Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures: a long-term follow-up of a randomised trial.
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.
Parker
Martyn J
MJ
Department of Orthopaedics, Peterborough District Hospital, Thorpe Road, Peterborough PE3 6DA, UK. Martyn.Parker@pbh-tr.nhs.uk
Pryor
Glyn
G
Gurusamy
Kurinchi
K
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006620:Hip Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010146:Pain / Q000453:epidemiology; D011475:Prosthesis Failure; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D016138:Walking / Q000502:physiology