This article is more than 5 years old. Information may no longer be current.
Total hip arthroplasty may be preferable to hemiarthroplasty for femoral neck fractures in active, elderly patients
Click Here to Manage Email Alerts
BALTIMORE — Total hip arthroplasty — rather than hemiarthroplasty — should be the preferred treatment method for active, elderly patients with displaced femoral neck fractures, according to a study presented here.
Carl J. Hedbeck, MD, described his team’s findings at the 2010 Annual Meeting of the Orthopaedic Trauma Association.
“The aim was to analyze the difference in outcome after 4 years regarding hip complications, hip function and quality of life in elderly patients with displaced femoral neck fracture,” Hedbeck said.
Hedbeck and his team randomized 120 patients who had an acute displaced femoral neck fracture to undergo either a bipolar hemiarthroplasty or a total hip arthroplasty (THA). The study included patients between ages 70 and 90 years who had no severe cognitive dysfunction and possessed both an independent living status and an independent walking capability.
|
|
The investigators assessed the patients’ hip complications, hip function using the Harris Hip score and health-related quality of life using the Euroquol-5D (EQ-5D). They also graded acetabular erosion on a scale of 0 to 3.
“Zero equals no erosion [on the scale],” Hedbeck said. “Three equals protrusive.”
Hedbeck reported no significant differences in hip complications and reoperations between the two groups, as well as a complete lack of dislocations in both groups. Hedbeck noted that five patients in the hemiarthroplasty group reported with grade 1 acetabular erosion, but this did not impact hip function.
The investigators found that the THA group had better hip function at 1 year, and this result increased during the study period. They also discovered that the THA group had better health-related quality of life scores at each follow-up, but this difference was only significant at 48 months.
Hedbeck said “the results confirm that there is a better outcome for hip function and quality of life after THA when compared to bipolar hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck.”
He stressed, however, that the low rate of acetabular erosion after 4-year follow-up and the “relatively good” hip function after a modern bipolar hemiarthroplasty imply that the procedure “will suffice” as a valid treatment for “the oldest patients who have lower functional demands.” – by Robert Press
Reference:
- Hedbeck JC, et al. Bipolar hemiarthroplasty compared with total hip arthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomized controlled trial. Paper #42. Presented at the 2010 Annual Meeting of the Orthopaedic Trauma Association. Oct. 14-16, 2010. Baltimore, Md.
- Carl J. Hedbeck, MD, can be reached at Vo Ortopedi, Södersjukhuset, 118 83 Stockholm, Sweden.
- Disclosure: Hedbeck has no relevant financial disclosures.
