Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

 

Study design: RCT

Published: September 26, 2019

 

Trial design: international RCT of 1495 patients, 50 years+ with displaced femoral neck fractures that require surgical intervention

 

Goal of study: to assess the effect of total hip arthroplasty vs. hemiarthroplasty

 

Patients were assigned to undergo either total hip arthroplasty or hemiarthroplasty. Patients underwent assessment at 1 week, 10 weeks, and 6, 9, 12, 18 and 24 months after surgery- either in person or by telephone.

 

749 patients received a total hip arthroplasty and 746 received a hemiarthroplasty.

Of the 1295 patients that underwent randomization, 1441 were included in the final analysis.

Of the 1243 patients that were alive at the 24-month mark, 1058 (85.1%) had 24-month follow up data available for analysis at end point.

 

Majority of patients were female (70.1%), 70 year or older (80.2%) and able to ambulate without the use of an assistance device prior to fracture (74.4%). Most injuries were subcapital femoral neck fractures (61.9%).

 

Primary outcomes: A secondary hip procedure within 24 months occurred in 7.9% of patients who received a total hip arthroplasty and in 8.3% who received a hemiarthroplasty. At the 1-year mark, the risk of a secondary hip procedure was higher in the total hip arthroplasty group than in the hemiarthroplasty. After 1 year, up to the 2-year mark- risk was higher is hemiarthroplasty group compared to total arthroplasty group.

• Hip dislocations that were treated with open or closed reduction were the most common secondary procedure in the total hip arthroplasty group. Implant revision was the most common secondary procedure in the hemiarthroplasty group

 

Secondary outcomes:

• Over 24 months, 13.7% of patients died. Mortality did not significantly differ between groups
• Serious adverse events occurred in 300 of 718 patients (41.8%) in the total arthroplasty group and in 265 of 723 (36.7%) in the hemiarthroplasty groups. Overall, hip-related complications were more common in the total hip arthroplasty group.
• Hip instability was seen in 4.7% of patients in the total hip arthroplasty group and in 2.4% of the hemiarthroplasty group.
• In regard to functional assessment and quality of life, EQ-5D visual analogue scale scores, the 12-Item Short Form General Health Survey (SF-12) physical and mental component summary scores, and TUG scores did not differ significantly between the treatment groups during follow-up.
• Pt that underwent total hip arthroplasty had superior function as measured by the WOMAC total score, WOMAC pain score, WOMAC stiffness score, and WOMAC function score. These differenced fell below the threshold for a minimal clinically important difference.

 

Final conclusion: among patients with displaced fractures of the femoral neck, they found that type of arthroplasty had no significant influence on the risk of unplanned secondary hip procedures over 24 months. Functional end points favored total hip over hemiarthroplasty during the 24-month period. Patients who underwent a total hip arthroplasty has a slightly higher incidence of serious adverse events.