Hip fractures are a leading cause of hospital admission and an increasing problem within the ageing population. The two main treatment options for displaced intracapsular fractures are total hip arthroplasty and hemiarthroplasty.

This service evaluation aims to compare the outcomes of patients over 80 years old with a younger cohort undergoing the two main treatment modalities.

The study included 378 patients admitted to a major UK trauma centre between April 2011 and March 2013. The main outcome measures were: mortality rate at 30 days and 1 year; reoperation rate at 30 days; proportion living in their own home/sheltered accommodation at 30 days, 1 year and upon NHS discharge; change in walking ability indoors and outdoors at 30 days and 1 year.

All patients receiving THA were discharged home compared to 74.3% under 80 receiving hemiarthroplasty and 57.3% over 80 receiving hemiarthroplasty. No THA patients required reoperation at 30 days. 4.4% under 80 receiving hemiarthroplasty required reoperation, as did 2.0% over 80 receiving hemiarthroplasty. Mortality rates were higher following hemiarthroplasty. Patients receiving THA in both age groups were more likely to retain their pre-injury walking ability at 1 year; however loss of walking ability was similar at 30 days regardless of age or treatment.

Patients receiving THA in the trust had less risk of mortality and reoperation with an increased chance of retaining pre-injury walking ability and place of residence; however these patients were healthier prior to the operation. Age had a larger impact on walking ability for those receiving hemiarthroplasty.