A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: A randomised controlled multicentre trial in patients aged 70 years and over

M. P.J. Van Den Bekerom, E. F. Hilverdink, I. N. Sierevelt, E. M.B.P. Reuling, J. M. Schnater, H. Bonke, J. C. Goslings, C. N. Van Dijk, E. L.F.B. Raaymakers

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

The aim of this study was to analyse the functional outcome after a displaced intracapsular fracture of the femoral neck in active patients aged over 70 years without osteoarthritis or rheumatoid arthritis of the hip, randomised to receive either a hemiarthroplasty or a total hip replacement (THR). We studied 252 patients of whom 47 (19%) were men, with a mean age of 81.1 years (70.2 to 95.6). They were randomly allocated to be treated with either a cemented hemiarthroplasty (137 patients) or cemented THR (115 patients). At one- and five-year follow-up no differences were observed in the modified Harris hip score, revision rate of the prosthesis, local and general complications, or mortality. The intra-operative blood loss was lower in the hemiarthroplasty group (7% > 500 ml), THR group (26% > 500 ml) and the duration of surgery was longer in the THR group (28% > 1.5 hours versus 12% > 1.5 hours). There were no dislocations of any bipolar hemiarthroplasty than in the eight dislocations of a THR during follow-up. Because of a higher intra-operative blood loss (p < 0.001), an increased duration of the operation (p < 0.001) and a higher number of early and late dislocations (p = 0.002), we do not recommend THR as the treatment of choice in patients aged ≥ 70 years with a fracture of the femoral neck in the absence of advanced radiological osteoarthritis or rheumatoid arthritis of the hip.

Original languageEnglish
Pages (from-to)1422-1428
Number of pages7
JournalJournal of Bone and Joint Surgery - Series B
Volume92
Issue number10
DOIs
Publication statusPublished - 1 Oct 2010
Externally publishedYes

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