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Better 5-year results with hemiarthroplasty vs. internal fixation for displaced femoral neck fractures in the elderly

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

Ragnhild Stoen, PhD, shared her team's results at the 12th EFORT Congress 2011 here.

To compare the function and quality of life of patients with displaced femoral neck fractures who underwent internal fixation rather than hemiarthroplasty, Stoen’s group studied 222 consecutive patients aged 60 years or older. The patients 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.

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. The with Euroquol-5D (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. Forty-two percent of patients in the internal fixation group reported good function, while 52% in the hemiarthroplasty group reported good function. Following 2 years, 44 hips (42%) in the internal fixation group underwent a major reoperation – while 11 hips (10%) in the hemiarthoplasty group underwent reoperation.

“Knowing that two-thirds of the patients are dead after 5 years, results in the short-term are very important for these patients,” Stoen said. “Hemiarthroplasty has shown to be superior in this patient group.”

Reference:

• Stoen 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.

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