Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures: A long-term follow-up of a randomised trial

Abstract

In a prospective randomised trial, 455 patients presenting to one hospital with a displaced intracapsular fracture were randomised to either closed reduction and internal fixation with three cancellous screws or replacement with an uncemented hemiarthroplasty. Follow-up of surviving patients was for between 9 and 15 years to determine the long-term outcome for the two treatment methods. 93% of patients died during this follow-up period. There was no difference in mortality between the two procedures. The need for revision surgery to the hip was increased for those treated by internal fixation (93% versus 62% implant survival rate; hazard ratio: 0.14, 95% CI 0.08–0.24). 91% of revision's operations occurred within 2 years from injury. There was no difference in the degree of residual pain between groups neither was there any difference in the number of patients requiring institutional care. These results demonstrate that both treatment methods produce comparable final outcomes but internal fixation is associated with an increased re-operation rate.

Introduction

The displaced intracapsular fracture has frequently been termed the unsolved fracture with continued debate as to whether the femoral head should be preserved or replaced.⁵ A number of recently reported randomised trials comparing these two methods of treatment have tended to favor arthroplasty as this method of treatment was found to have a lower re-operation rate and a tendency to a better functional outcome.⁶ We have undertaken the largest randomised trial to date on this topic and an earlier report presented the results with a 3-year follow-up for these patients.⁷ This report presents the long-term follow-up for the patients recruited to this study with a mean follow-up for the surviving participants of 11 years.