Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture.
OBJECTIVE
The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO) study compared total hip arthroplasty (THA) to hemiarthroplasty in the treatment of displaced femoral neck fractures.


METHODS
This study was designed as a prospective, randomized clinical trial.


METHODS
The study was conducted in five US academic and private medical centers.


METHODS
Patients were composed of independent, mentally competent individuals, >50 years old who suffered a displaced femoral neck fracture without existing arthritis at the hip. Forty-one patients were enrolled.


METHODS
Functional outcomes and quality of life were assessed at 6 and 12 months post-fracture using the SF-36, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Harris Hip Score, and the Timed "Up & Go" Test (TUG test).


RESULTS
Groups were equivalent at baseline in terms of age, comorbid conditions, and functional status. At 6 months, there were no significant differences between the groups using the outcome measures or overall rates of complications. There was one dislocation in the THA group (5.8% of patients). At 12 months, the THA group reported significantly less pain (53.2 +/- 10.2) than the hemiarthroplasty group (42.4 +/- 11.5) using the SF-36 (p = 0.02). Using the TUG Test, we observed a greater proportion of THA patients remain functionally independent 1 year after surgery compared the hemiarthroplasty group (p = 0.08, controlling for age and sex).


CONCLUSIONS
These differences in pain and functional outcomes suggest THA is a viable treatment option for the active elderly displaced femoral neck fracture population.
Macaulay
William
W
Center of Hip and Knee Replacement, Columbia University, 622 W 168 St, PH-1146, New York, NY 10032, USA. wm143@columbia.edu
Nellans
Kate W
KW
Iorio
Richard
R
Garvin
Kevin L
KL
Healy
William L
WL
Rosenwasser
Melvin P
MP