to, guidelines should confer high efficacy but no attributable risk and they should help with difficult decisions, making the process easier.…”

“…9 Despite the recommendations, there are still reservations about THR performed for hip fracture, particularly regarding the risks of dislocation and the long-term clinical benefit. 7,[10][11][12][13][14][15] This study was performed to assess the practice and variation in the provision of THR for displaced intracapsular hip fractures in a defined geographic region. The reasons for not performing THR when a patient was deemed eligible based on the NICE criteria were also evaluated.…”