title: Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial.
abstract: BACKGROUND
  There were higher rates of revision, complication, non-union, delayed union, and poorer functional outcomes reported in super-aged patients of undisplaced femoral neck fractures treated with internal fixation. Therefore, we designed this randomized comparative study aiming to compare the effectiveness and long-term follow-up results of hemiarthroplasty (HA) with that of multiple cannulated screws (MCS).
  
  
  METHODS
  Eligible participants were randomly assigned into two groups for different methods of operation (hemiarthroplasty group and internal fixation group). The related indexes and data of two groups were collected for comparative analysis during the average follow-up period of 38.68 ± 28.24 months.
  
  
  RESULTS
  There were only two patients performed reoperation in HA group, and the reoperation rate of HA group (5.41%, 2/37) was significantly lower than that of IF group (21.4%, 9/41) (P value = 0.000). The comparison of survival curves for reoperation showed significant differences between two groups (P value = 0.031).The results of Cox proportional hazards model suggested that only operation method significantly affected the occurrence of reoperation (P value = 0.049). The results of survival analysis showed that there was no significant difference in survival time between two groups (P value = 0.682). And in the Cox proportional hazards model, only age significantly affected the occurrence of death (P value = 0.000). The average Harris scores of two groups were all above 75 points, and there was no significant difference in Harris scores between the two groups (P value greater than 0.05). But in the early term follow-up, the excellent and good rate of hip joint function in HA group was significantly higher than that in IF group (P value less than 0.05).
  
  
  CONCLUSIONS
  Hemiarthroplasty with less postoperative complications, low reoperation rate and better function recovery in early stage provide a good choice for the treatment of super-aged patients with nondisplaced femoral neck fracture.
authors.affiliation: Department of Orthopaedics, Affiliated Taizhou People's Hospital of Nantong University, Jiangsu, 225300, China. tzlqf62@163.com.
authors.forename: Qifeng
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Orthopaedics, Affiliated Taizhou People's Hospital of Nantong University, Jiangsu, 225300, China.
authors.forename: Genling
authors.initials: G
authors.lastname: Tang
authors.affiliation: Department of Orthopaedics, Affiliated Hospital of Jiangnan University, Wuxi, 21400, China.
authors.forename: Xijiang
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedics, Affiliated Taizhou People's Hospital of Nantong University, Jiangsu, 225300, China.
authors.forename: Shuguang
authors.initials: S
authors.lastname: Guo
authors.affiliation: Department of Orthopaedics, Affiliated Taizhou People's Hospital of Nantong University, Jiangsu, 225300, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Cai
authors.affiliation: Department of Orthopaedics, Affiliated Taizhou People's Hospital of Nantong University, Jiangsu, 225300, China.
authors.forename: Qingsong
authors.initials: Q
authors.lastname: Li
mesh_terms: D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D062785:Hemiarthroplasty / Q000009:adverse effects; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome
keywords: Femoral neck fractures; Hemiarthroplasty; Internal fixation; Super-aged; Undisplaced