BIPOLAR HEMIARTHROPLASTY COMPARED WITH TOTAL HIP REPLACEMENT FOR DISPLACED FEMORAL NECK FRACTURES IN THE ELDERLY. A RANDOMISED, CONTROLLED TRIAL.

Abstract

Introduction: The treatment for the active and lucid elderly patient with a displaced femoral neck fracture is still controversial. Recent randomized controlled trials have shown that a primary total hip replacement (THR) is superior to internal fixation (IF) regarding the need for secondary surgery, hip function, and the health-related quality of life (HRQoL). Despite the good results with THR in this patient group, a vast majority of orthopaedic surgeons prefer hemiarthroplasty (HA) before THR. The aim of this study was to analyze the outcome regarding hip function and HRQoL after a displaced femoral neck fracture in a active and lucid elderly patient randomized to either a bipolar HA or THR.

Patients and Methods: 120 patients (101 females), mean age 81 (range 70 – 90), with an acute displaced femoral neck fracture (Garden III and IV) were randomized to bipolar HA or THR. Perioperative data, hip complications, general complications, hip function (Harris Hip Score, HHS) and HRQoL (EQ-5D) were assessed. The patients were summoned at 4 and 12 months.

Results: The duration of surgery was longer in the THR group, 102 versus 78 min, and the intraoperative blood loss was higher, 460 ml versus 320 ml. There were no differences between the groups regarding hip complications and general complications including mortality. There were no dislocations. Hip function (HHS score) was significantly better in the THR group at both follow-ups, p< 0.05 and < 0.001, respectively, with a trend towards an increasing difference with time. The HRQoL (EQ-5D index score) were in favor of the THR group although not statistically significant.

Discussion: The results of this study indicate that a THR gives better hip function compared to a bipolar HA already after one year without increasing the complication rate. There are good reasons to assume that this difference will increase with time. We recommend THR as the primary treatment for the active and lucid elderly patient with a displaced femoral neck fracture.