Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial.
OBJECTIVE
To compare the functional results after displaced fractures of the femoral neck treated with internal fixation or hemiarthroplasty.


METHODS
Randomised trial with blinding of assessments of functional results.


METHODS
University hospital.


METHODS
222 patients; 165 (74%) women, mean age 83 years. Inclusion criteria were age above 60, ability to walk before the fracture, and no major hip pathology, regardless of cognitive function.


METHODS
Closed reduction and two parallel screws (112 patients) and bipolar cemented hemiarthroplasty (110 patients). Follow-up at 4, 12, and 24 months.


METHODS
Hip function (Harris hip score), health related quality of life (Eq-5d), activities of daily living (Barthel index). In all cases high scores indicate better function.


RESULTS
Mean Harris hip score in the hemiarthroplasty group was 8.2 points higher (95% confidence interval 2.8 to 13.5 points, P=0.003) at four months and 6.7 points (1.5 to 11.9 points, P=0.01) higher at 12 months. Mean Eq-5d index score at 24 months was 0.13 higher in the hemiarthroplasty group (0.01 to 0.25, P=0.03). The Eq-5d visual analogue scale was 8.7 points higher in the hemiarthroplasty group after 4 months (1.9 to 15.6, P=0.01). After 12 and 24 months the percentage scoring 95 or 100 on the Barthel index was higher in the hemiarthroplasty group (relative risk 0.67, 0.47 to 0.95, P=0.02. and 0.63, 0.42 to 0.94, P=0.02, respectively). Complications occurred in 56 (50%) patients in the internal fixation group and 16 (15%) in the hemiarthroplasty group (3.44, 2.11 to 5.60, P<0.001). In each group 39 patients (35%) died within 24 months (0.98, 0.69 to 1.40, P=0.92)


CONCLUSIONS
Hemiarthroplasty is associated with better functional outcome than internal fixation in treatment of displaced fractures of the femoral neck in elderly patients.


BACKGROUND
NCT00464230.
Frihagen
Frede
F
Orthopaedic Centre, Ulleval University Hospital, Oslo, Norway, and Faculty of Medicine, University of Oslo, Norway. j.f.frihagen@medisin.uio.no
Nordsletten
Lars
L
Madsen
Jan Erik
JE
D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006617:Hip Dislocation / Q000401:mortality / Q000601:surgery*; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome