Background: Hemiarthroplasty and total hip arthroplasty are commonly
used to treat displaced intracapsular fractures of the femoral neck, but each
has disadvantages and the optimal treatment of these fractures remains
Methods: In the present prospectively randomized study, eighty-one
patients who had been mobile and lived independently before they had sustained
a displaced fracture of the femoral neck were randomized to receive either a
total hip arthroplasty or a hemiarthroplasty. The mean age of the patients was
seventy-five years. Outcome was assessed with use of the Oxford hip score, and
final radiographs were assessed.
Results: After a mean duration of follow-up of three years, the mean
walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23
mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip
score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip
arthroplasty group. Patients in the total hip arthroplasty group walked
farther (p = 0.039) and had a lower (better) Oxford hip score (p = 0.033) than
those in the hemiarthroplasty group. Twenty of thirty-two living patients in
the hemiarthroplasty group had radiographic evidence of acetabular erosion at
the time of the final follow-up. None of the hips in the hemiarthroplasty
group dislocated, whereas three hips in the total hip arthroplasty group
dislocated. In the hemiarthroplasty group, two hips were revised to total hip
arthroplasty and three additional hips had acetabular erosion severe enough to
indicate revision. In the total hip arthroplasty group, one hip was revised
because of subsidence of the femoral component.
Conclusions: Total hip arthroplasty conferred superior short-term
clinical results and fewer complications when compared with hemiarthroplasty
in this prospectively randomized study of mobile, independent patients who had
sustained a displaced fracture of the femoral neck.
Level of Evidence: Therapeutic Level I. See Instructions
to Authors for a complete description of levels of evidence.