Study finds better postop function from hemiarthroplasty vs. internal fixation of displaced femoral neck fractures

Patients in the internal fixation group had risks of complications and reoperations 3.4 to 4.2 times higher than in the hemiarthroplasty group.

Hemiarthroplasty produces significantly better functional outcomes compared to closed reduction with internal fixation for treating displaced femoral neck fractures in elderly patients, according to a study by researchers in Norway.

"In patients with displaced intracapsular femoral neck fractures, hemiarthroplasty results in better hip function, higher health-related quality of life and more independence than internal fixation," the study authors wrote. "The primary outcome measure, the Harris Hip Score at 12 months, was a mean of 6.7 points higher in the hemiarthroplasty group."

Frede Frihagen, MD, and colleagues at Ullevål University Hospital, Oslo, compared postoperative function among 222 patients randomly assigned to one of the two surgical interventions.

All patients were older than 60 years, averaging 83 years old. Study inclusion criteria consisted of the ability to walk before sustaining the fracture and no major hip pathology, regardless of cognitive function, according to the study, published in British Medical Journal.

The internal fixation group included 112 patients treated with closed reduction and placement of two parallel cannulated screws (Olmed, DePuy, a Johnson & Johnson Company).

For the hemiarthroplasty group, which included 110 patients, surgeons implanted a Charnley-Hastings bipolar cemented hemiarthroplasty device (DePuy, a Johnson & Johnson Company), according to the study.

The researchers found that the Harris Hip Score for the hemiarthroplasty group averaged 8.2 points higher (P=.003) at 4 months follow-up and 6.7 points higher (P=.01) at 12 months compared to the internal fixation group.

Additionally, the hemiarthroplasty group showed significantly better results for health-related quality of life (Eq-5d) and for activities of daily living using the Barthel index.

The Eq-5d index score averaged 0.13 points higher (P=.03) at 24 months follow-up and the Eq-5d visual analog scale score averaged 8.7 points higher at 4 months follow-up among hemiarthroplasty-treated patients (P=.01), according to the study.

"After 12 and 24 months, the percentage scoring 95 or 100 on the Barthel index was higher in the hemiarthroplasty group (P=.02)," the authors wrote.

In addition to showing better postoperative function, patients treated with hemiarthroplasty experienced significantly fewer complications compared to the internal fixation group.

Complications occurred in 56 (50%) patients treated with internal fixation and in 16 (15%) patients treated with hemiarthroplasty (P<.001).

"The risks of complications and reoperations were 3.4 to 4.2 times higher in the internal fixation group," the authors wrote. "Sixteen patients had to have more than one further operation (two to six); 14 of them were in the internal fixation group (P=.002)."

For more information:
Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ. 2007;335:1251-1254.