INTERNAL FIXATION OR ARTHROPLASTY FOR DISPLACED INTRACAPSULAR FRACTURESIN THE ELDERLY: A LONG-TERM FOLLOW-UP OF A RANDOMISED CONTROLLED TRIAL

Abstract

To determine the optimum choice of treatment for the displaced intracapsular fracture in the elderly, 455 patients aged over 70 years with a displaced intracapsular fracture were entered into a prospective randomised trial. Treatment was either an uncemented Austin Moore hemiarthroplasty or reduction and internal fixation with three AO cancellous screws. Analysis of pre-operative characteristics of patients showed there was no significant difference between the two groups.

Follow-up of surviving patients was continued for between seven to 15 years to determine the long-term outcome for the two treatment Methods: 90% of patients died during this follow-up period.

Regarding short term outcomes, internal fixation resulted in a reduced mean operative time, operative blood loss and transfusion requirements.

There was no significant difference in the length of hospital stay or incidence of general post-operative complications. There was no difference in either the short term or long-term mortality between the two procedures. The need for revision surgery to the hip was increased for those treated by internal fixation (7% versus 38% implant revision rate). There was no difference in the degree of residual pain between groups neither was there any difference in the number of patients requiring institutional care. There was a tendency to slightly better mobility for those treated by internal fixation although the Results: were not statistically significant. These results demonstrate that both treatment methods produce comparable final outcomes but internal fixation is associated with an increased re-operation rate.