Do hip replacements improve outcomes for hip fracture patients?
BACKGROUND
Hip fracture is a common problem among older Americans. Two types of procedures are available for repairing hip fractures: hip replacement and open or closed reduction with or without internal fixation. The assumption has been that hip replacement produces better functional outcomes. Although that is the common wisdom, outcome studies evaluating hip replacement for treatment of hip fracture are few and have not clearly documented its superiority.


OBJECTIVE
To compare outcomes of hip fracture patients who receive hip replacement versus another stabilizing procedure (open or closed reduction with or without internal fixation).


METHODS
Prospective cohort study.


METHODS
We studied 332 patients (age, > 65) who were hospitalized for a femoral neck fracture and discharged alive.


METHODS
We examined 2 treatment groups, hip replacement versus another procedure, on 6 outcomes [Activities of Daily Living (ADLs), walking, living situation (institutionalized or not), perceived health (excellent/good vs. fair/poor), rehospitalization, and mortality] at 3 postdischarge times (6 weeks, 6 months and 1 year).


RESULTS
Mean age was 80, 80% were female, 96% White, 28% married, and 71% had a hip replacement. The treatment groups were similar at baseline (3 months before admission as reported at discharge) on ADLs, walking, living situation, and perceived health (all P > 0.24). After adjusting for demographics, clinical characteristics, fracture characteristics, and prior ADLs, walking ability, living situation, and perceived health, patients with a hip replacement did not do better at 6 weeks, 6 months, or 1 year post-discharge on any of the 6 outcome measures (all 18 P > 0.10). A global test of all 6 outcomes finds hip replacement patients doing less well at one year (P = 0.02).


CONCLUSIONS
Despite the commonly held belief that hip replacement is a superior treatment for hip fracture, we found no suggestion of better outcomes for hip replacement on any of 6 key outcomes.
Burns
R B
RB
Evans Department of Medicine, Boston University Medical Center, MA 02118-2334, USA.
Moskowitz
M A
MA
Ash
A
A
Kane
R L
RL
Finch
M
M
McCarthy
E P
EP
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D003430:Cross-Sectional Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005592:Fracture Fixation / Q000379:methods; D006304:Health Status; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008910:Minnesota / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome