Issue: Issue 5 2011
September 01, 2011
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Good 5-year hemiarthroplasty results for displaced femoral neck fractures in the elderly

Issue: Issue 5 2011
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COPENHAGEN, Denmark — Findings from Norwegian investigators support hemiarthroplasty as a superior treatment to internal fixation for elderly patients with displaced femoral neck fractures.

Ragnhild Ø. Støen, MD, shared her team’s results at the 12th EFORT Congress 2011 here.

Støen’s findings were part of a follow-up on 2-year study results presented in 2007. In that presentation, Støen noted, her group found hemiarthroplasty offered better hip function than internal fixation as measured by the Harris hip score at 4 months, 12 months and 24 months postoperatively. EuroQuol-5D (EQ-5D) scores revealed similar results, with patients in the hemiarthroplasty group reporting superior quality of life at all measuring points.

“It has been a concern that hemiarthroplasty is more expensive than doing internal fixation, but actually what our group found was that hemiarthroplasty is cheaper than internal fixation,” Støen added. “That is because of the very high rate of reoperation in the internal fixation group.”

The updated results of her study, she said, determine the 5-year function and quality of life for both hemiarthroplasty patients and internal fixation patients.

Study methods and parameters

To compare the function and quality of life of patients with displaced femoral neck fractures who underwent internal fixation rather than hemiarthroplasty, Støen and colleagues studied 222 consecutive patients aged 60 years or older who were randomized to receive either internal fixation with two parallel screws or hemiarthroplasty. Following a 5-year period, 68 of the 70 surviving patients had a follow-up visit. Reviewers were blinded to the patients’ initial treatment.

“On inclusion, the patients had to be more than 60 years old, with displaced femoral neck fractures,” Støen said. “Patients with dementia were also included — about 40% to 50% of the patients in the study had a diagnosis of dementia before they broke their hip. Surgeries were performed by the resident on call, as is usual in our department.”

Hemiarthroplasty: Good results

Mean survival of each group was similar. The average Harris hip score was 70 for the internal fixation group and 70.4 for the hemiarthroplasty group. EQ-5D index scores were 0.56 for the internal fixation group and 0.45 for the hemiarthroplasty group.

The team used the Barthel Activities of Daily Living index to categorize patients as either having good or reduced function, with 42% in the internal fixation group and 52% in the hemiarthroplasty group reporting good function. After 2 years, 44 hips (42%) in the internal fixation group underwent a major reoperation compared to 11 hips (10%) in the hemiarthroplasty group.

“Hemiarthroplasty has produced good long-term surgical results, and we found no evolving problems over time with the procedure. Knowing that two-thirds of the patients are dead after 5 years, results in the short-term are very important for these patients,” Støen said. “Hemiarthroplasty has shown to be superior in this patient group.” – by Robert Press

Reference:
  • Støen R, Nordsletten L, Madsen J, et al. Hemiarthroplasty or internal fixation for displaced femoral neck fractures in the elderly: 5-year RCT. Paper #2270. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.
  • Ragnhild Ø. Støen, MD, can be reached at Orthopaedic Department, Oslo University Hospital, Kirkeveien 164, N-0861 Oslo, Norway; email: r-o-st@online.no or STOX@ous-hf.no.
  • Disclosure: Støen has no relevant financial disclosures.