The authors declare that they have no competing interests.
OS initiated the study, designed the study, wrote the manuscript, supervised GC and SM and is the principal investigator of the study. GC initiated the study, designed the study and wrote the manuscript. SM wrote the first draft of the manuscript. MS and OM helped design the study and wrote the manuscript. HS and C-JH wrote the manuscript. All authors read and approved the final manuscript.
A femoral neck fracture (FNF) is a common cause of suffering and premature death in the elderly population. Optimizing the treatment for improved outcome and a reduced need for secondary surgery is important both for the patient and the society. The choice of primary total or hemiarthroplasty in patients over eighty years are controversial. We hypothesized that total hip arthroplasty has an equal or better outcome in patient-reported outcome compared with hemiarthroplasty.
A prospective, randomized, single-blinded trial will be conducted. We will include 120 patients, 80 years of age and over with an acute (<36 h) displaced femoral neck fracture. The patients will be randomized in a 1:1 ratio to either total hip arthroplasty or hemiarthroplasty. The primary endpoints are Harris hip Score and EQ-5D. Secondary endpoints include pain measured with visual analogue scale, surgical time, reoperations, complications and radiological measurement of erosion in patients operated with hemiarthroplasty. Follow-up will be performed postoperatively after three months, 1, 2, 4 and 10 years.
To our knowledge, this is the first randomized controlled trial comparing total hip arthroplasty and hemiarthroplasty for displaced femoral neck fracture in patients age 80 years and over.
Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta 3rd P, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003;85-A(9):1673–81. PubMed
Leonardsson O, Sernbo I, Carlsson A, Akesson K, Rogmark C. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients. J Bone Joint Surg Br. 2010 Mar;92(3):406–12. doi: 10.1302/0301-620×.92B3.23036. Erratum in. J Bone Joint Surg Br. 2010;92(6):901.
Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, et al. Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br. 2011;93(8):1045–8. doi: 10.1302/0301-620×.93B8.27132. CrossRefPubMed
Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007;89(2):160–5. CrossRefPubMed
Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am. 2011;93(5):445–50. doi: 10.2106/JBJS.J.00474. CrossRefPubMed
Macaulay W, Nellans KW, Garvin KL, Iorio R, Healy WL, Rosenwasser MP. Other members of the DFACTO Consortium. Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award. J Arthroplasty. 2008;23(6 Suppl 1):2–8. doi: 10.1016/j.arth.2008.05.013. CrossRefPubMed
van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, et al. 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. J Bone Joint Surg Br. 2010;92(10):1422–8. doi: 10.1302/0301-620×.92B10.24899. CrossRefPubMed
Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop. 2012;36(8):1549–60. doi: 10.1007/s00264-012-1569-7. CrossRefPubMedPubMedCentral
Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technol Assess. 2005;9(41):1–65. iii-iv, ix-x. CrossRef
Garden RS. Low-angle fixation of fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–63.
Gammer W. A modified lateroanterior approach in operations for hip arthroplasty. Clin Orthop Relat Res. 1985;199:169–72. PubMed
Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51–4:737–55.
Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score: comparison of patient self-report with surgeon assessment. J Arthroplasty. 2001;16–5:575–80. CrossRef
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33–5:337–43. CrossRef
Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37–4:378–81. CrossRef
Reuling EM, Sierevelt IN, van den Bekerom MP, Hilverdink EF, Schnater JM, van Dijk CN, et al. Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score. Arch Orthop Trauma Surg. 2012;132(2):249–56. doi: 10.1007/s00402-011-1424-0. CrossRefPubMed
- HOPE-trial: hemiarthroplasty compared to total hip arthroplasty for displaced femoral neck fractures in the elderly-elderly, a randomized controlled trial
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II