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THA better than hemiarthroplasty after femoral neck fracture
No significant differences seen between groups in complications in multicenter study at 1 year.
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PHOENIX — A randomized controlled trial revealed that total hip arthroplasty outperformed hemiarthroplasty for displaced femoral neck fractures at 1-year postop — a finding that came 2 years earlier than expected.
William Macaulay, MD, of New York, presented data from the multicenter study at the Orthopaedic Trauma Association meeting. The results showed better SF-36 pain scores in elderly patients receiving total hip arthroplasty (THA) compared to patients receiving hemiarthroplasty for displaced femoral neck fractures — 53.2 vs. 42.4, respectively.
Macaulay and colleagues also discovered more patients in the THA group ambulated without assistance than in the hemiarthroplasty group at 1-year follow-up.
"Our study, I think in a more regimented and controlled way than has ever been done before, has shown that in a very specific patient population ... total hip arthroplasty is superior to hemiarthroplasty with regard to pain and the ability to create independent ambulators, even at the 1-year mark, which was very surprising to us," Macaulay told Orthopedics Today.
The THA group performed better on Timed up and go (TUG) tests and reported less stiffness than the hemiarthroplasty cohort at 6 months. Yet, 1-year results showed no significant differences in stiffness, he said. The finding of more independent walkers in the THA group speaks to the potential that if a similar rigorous, but larger randomized controlled clinical trial is performed, it is likely that the cost effectiveness of THA can be demonstrated.
The study included 40 patients older than 60 years. The researchers randomized the patients to receive either hemiarthroplasty or THA and did not standardize the type of implant used during the procedures. The investigators have followed the patients for nearly 2 years and collected WOMAC, Harris Hip and SF-36 scores.
The Orthopaedic Research and Education Foundation and the American Association of Hip and Knee Surgeons funded the study.
The researchers found one dislocation in the THA-treated group, which was later revised. However, they found no significant difference between the groups regarding complications.
Macaulay noted the small sample size as a study limitation. He said that the study originally called for 300 patients to adequately power a cost analysis and complication rate comparison.
"We think that many of these painful hemis are going to be converted to totals over time," he said.
Centers participating in the study included Columbia University Medical Center, in New York, University of Nebraska Medical Center, in Omaha, and the Lahey Clinic in Burlington, Mass.
For more information:
- Macaulay W, Nellans KW, Garvin KL, et al. Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty: functional outcomes in the treatment of displaced femoral neck fractures. #55. Presented at the Orthopaedic Trauma Association 22nd Annual Meeting. Oct. 4-7, 2006. Phoenix, Ariz.
- William Macaulay, MD, director of the Center for Hip and Knee Replacement at Columbia University Medical Center, 622 West 168 Street, PH11-Center, New York, NY 10032, 212-305-6959, wm143@columbia.edu. He has received research funding from Zimmer, Inc. and fee for service from Smith&Nephew and Wright Medical Technologies. This study was not industry funded.