Hemiarthroplasty for femoral fracture associated with lower risk of dislocation vs. THA
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Key takeaways:
- Hemiarthroplasty was associated with a lower risk of hip dislocation at 1 year compared with THA.
- Researchers noted no differences in the likelihood of revision or conversion at 1 year between the groups.
Published results showed hemiarthroplasty was associated with a lower risk of hip dislocation at 1 year compared with total hip arthroplasty, although researchers questioned whether the results are clinically significant.
Adam I. Edelstein, MD, and colleagues at the Medical College of Wisconsin in Milwaukee retrospectively analyzed data on 61,695 Medicare patients aged 65 years and older who underwent THA (n = 10,286; 16.6%) or hemiarthroplasty (n = 51,427; 83.4%) following a femoral neck fracture.
Researchers found THA was associated with a “significantly higher” risk of dislocation at 1 year compared with hemiarthroplasty, as patients who underwent THA had a 2.9% dislocation rate at 1 year and patients who underwent hemiarthroplasty had a 1.9% dislocation rate at 1 year. However, researchers noted both dislocation rates were low. Researchers also noted no significant differences in the likelihood of revision or conversion at 1 year between patients who underwent either THA or hemiarthroplasty.
“Our results further inform the discussion of risks with precise estimates of the risk of dislocation and revision in a U.S. population,” Edelstein and colleagues wrote in the study. “Additionally, our data revealed significant differences in outcomes by age, sex, race, income status and cement status,” they added.
Perspective
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William T. Obremskey, MD, MPH, MMHC
All orthopedic surgeons who take general call should be well-versed in the American Academy of Orthopaedic Surgeons guidelines for management of hip fractures in the elderly. The AAOS board of directors endorsed evidence-based clinical practice guidelines in 2014. Some controversy exists if patient should receive a THA or a hemiarthroplasty. Stable femoral neck fractures have moderate evidence to support operative fixation. Displaced fractures have strong evidence for arthroplasty. If a hemiarthroplasty is planned, bipolar and unipolar implants have similar results. Also, moderate evidence supports the use of cemented femoral stems due to increased incidence of fractures, subsidence and thigh pain with uncemented femoral implants. Moderate evidence supports an anterior, lateral or anterolateral approach for implantation of an arthroplasty due to a lower dislocation event. Patients with dementia have a sevenfold increase in dislocation with a posterior approach. Patients without dementia have a fivefold increase in this location with a posterior approach.
Historically, patients who are higher functioning have often received a THA due to potentially lower incidence of hip pain and revision with a THA compared to a hemiarthroplasty. More recent reviews question this and have found that THA and hemiarthroplasty have similar long-term results. These are common injuries and surgeons need to be familiar with the clinical practice guidelines that are endorsed by the AAOS.
References:
Ekhtiari S, et al. J Bone Joint Surg Am. 2020;doi:10.2106/JBJS.20.00226.
Liu Y, et al. J Orthop Surg Res. 2020;doi:10.1186/s13018-020-01725-3.
Page BJ, et al. J Orthop Trauma. 2023;doi:10.1097/BOT.0000000000002614.
Roberts KC, et al. J Am Acad Orthop Surg. 2015;doi:10.5435/JAAOS-D-14-00433.
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