Clinical Orthopaedics and Related Research®

, Volume 472, Issue 1, pp 360–367 | Cite as

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

  • Ragnhild Øydna StøenEmail author
  • Cathrine M. Lofthus
  • Lars Nordsletten
  • Jan Erik Madsen
  • Frede Frihagen
Clinical Research



Hemiarthroplasty has been shown superior to internal fixation for displaced femoral neck fractures (FNF) in the first 2 years. However, there are unanswered questions about the performance of hemiarthroplasty over the longer term compared with internal fixation.


We sought to compare hemiarthroplasty with internal fixation in terms of (1) outcomes scores for pain, hip function, and quality of life at a minimum of 5 years after surgery in a randomized trial. A secondary purpose was to compare (2) patient survival and (3) frequency of reoperation in the two groups.


A total of 222 consecutive patients older than 60 years, including those cognitively impaired, with FNF were randomized to either internal fixation with two parallel screws or bipolar hemiarthroplasty. At a minimum followup of 4.9 years (mean, 5.9 years; range, 4.9–7.2 years), 68 of the 70 surviving patients were examined by a study nurse and study physiotherapist blinded to initial treatment. Questionnaires on hip function (Harris hip score), quality of life (Eq5D), and activity of daily living function (Barthel ADL) were administered. The Barthel ADL index score was split into good function (score 95 or 100) and reduced function (score below 95).


The mean survival of the groups was similar with 66.4% (73 of 110) of the patients undergoing hemiarthroplasty and 70.5% (79 of 112) of the patients undergoing internal fixation having died since surgery (p = 0.51). Only 12 of 31 living patients in the internal fixation group had retained their native hips at a mean of 6 years. Between 2 and 6 years, there were two new major reoperations (both in the internal fixation group, for avascular necrosis and deep wound infection). The mean Harris hip score was 66 (SD 19) and 67 (SD 20) in the internal fixation and hemiarthroplasty groups, respectively (p = 0.96). The mean Eq5D index was 0.50 (SD 0.40) in the internal fixation group and 0.34 (SD 0.36) in the hemiarthroplasty group (p = 0.10). Function in terms of ADLs was comparable between the groups; of the patients in the internal fixation group, 42% reported good function on the Barthel ADL index, and the corresponding number in the hemiarthroplasty group was 51% (p = 0.44).


Hemiarthroplasty has predictable and good long-term results after FNF and is the treatment of choice compared with internal fixation. Further studies will evaluate if total hip arthroplasty has advantages over hemiarthroplasty in patients with fracture with long life expectancy.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Internal Fixation Femoral Neck Fracture Displace Femoral Neck Fracture Bipolar Hemiarthroplasty Hemiarthroplasty Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank study nurse Kenneth Nilsen and physiotherapists Åsa Axelsson and Marte T. Magnusson who participated in the collection of data.


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Ragnhild Øydna Støen
    • 1
    • 2
    • 3
    Email author
  • Cathrine M. Lofthus
    • 4
  • Lars Nordsletten
    • 1
    • 2
  • Jan Erik Madsen
    • 1
    • 2
  • Frede Frihagen
    • 1
    • 2
    • 3
  1. 1.Department of Orthopaedic SurgeryOslo University HospitalOsloNorway
  2. 2.University of OsloOsloNorway
  3. 3.Department of OrthopaedicsRingerike Hospital, Vestre Viken Hospital TrustHønefossNorway
  4. 4.Department of EndocrinologyOslo University HospitalOsloNorway

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