Abstract
Recent NICE guidelines have suggested abandoning the Thompson hemiarthroplasty (TH) in favour of a ‘proven prosthesis’ such as the Exeter Trauma Stem (ETS). This is controversial because of significant cost implications and limited research assessing outcomes of the ETS. The aim of this study was to assess the treatment of intracapsular neck of femur fractures with the TH.
Between 2002 and 2006 (minimum 5 year follow-up), 431 cemented TH's were performed. Death rate at 1 year and 5 years were 26.0% and 67.7% respectively. Dislocation (1.4%) and infection (0.2%) rates were low and revision rate was 1.2%. Comparison was made to Bipolar hemiarthroplasties over the same period (total 194). These had lower rates of dislocation (0.5%) and infection (0.5%) with a significantly higher (3.6%) revision rate.
We feel that the TH remains the current gold standard treatment for intracapsular fractures, in appropriate patients, due to low complication and revision rates. Modern implants may provide better function or longevity, but there is no evidence in the literature to support abandoning the TH. Surgeons should assess patients and decide on its use, despite NICE guidelines, as it remains a cost effective treatment method, particularly for older, less mobile and cognitively impaired patients.
