title: Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data.
abstract: BACKGROUND
  The treatment of choice for intracapsular neck of femur (NOF) fractures in younger, more active patients remains unknown. Some surgeons advocate total hip replacement (THR).
  
  
  OBJECTIVE
  This study aimed to compare complications following THR and hemiarthroplasty using the Hospital Episode Statistics (HES) database in England.
  
  
  METHODS
  Dislocation and revision rates were extracted for all patients with NOF fracture who underwent either cemented hemiarthroplasty or cemented THR between January 2005 and December 2008. To make a 'like for like' comparison all 3866 THR patients were matched to 3866 hemiarthroplasty patients (from a total of 41,343) in terms of age, sex and Charlson score.
  
  
  CONCLUSIONS
  Eighteen-month dislocation was significantly higher in the THR group (2.4% vs. 0.5%, odds ratio (OR) 3.90 (2.99-5.05), p<0.001). This difference was sustained at the 4-year stage (2.9% vs. 0.9%, OR 3.18 (1.58-6.94), p=0.001) in a subset of patients with longer follow-up. There was no significant difference in revision rate up to 4 years (1.8% vs. 2.1%, OR 0.85 (0.46-1.55), p=0.666). In this national analysis of matched patients short- and medium-term dislocation rates following THR were significantly higher than following cemented hemiarthroplasty, without any difference in revision rates at 4 years. The low risk of dislocation may be acceptable in order to experience the apparent functional benefits of THR.
authors.affiliation: National Orthopaedic Research and Surgical Outcomes Collaboration, UK; Northern Deanery Trauma & Orthopaedic Training Scheme, Waterfront 4, Goldcrest Way, Newcastle NE15 8NY, UK. Electronic address: simonjameson@doctors.org.uk.
authors.forename: Simon S
authors.initials: SS
authors.lastname: Jameson
authors.forename: Deborah
authors.initials: D
authors.lastname: Lees
authors.forename: Philip
authors.initials: P
authors.lastname: James
authors.forename: Andrew
authors.initials: A
authors.lastname: Johnson
authors.forename: Christopher
authors.initials: C
authors.lastname: Nachtsheim
authors.forename: James L
authors.initials: JL
authors.lastname: McVie
authors.forename: Amar
authors.initials: A
authors.lastname: Rangan
authors.forename: Scott D
authors.initials: SD
authors.lastname: Muller
authors.forename: Mike R
authors.initials: MR
authors.lastname: Reed
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D015897:Comorbidity; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D062785:Hemiarthroplasty; D006617:Hip Dislocation / Q000401:mortality / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012086:Reoperation; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Hemiarthroplasty; Hip surgery; Hip trauma; Intracapsular hip fracture; Management; National joint register; Outcomes; Proximal femoral fracture; Total hip replacement