Long-term prospective RCT comparing hemiarthroplasty (HEMI) and total hip arthroplasty (THA) for the treatment of intracapsular neck of femur fracture.

81 previously mobile, independent, orientated patients were randomised to receive THA or HEMI after sustaining a displaced neck of femur fracture. Patients were followed up with radiographs, Oxford hip score (OHS), SF-36 scores and their walking distance.

At a mean follow up of 8.7 years, overall mortality following THA was 32.5% compared to 51.2% following HEMI (p=0.09). Following THA, patients died after a mean of 63.6 months compared to 45 months following HEMI (p=0.093). Patients with THA walked further and had better physical function. No HEMIs dislocated but three (7.5%) THAs did. Four (9.8%) HEMI patients were revised to THA, but only one (2.5%) THA required revision. All surviving HEMI patients had acetabular erosion and all surviving THA patients had wear of the cemented polyethylene cup.

Patients with THA have better function in the medium-term and survive longer.

Introduction: We report on the long-term follow up of a previously published randomised controlled trial comparing Hemiarthroplasty (HEMI) and total hip arthroplasty (THA) for the treatment of intracapsular fracture neck of femur.

Methods: In this prospectively randomized study, 81 patients who had been mobile and lived independently and who sustained a displaced fracture of the femoral neck were randomized to receive either a fixed acetabular component THA or HEMI. The mean age of the study group was 75 years at fracture. All patients received the same cemented collarless tapered femoral stem and all procedures were performed through a transgluteal approach. Patients were followed up with radiographs, Oxford hip score (OHS), SF-36, Euroqol and their walking distance.

Results: At a mean follow-up of 8.6 years (7.18 to 10.27), 19 HEMI patients and 27 THA were alive (p=0.042). The mean walking distance of patients after HEMI was 600m and the OHS 21. After THA, the mean walking distance was 1200m and the OHS was 22. Both groups had a deterioration of their OHS over time. There were no significant differences between the groups with respect to both physical and mental component SF-36 scores and Euroqol visual analogue scores.

Of the survivors four of the HEMI group were revised to total hip arthroplasty. One patient had been revised in the THA group. Radiographically six of seven patients in the HEMI group had evidence of acetabular erosion and 13 of 15 patients in the THA group had a lucency around their acetabular component.

Discussion: Patients with THA walked further and survived longer. After a mean of nine years follow up there was no difference with respect to function as measured by OHS, Euroqol and SF-36 scores.

A prospective study of allergic contact dermatitis after metal-on-plastic total hip replacement was undertaken in 69 patients, of whom 54 were available for review after operation. Before operation six patients were metal sensitive, but only one remained so afterwards; this patient had given a clear history of metal sensitivity and a titanium prosthesis had therefore been used. In all six patients the result of the operation was good and no case of loosening occurred. Sixty-three patients had negative patch tests before operation; in none of these was metal sensitivity detected after operation. Cutaneous sensitivity to various metals is well documented after the insertion of metal-on-metal prostheses and in failed prostheses. We have not found any such increased sensitivity after metal-on-plastic hip replacement. There is little evidence of a direct causal relationship between metal sensitivity and subsequent loosening. The cutaneous sensitivity may be the consequence of loosening rather than its cause. Our results suggest that, providing metal-on-plastic prostheses are used, routine patch testing before hip replacement is no longer required.

Hemicircumferential division of the periosteum was performed on the upper tibia of the rabbit. Division of the medial side regularly caused a valgus angulation, but other injuries about the upper tibia had no effect. The cause of deformity after periosteal damage is discussed.

Five cases of Kienbock's disease occurring in a group of fifty-three adults with cerebral palsy are described. The increased incidence of the disease is attributed to the flexed posture habitual in the affected wrist and to an effect on the pattern of blood supply to the lunate.