Although few published papers assess the results of revision total shoulder replacement for painful hemi-arthroplasty with a functional rotator cuff, surgical outcome is accepted as being poor. Our experience suggests that results are poor if a well-fixed humeral stem is revised to correct version, and if a non-functional rotator cuff is not alternatively managed. We identified fifteen patients with painful hemi-arthroplasty and a suspected functional rotator cuff that underwent revision total shoulder replacement at Wrightington hospital over a ten year period. The aetiology comprised osteoarthritis (seven), inflammatory arthritis (five), trauma (two) and avascular necrosis (one). The average time interval to revision surgery was 44.5 months. Humeral head size was up-sized in two and down-sized in seven cases at revision surgery. Three cases underwent iliac crest autografting for glenoid deficiency. Four cases underwent humeral stem revision for incorrect version. The average surgical time for primary total shoulder replacement at Wrightington hospital is 80 minutes while the average time for these revision total shoulder replacements was 105 minutes. Four patients had an unsatisfactory outcome according to Neer’s criteria due to an intra-operative greater tuberosity fracture (one), an intra-operative humeral shaft fracture (one) and a non-functional rotator cuff (two), one of which was revised to an extended head prosthesis with good outcome. Surgical time for revision and primary total shoulder replacement did not differ significantly if humeral stem revision or glenoid augmentation was not indicated. Oversized humeral head components may cause pain due to overstuffing the joint and soft tissues. Revision total shoulder replacement for hemi-arthroplasty with incorrect prosthetic version cannot guarantee an improved outcome. Significant glenoid deficiencies can be effectively managed by iliac crest bone grafting at revision total shoulder replacement. Rotator cuff deficient patients should be managed with alternative prostheses

Objective: We had performed bipolar hemi-arthroplasty for osteoarthritis of the hip, with the technique of ace-tabular reaming until 1991. We studied the long-term results of this procedure radiographically. Materials and methods: 62 patients (70 hips) were followed up for at least eight years after bipolar hemi-arthroplasty without cement. The diagnosis of all patients was osteoarthritis of the hip, which mainly came from dysplasia of the hip. The patients consisted of 13 men and 49 women. The average age at the operation was 43 years old (36–74 years old). The average duration of follow-up was 11 years (8–14 years). Smooth-surface press-fit type stem (Omnifit, Osteonics) was implanted for all cases. Focal osteolysis around component, the migration of the outer head and the subsidence of stem, were evaluated radiographically. By reviewing serial A-P radiographs, the first recognition of osteolysis and the extension of the lesion were researched. Results: The mean migration of the outer head was 3.0mm medially and 9.1mm superiorly. The mean subsidence of stem was 7.2mm at final follow-up. The ace-tabular focal osteolysis was identified in 31 hips (44 %) and was first recognized at average 3.1years(1–9years) postoperatively. The femoral focal osteolysis was identified in 33 hips (47%) and was first recognized at average 2.3 years (1–9years) postoperatively. After the first recognition of osteolysis, the lesion was progressively spreading, especially on femoral side. Conclusion: From these results, bipolar hemi-arthroplasty with the technique of acetabular reaming should not be indicated for osteoarthritis of the hip. This procedure causes osteolysis, which is progressive, and the migration of the outer head so often that it is difficult to preserve acetabular bone stock

We evaluated the long-term survival and patient reported outcome of the Copeland mark III humeral resurfacing hemi-arthroplasty (Biomet, Warsaw, Indiana). At a UK District General Hospital 95 shoulder replacements in 85 patients were performed from 1994 to 2003 (mean age 68.9). At the time of follow-up (mean of 12 years, range 8.7–18.0) 49 patients had survived. This study group were posted Oxford Shoulder Score (OSS) and SF-12 questionnaires and their case notes were reviewed. There was an 82% response rate. The responders comprised 46 shoulders in 40 patients. 40 shoulders had a pre-operative diagnosis of osteoarthritis and 6 had other pathologies. The median OSS was 36. The median functional score was 24 (IQR: 9.5), where 32 is the best. The median pain score was 13 (IQR: 7) with 16 being the best score. There was a median SF 12 score of 31 (IQR: 3), where the maximum score is 47. There were 3 revision operations and 95% survivorship at 18 years, according to Kaplan Meier survival analysis. The Copeland mark III hemi-arthroplasty prosthesis has a good long term survival, few post-operative complications and a good functional outcome in an elderly population. We would advocate its use in this patient group

Fractures of the femoral neck in the elderly are associated with significant morbidity and mortality. In the UK, patients with these fractures occupy 20% of orthopaedic beds. Between September 1999 and August 2000 a prospective study was conducted to evaluate the outcome in 36 patients, 24 of them women, with femoral neck fractures treated by uncemented Thompson’s hemi-arthroplasty. The mean age of patients was 71.6 years. All patients had sustained a Garden type-III or IV fracture, and 89% were due to low velocity trauma. Associated conditions were hypertension (66%), diabetes mellitus (27%), dementia (22%), ischaemic heart diseases (16%), cerebrovascular accident (16%), asthma (16%), alcoholism, epilepsy and malignancies (5% each). Before the injury, 55% of patients walked normally, while 19% had a limp and 28% were using a walking aid. At the time of injury 67% were living with family, 22% independently and 11% in a nursing home. Surgery was performed under spinal anaesthetic at a mean of 12.5 days (3 to 30) after injury. None of the patients received prophylactic treatment for deep vein thrombosis. Postoperative mobilisation was commenced at 48 hours, and patients were discharged a mean of 5.5 days (2 to 28) postoperatively to nursing homes (27.5%), family (27.5%) or independent living (16.5%). In the first month after surgery 27.5% of patients died. At six months 14% of patients had normal mobility, while 25% had a limp, 30% used a walking aid and 3% were wheelchair-bound. The overall results in this study are comparable with those in the literature. The delay in surgery did not affect morbidity or mortality

Methicillin-resistant Staphylococcus aureus (MRSA) has increased in prevalence and significance over the past ten years. Studies have shown rates of MRSA in Trauma and Orthopaedic populations to be from 1.6% to 38%. Rates of MRSA are higher in long term residential care. It has been Department of Health policy to screen all Trauma and Orthopaedic patients for MRSA since 2001. This study audited rates of MRSA screening in patients who presented with fractured neck of femur treated with Austin Moore hemi-arthroplasty over the course of one year. Rates of MRSA carriage and surgical site infection (SSI) were derived from the computerised PAS system and review of case notes. 9.8 % of patients were not screened for MRSA at any time during their admission. The rate of MRSA carriage within the study population was 9.2%. The MRSA SSI rate was 4.2%. MRSA infections are associated with considerable cost and qualitative morbidity and mortality. There is good evidence for the use of nasal muprocin and triclosan baths in reducing MRSA. Single dose Teicoplanin has been shown to be as effective as traditional cephalosporin regimes. There is new guidance for the use of prophylactic Teicoplanin for prevention of SSI. We should consider introducing both topical and antimicrobial MRSA prophylaxis

All patients who had received an Austin Moore hemi-arthroplasty between 6 February 1998 and 14 July 2002 were included in the study. Of the 101 patients, 34 were lost to follow-up, 34 had passed away and one did not give consent for the study. The Physical Performance of Activities of Daily Living (PODL) was evaluated, using a modified version of the functional status index by Jette. The level of social functioning was determined by a questionnaire developed by House . Muscular function was evaluated by a timed ‘carpet run’ of 20 m and measuring the time it took to rise twice from an armless chair. The data were compared to an age-matched control group of 44 volunteers. The 45% complication rate in the study group included four dislocations (12%), two femoral fractures (6%) and three deep infections (9%). The social functioning questionnaire showed an average or above average score in most of the patients, 22 of whom (69%) were satisfied with the results. On the PODL score 19 patients (60%) were above average in dependency. Ten (31%) reported no functional pain and four (10%) reported severe pain. Muscular function tests showed a statistically significant difference between the operated group and the control group, with the mean ‘carpet run’ three times longer. Even though the study showed good results as far as dependency and social functioning was concerned, there was a high complication rate and a low objective functional outcome. We concluded it was an effective procedure for patients who did not have high functional expectations, and that physiological status should play a greater role than chronological age in therapeutic decision-making

Aims

The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients.

[Background]

Bipolar hemiarthroplasty (following BHA) have historically had poor results in patients with idiopathic osteonecrosis of femoral head (OFNH). However, most recent report have shown excellent results with new generation BHA designs that incorporate advances in bearing technology. These optimal outcomes with bipolar hemiarthroplasty will be more attractive procedure for young patients who need bone stock for future total arthroplasty. The purpose of the current study was to evaluate the clinical and radiographic finding of this procedure for the treatment of OFNH at our institution after 7-to 21years follow-up.

The purpose of the study was to review and present a series of early failures of the Miller Galante unicom-partmental knee replacement (UKR). Following several early failures all Miller Galante UKR’s inserted by the author (60 patients, 72 knees) were recalled for clinical and radiological review including assessment using the American Knee Society Score and the Oxford Knee Score. All knees with effusions were aspirated and specimens sent for histological analysis.

There were 22 females and 38 males with a mean age of 67 years. The mean follow up was 3.4 years. Six failures were noted with follow up from 10 months to 4 years. These 6 cases will be discussed in more detail including operative findings at revision and possible reasons for failure.

Early failure of this arthroplasty is unacceptable and caution should be exercised if contemplating using this implant unless more definite causative factors are identified.

Introduction: The Copeland Shoulder prosthesis was developed as an alternative to the more traditional prostheses. This cementless design differs in that it resurfaces, rather than replaces, the native humeral head. The obvious advantage of this design is only a minimum of bone is removed thus preserving bone stock for future revisions if needed. There exists little in the orthopaedic literature concerning the clinical results of patients with a Copeland shoulder prosthesis.

Materials and methods: Twenty-four patients receiving a Copeland hemiarthroplasty were identified at our institution between 1997 and 1999. All operations were performed by the senior author. A minimum of one-year follow-up was essential. Nineteen patients with twenty shoulders were available for follow-up at a mean of 2.2 years. Patients’ charts and operative reports were examined, and patients’ received retrospective pre-operative and prospective post-operative application of the constant score. AP and axillary lateral radiographs were examined for component position, evidence of osteolysis, and glenoid wear.

Results: The average Constant scores showed improvement in all subgroups: pain relief increased from 0.4 pre-operatively to 8.4 post-operatively; function rose from 9.3 to 14.3; and range of motion from 14.4 to 29.3. Two of twenty components required revision: one for loosening and the other for head collapse. One prosthesis showed some evidence of osteolysis, and five glenoids showed evidence of further wear.

Conclusion: Copeland hemiarthroplasty of the shoulder is effective in providing improved pain relief and function in short-term follow-up. The ability to preserve bone stock for future procedures may be ideal especially for the young, active patient. Complications are similar to those seen in more traditional hemiarthroplasties—loosening, osteolysis, and progressive glenoid wear. The 10% revision rate is slightly higher than reported in most total shoulder and hemiarthroplasty series. Longer follow-up will be essential to make any definitive conclusions.

The indications for use of a glenoid component are: 1.) sufficient degenerative changes on the glenoid to expose the subchondral bone 2.) the glenoid should have sufficient glenoid bone stock to allow for secure and longterm fixation of the component, and 3.) the rotator cuff should be intact or repairable and the humeral head should be centred within the glenoid component. Other factors that secondarily affect the decision to use a glenoid component, include the patient’s age and activity level, which should be such that they are not likely to result in multiple revisions for glenoid wear or loosening.

Given these factors most patients with osteoarthritis, the leading indication for prosthetic replacement for arthritis should undergo a total shoulder replacement. Patients with acute proximal humeral fractures, the overall leading indication for prosthetic arthroplasty, should have a hemiarthroplasty. Patients with rotator cuff tear arthropathy or crystalline arthropathy are indicated for hemiarthroplasty due to the massive irreparable cuff tears present in these conditions. Patients with rheumatoid arthritis have variable diseases affecting the rotator cuff and variable degrees of bone loss resulting in the need to individualise the indications for the use of a glenoid to the patient’s pathoanatomy. The reason for use of a glenoid component, when indicated, is the fact that pain relief and function is predictably better when compared to hemiarthroplasty for the same indication and pathoanatomy. Proper insertion of a glenoid component requires wide exposure of the glenoid fossa and bone preparation, which for most general orthopaedic surgeons is difficult and not reproducible. This is, in my opinion, the primary reason that hemiarthroplasty or bipolar arthroplasty is used for treatment of many patients with primary osteoarthritis. Both of these procedures result, on average, in a less favourable outcome than non-constrained total shoulder arthroplasty.

Osteoarthritis is characterised by flattening and enlargement of the humeral head and is associated with peripheral osteophyte formation. Loss of articular cartilage results in eburnated bone and on the glenoid side posterior bone loss. Capsular contracture results in loss of passive arcs of motion, particularly anteriorly with loss of external rotation. Posterior subluxation of the humeral head can occur, associated with anterior soft tissue contracture and/or posterior glenoid bone loss. The severity of this pathoanatomy is variable among patients with primary osteoarthritis and each of these factors will have a variable effect on outcome of shoulder arthroplasty as well as the indication for hemiarthroplasty versus total shoulder arthroplasty.

In a 2–7 year follow-up multicentre study using the DePuy Global Shoulder in 127 patients, those cases with osteoarthritis without humeral head subluxation, severe glenoid bone loss, or rotator cuff tears had the best results, for pain relief and function, with total shoulder arthroplasty. In patients with severe glenoid bone loss total shoulder has improved function when compared to hemiarthroplasty. This finding supports the data of others that demonstrate less favourable results of hemiarthroplasty for treatment of osteoarthritis in cases with eccentric glenoid wear. Patients with humeral head subluxation have less favourable results regardless of the use of a hemiarthroplasty or total shoulder arthroplasty. The presence of a full thickness reparable rotator cuff tear limited to the supraspinatus tendon does not adversely affect outcome or the ability to use a glenoid component. Patients with less than 10° of external rotation achieve statistically less postoperative forward flexion and external rotation than those patients with greater degrees of preoperative external rotation.

OBJECTIVE OF THE STUDY

The objective of this study is to establish the short-term and medium-term clinical and radiological results with the cementless three-dimensional Vektor-Titan stem (Figure 1). This three-dimensional tapered stem has been given to evaluate the extent to which the implant design achieves an optimal proximal anchoring property, thus reducing bone atrophy and avoiding stress shielding in the proximal femur.

We prospectively compared hemiarthroplasty (HA) and total shoulder replacement (TSR) in cuff intact osteoarthritis. The 2 years postoperative review, which has been presented previously, showed an advantage of TSR over HA. This study reviewed the longer term outcome in the same patients at a minimum of 10 years to assess the longer term durability of the glenoid components. Patients with Osteoarthritis and an intact rotator cuff were intraoperatively randomisation to HA or TSR using the Global^™ Shoulder Arthroplasty system after glenoid exposure. Post-operative mobilisation for the two groups was identical, and up until two years, patients were assessed using the UCLA and Constant Score, as well as analog pain scales and functional questionnaire. At the 10 year review patients were assessed using a similar range of subjective evaluations by telephone, or reviewed in the clinic as was possible

Thirty-three shoulders in thirty-two patients were entered into the trial (14 HA and 19 TSR). At six months and one year, function scores and motion were similar, but the TSR group had less pain than the HA patients (p < 0.05) and this became more apparent at two years postoperatively (p< 0.02). Apart from those who died, no patients were lost to follow-up. At the two year mark postoperatively one patient in the HA group had undergone revision to TSR due to severe pain secondary to glenoid erosion, and three further HA were subsequently revised (2 at 3 years, and one at 4 years). Two shoulders in the TSR group have been revised (at 5 years and 7 years). At 10 years from the initial arthroplasty, 5 of the 14 HA and 6 of the 19 TSR had died. 10 of the 14 HA (71%) and 17 of the 19 TSR (89%) remained in situ at the time of death or at the 10 year review. Overall outcomes in each group were similar with respect to pain, function, daily activities. Based on this longer term review, our recommendation remains that TSR has advantages over HA with respect to pain and function at two years, and there has not been a reversal of the outcomes on prolonged follow-up. Revision from HA to TSR is made difficult due to glenoid erosion. Overall 89% of TSR remain insitu at death or 10 year, whereas 71% of HA were intact at the same times. The contention that HA will avoid later arthroplasty complications and, in particular, an unacceptable rate of late glenoid failure is not supported by this longer term review.

Introduction: We investigated the use of suture repair for tuberosities in hemiarthroplasty for 4 part fractures, by examining cadaveric repairs after repetitive loading tests.

Sutures are the most popular repair tool currently. However tuberosity “disappearance” with this is common; and touted as the prime cause for failure. In some studies biochemical lysis has been suggested to explain this. The aim of this study was to analyse the mode of failure.

Materials and Methods: Tests were carried out in line with UK HTA regulations. Eight fresh frozen cadaver shoulders were stripped of all soft tissue except the rotator cuff. A 4 part fracture was then created by osteotomising the tuberosities. A standard hemiarthroplasty implant was cemented in at the native height and retroversion. A tuberosity repair with Ethibond 5 sutures, employed transverse cerclage sutures; and vertical figure of eight repairs, from the cuff to a shaft drill hole.

The repairs were subjected to cyclical tension on the cuff musculature, and simultaneous gleno-humeral motion; using a test process we have described separately. During the entire process the repair site was videoed

At the end of 8000 cycles the tuberosities were probed with a forceps, to record any movement in vertical, horizontal and axial planes. The humeral shaft was also rotated to check for dissociation between tuberosities and shaft.

Results: Uniform failure of the hold on the tuberosities occurred by 8000 cycles. Defining failure as movement of any tuberosity more than 3mm, failure rate was 100% (exact 95% confidence interval 65.2 – 100% due to sample size). Movements of at least 1cm were commonly observed. The sutures were loose but never snapped. Failure mechanisms involved digging of the sutures into the tendon, cutting of the sutures through bone, loss of cancellous supporting structure, and migration of the sutures. Failure occurred early in what we considered to the parallel of 1 to 2 weeks of rehabilitation.

Conclusion: Suture repair of tuberosities has a high chance of failure if the cuff can not be prevented from contracting. We believe failure is early and mechanical, rather than by lysis or biochemical means. More effective alternatives to suture techniques would be desirable.

Long term clinical data and patient satisfaction is reported on 152 patients implanted with the UniSpacer interpositional spacer during the first four years of clinical use with a minimum 5-year, maximum 9-year follow-up. 156 UniSpacer™ Knee System implants were implanted in 152 patients (4 bilateral), for treatment of isolated medial compartment osteoarthritis over a 4-year period. The minimum follow-up for this group of patients is 5 years with a range of 60 to 108 months. Revisions to a TKR within one year of the implantation date during the first and second year of UniSpacer implantations were 6% and 5% respectively. By years three and four, the TKR revision rate within the first year had dropped to 0% (zero). The data reflects the improvement in surgical technique and the development of proper patient selection criteria. The long term data provides validation that the UniSpacerÔ can provide a successful, long term, bone preserving, treatment alternative to the current HTO, UKR or TKR procedures.

Introduction and Aims: The purpose of this study was to evaluate the effect on movement under load of different techniques of reattachment of the humeral tuberosities following four-part proximal humeral fracture.

Method: Biomechanical test sawbones were used. Four-part fracture was simulated and a cemented Neer3 prosthesis inserted. Three different techniques of reattachment of the tuberosities were used: 1) tuberosities attached to the shaft, and to each other through the lateral fins in the prosthesis with one cerclage suture through the anterior hole in the prosthesis; 2) as one without cerclage suture; 3) tuberosities attached to the prosthesis and to the shaft. All methods used a number five ethibond suture. Both tuberosities and the shaft had multiple markers attached. Two digital cameras formed an orthogonal photogrammetric system, allowing all segments to be tracked in a 3-D axis system. Humeri were incrementally loaded in abduction using an Instron machine, to a minimum 1200N, and sequential photographs taken. Photographic data was analysed to give 3-D linear and angular motions of all segments with respect to the anatomically relevant humeral axis, allowing intertuberosity and tuberosity-shaft displacement to be measured.

Results: Techniques one and two were the most stable constructs with technique three, allowing greater separation of fragments and angular movement. True inter-tuberosity separation at the midpoint of the tuberosities was significantly greater using technique three (p< 0.05). The cerclage suture used in technique two added no further stability to the fixation.

Conclusion: Our model suggests that the most effective and simplest technique of reattachment involves suturing the tuberosities to each other, as well as to the shaft of the humerus. The cerclage suture appears to add little to the fixation in abduction, although the literature would suggest it may have a role in resisting rotatory movements.

Abstract. BACKGROUND. Hemi-arthroplasty (HA) as a treatment for fractured neck of femur has slightly increased since 2019 and remarkably after the COVID pandemic. The main drawback of the treatment is ongoing cartilage deterioration that may require revision to THR. OBJECTIVE. This study assessed cartilage surface damage in hip HA by reproducing anatomical motion and loading conditions in a hip simulator. METHODS. Experimental design. HA tests were conducted using porcine acetabula and CoCr femoral heads. Five groups (n=4) were included: a control group comprising natural tissue and four HA groups where the acetabula were paired with metal heads to allow radial clearance (RC) classed as small (RC<0.6mm), large (2mm<RC<4mm), extra-large (4mm<RC), and oversized (RC<−0.6mm). Tests were carried out in an anatomical hip simulator that reproduced a simplified twin peak gait cycle, adapted for porcine hip joints, from the ISO 14242 standard for wear of THR prostheses (peak load of 900N). The test length was 6 hours, with photogrammetry taken at 1-hour intervals. Ringers solution was used as a lubricant. RESULTS. No changes were observed in the control group. However, cartilage surface changes were observed in all hemi-arthroplasty groups. Discolouration on the cartilage surface was noticeable at the posterior-superior part of the acetabulum after 1-hour (extra-large and oversized groups). Damage severity and location were characteristic of each clearance group. Of all the groups, the oversized group showed more significant damage. No labrum separation was seen after the simulation. CONCLUSIONS. These results are relevant to understand the effect of femoral head clearance on cartilage damage risk after HA. Declaration of Interest. (a) fully declare any financial or other potential conflict of interest

The National Institute for Health and Clinical Excellence (NICE) guidelines from 2011 recommend the use of cemented hemi-arthroplasty for appropriate patients with an intracapsular hip fracture. In our institution all patients who were admitted with an intracapsular hip fracture and were suitable for a hemi-arthroplasty between April 2010 and July 2012 received an uncemented prosthesis according to our established departmental routine practice. A retrospective analysis of outcome was performed to establish whether the continued use of an uncemented stem was justified. Patient, surgical and outcome data were collected on the National Hip Fracture database. A total of 306 patients received a Cathcart modular head on a Corail uncemented stem as a hemi-arthroplasty. The mean age of the patients was 83.3 years (. sd. 7.56; 46.6 to 94) and 216 (70.6%) were women. The mortality rate at 30 days was 5.8%. A total of 46.5% of patients returned to their own home by 30 days, which increased to 73.2% by 120 days. The implant used as a hemi-arthroplasty for intracapsular hip fracture provided satisfactory results, with a good rate of return to pre-injury place of residence and an acceptable mortality rate. Surgery should be performed by those who are familiar with the design of the stem and understand what is required for successful implantation. Cite this article: Bone Joint J 2013;95-B:1538–43

One of the most important sequelae to ageing is osteoporosis and subsequently hip fractures. Hip fractures are associated with major morbidity, mortality and costs. Most patients require surgery to restore mobility. Provision of surgery and its complications is poorly understood in South Africa. Our aim was to collect and report current hip fracture care at four centres in South Africa, as well as reporting surgical and general patient outcomes. A three year retrospective cohort at four centres will be described, focussing on provision of surgical care, mortality, types of surgery and complications. We identified 562 patients who had surgical intervention for fragility fractures, 66% were females. Forty nine percent had open reduction and internal fixation, 28% had hemi-arthroplasty replacement whilst 23% had total hip replacements. Twenty percent of patients had operative intervention within 36 hours of presentation to the emergency department. Mortality was 9% at 30 days. The most common complications were lower respiratory infections (29%), urinary tract infections (21%) and surgical site infections (9%). This is the largest cohort of surgically treated hip fracture from South Africa. Proportions of patients receiving different surgical interventions such as THR are comparable to the broader literature. However a number of key performance indicators such as surgery within 36 hours are challenging to meet. Given the changing demographics of South Africa, this study provides an early insight to contemporary care and may help provide direction for broader national strategies for reporting and improving hip fracture care

We aimed to examine outcomes between displaced femoral neck fracture (FNF) patients managed with total hip arthroplasty (THA) or hemi-arthroplasty (HA) via the anterolateral vs. posterior approach. We used data from the HEALTH trial (1,441 patients aged ≥50 with displaced FNFs randomized to THA vs. HA). We calculated each patient's propensity to undergo arthroplasty via the posterior approach, and matched them to 1 control (anterolateral approach) based on age (±5 years), and propensity score. We used Chi-Square/Fisher-Exact tests to compare dichotomous outcomes, and repeated measures ANOVA to examine differences in patient-reported outcomes (via the WOMAC subscores) from baseline to one-year postoperative. We used logistic regression to identify independent predictors of reoperation for instability in the posterior group. We identified 1,306 patients for this sub-analysis, 876 (67.1%) who received arthroplasty via an anterolateral approach, and 430 (32.9%) a posterior approach. The unadjusted rate of reoperation was significantly higher in the posterior group (10.7% vs. 7.1%). Following propensity score matching, we retained 790 patients (395 per group), with no between-group differences in patient, fracture, or implant characteristics. The matched cohort had a higher rate of comorbidities, and were less likely to be employed vs. the unmatched cohort. The rate of treatment for dislocation remained higher in the posterior group (6.1% vs. 2.0%) following matching. Repeated measures ANOVA revealed significantly better WOMAC pain, stiffness, function, and total scores in the posterior group. Between-group differences at 12-months were: pain - 0.59 (0.03–1.15); stiffness - 0.62 (0.35–0.87); function - 2.99 (0.12–5.86); total - 3.90 (0.24–7.56). We identified THA (vs. HA, odds ratio 2.05 [1.05–4.01]) as the only independent predictor of treatment for dislocation in the posterior group. Our analyses revealed that compromised patients with displaced FNFs who undergo arthroplasty via the posterior approach may report better symptoms at one-year vs. the anterolateral approach, despite a higher odds of reoperation for instability