Total hip arthroplasty vs hemiarthroplasty for hip fracture

Editor's Note

In this study of patients with displaced femoral neck fractures, the incidence of secondary procedures did not differ significantly between patients who had total hip arthroplasty (THA) and those who had hemiarthroplasty. THA was associated with modestly better function over 2 years but with a slightly higher incidence of serious adverse events.

A total of 1,495 independently ambulatory patients from 80 centers in 10 countries with displaced femoral neck fractures were randomized to either THA or hemiarthroplasty.

Hip instability or dislocation occurred in 34 patients assigned to THA and 17 patients assigned to hemiarthroplasty. Function scores modestly favored THA, mortality was similar (14.3% for THA vs13.1%), and serious adverse events occurred in 41.8% of THA patients vs 36.7% of hemiarthroplasty patients.

Though the American Academy of Orthopaedic Surgeons and National Institute for Health and Care Excellence Guidelines recommend THA for all patients with displaced femoral neck fractures who are able to ambulate independently, this study’s findings suggest that the advantages of THA may not be compelling, the researchers say.