Authors: Ragnhild Øydna Støen Cathrine M Lofthus Lars Nordsletten Jan Erik Madsen Frede Frihagen
Publish Date: 2013/08/24
Volume: 472, Issue: 1, Pages: 360-367
Abstract
Hemiarthroplasty has been shown superior to internal fixation for displaced femoral neck fractures FNF in the first 2 years However there are unanswered questions about the performance of hemiarthroplasty over the longer term compared with internal fixationWe sought to compare hemiarthroplasty with internal fixation in terms of 1 outcomes scores for pain hip function and quality of life at a minimum of 5 years after surgery in a randomized trial A secondary purpose was to compare 2 patient survival and 3 frequency of reoperation in the two groupsA total of 222 consecutive patients older than 60 years including those cognitively impaired with FNF were randomized to either internal fixation with two parallel screws or bipolar hemiarthroplasty At a minimum followup of 49 years mean 59 years range 49–72 years 68 of the 70 surviving patients were examined by a study nurse and study physiotherapist blinded to initial treatment Questionnaires on hip function Harris hip score quality of life Eq5D and activity of daily living function Barthel ADL were administered The Barthel ADL index score was split into good function score 95 or 100 and reduced function score below 95The mean survival of the groups was similar with 664 73 of 110 of the patients undergoing hemiarthroplasty and 705 79 of 112 of the patients undergoing internal fixation having died since surgery p = 051 Only 12 of 31 living patients in the internal fixation group had retained their native hips at a mean of 6 years Between 2 and 6 years there were two new major reoperations both in the internal fixation group for avascular necrosis and deep wound infection The mean Harris hip score was 66 SD 19 and 67 SD 20 in the internal fixation and hemiarthroplasty groups respectively p = 096 The mean Eq5D index was 050 SD 040 in the internal fixation group and 034 SD 036 in the hemiarthroplasty group p = 010 Function in terms of ADLs was comparable between the groups of the patients in the internal fixation group 42 reported good function on the Barthel ADL index and the corresponding number in the hemiarthroplasty group was 51 p = 044Hemiarthroplasty has predictable and good longterm results after FNF and is the treatment of choice compared with internal fixation Further studies will evaluate if total hip arthroplasty has advantages over hemiarthroplasty in patients with fracture with long life expectancy
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