A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over.

Abstract

The aim of this study was to analyse the functional outcome after a displaced intracapsular fracture of the femoral neck in active patients aged over 70 years without osteoarthritis or rheumatoid arthritis of the hip, randomised to receive either a hemiarthroplasty or a total hip replacement (THR). We studied 252 patients of whom 47 (19%) were men, with a mean age of 81.1 years (70.2 to 95.6). They were randomly allocated to be treated with either a cemented hemiarthroplasty (137 patients) or cemented THR (115 patients). At one- and five-year follow-up no differences were observed in the modified Harris hip score, revision rate of the prosthesis, local and general complications, or mortality. The intra-operative blood loss was lower in the hemiarthroplasty group (7% > 500 ml), THR group (26% > 500 ml) and the duration of surgery was longer in the THR group (28% > 1.5 hours versus 12% > 1.5 hours). There were no dislocations of any bipolar hemiarthroplasty than in the eight dislocations of a THR during follow-up. Because of a higher intra-operative blood loss (p < 0.001), an increased duration of the operation (p < 0.001) and a higher number of early and late dislocations (p = 0.002), we do not recommend THR as the treatment of choice in patients aged ≥ 70 years with a fracture of the femoral neck in the absence of advanced radiological osteoarthritis or rheumatoid arthritis of the hip.

• Authors: M P J van den Bekerom, E F Hilverdink, I N Sierevelt, E M B P Reuling, J M Schnater, H Bonke, J C Goslings, C N van Dijk, E L F B Raaymakers
• Journal: The Journal of bone and joint surgery. British volume (J Bone Joint Surg Br) Vol. 92 Issue 10 Pg. 1422-8 (Oct 2010) ISSN: 2044-5377 [Electronic] England
• PMID: 20884982 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip (adverse effects, methods)
• Blood Loss, Surgical
• Female
• Femoral Neck Fractures (surgery)
• Follow-Up Studies
• Humans
• Intraoperative Period
• Male
• Reoperation
• Treatment Outcome