HSS Journal

, Volume 4, Issue 1, pp 48-54

First online:

Total Hip Arthroplasty is Less Painful at 12 Months Compared with Hemiarthroplasty in Treatment of Displaced Femoral Neck Fracture

  • William MacaulayAffiliated withCenter of Hip and Knee Replacement, Columbia University Email author 
  • , Kate W. NellansAffiliated withDoris Duke Clinical Research, Columbia University
  • , Richard IorioAffiliated withDepartment of Orthopaedic Surgery, Lahey Clinic
  • , Kevin L. GarvinAffiliated withOrthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center
  • , William L. HealyAffiliated withDepartment of Orthopaedic Surgery, Lahey Clinic
  • , Melvin P. RosenwasserAffiliated withOrthopaedic Hand and Trauma Service, Columbia University
  • , DFACTO Consortium

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The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO) study compared total hip arthroplasty (THA) to hemiarthroplasty in the treatment of displaced femoral neck fractures.


This study was designed as a prospective, randomized clinical trial.


The study was conducted in five US academic and private medical centers.


Patients were composed of independent, mentally competent individuals, >50 years old who suffered a displaced femoral neck fracture without existing arthritis at the hip. Forty-one patients were enrolled.

Main outcome measures

Functional outcomes and quality of life were assessed at 6 and 12 months post-fracture using the SF-36, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Harris Hip Score, and the Timed “Up & Go” Test (TUG test).


Groups were equivalent at baseline in terms of age, comorbid conditions, and functional status. At 6 months, there were no significant differences between the groups using the outcome measures or overall rates of complications. There was one dislocation in the THA group (5.8% of patients). At 12 months, the THA group reported significantly less pain (53.2 ± 10.2) than the hemiarthroplasty group (42.4 ± 11.5) using the SF-36 (p = 0.02). Using the TUG Test, we observed a greater proportion of THA patients remain functionally independent 1 year after surgery compared the hemiarthroplasty group (p = 0.08, controlling for age and sex).


These differences in pain and functional outcomes suggest THA is a viable treatment option for the active elderly displaced femoral neck fracture population.

Key words

displaced femoral neck fracture total hip arthroplasty hemiarthroplasty pain functional outcomes