Abstract
Introduction
An intracapsular fracture of the femoral neck is frequent in the elderly. Patients can be treated with either total hip arthroplasty or hemiarthroplasty. There is a continuous discussion about the treatment in elderly patients who are still healthy, active and mentally untroubled. A potential consequence of hemiarthroplasty, especially in the relatively young elderly, could be conversion to total hip arthroplasty. The conversion rate must be acceptable, and clinical outcome must be sufficient to justify the treatment with hemiarthroplasty in this group of patients. This study evaluates the conversion rate of hemiarthroplasty to total hip arthroplasty and clinical outcome in patients under 75 years of age.
Methods
This study identified 248 patients, younger than 75 years at time of operation, with a fracture of the femoral neck treated with hemiarthroplasty. Patient-reported outcome measurements (VAS pain during rest and activity and WOMAC) were assessed by telephone interviews. Furthermore, radiographic evaluation for the presence of acetabular wear was performed.
Results
At a follow-up of 5.1 (0.9–9.6) years, the conversion rate was 7.3%. Mean VAS pain in rest was 0.89 (0–10), the mean VAS pain during activity was 2.2 (0–10), and the WOMAC showed a mean of 16.51 (0–64). At time of follow-up, 38.7% of patients had died. Radiographic evaluation of the unrevised group showed in one patient signs of acetabulum wear.
Conclusion
Hemiarthroplasty in the relatively young elderly after a fracture of the femoral neck demonstrates an acceptable conversion rate. Furthermore, unrevised patients show low complaints of pain. To prevent one conversion to total hip arthroplasty, 13.7 patients should be treated with total hip arthroplasty that will not undergo a conversion at a later stage. Therefore, hemiarthroplasty remains a viable treatment of femoral neck fractures in relatively young patients. There seems to be no space for standardized decision making concerning the choice of treatment. An individual approach is required.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kannan A, Kancherla R, McMahon R, Hawdon G, Soral A, Malhotra R (2012) Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop 36:1–8. https://doi.org/10.1007/s00264-011-1354-z
Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, Bannister GC (2011) Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br 93(8):1045–1048. https://doi.org/10.1302/0301-620X.93B8.27132
Leonardsson O, Rolfson O, Hommel A, Garellick G, Åkesson K, Rogmark C (2013) Patient-reported outcome after displaced femoral neck fracture a national survey of 4467 patients. J Bone Joint Surg Am 95(18):1693–1699. https://doi.org/10.2106/JBJS.L.00836
Baker RP, Squires B, Gargan MF, Bannister GC (2006) Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Br. 93(8):1045–1048. https://doi.org/10.1302/0301-620x.93b8.27132
Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur–13 year results of a prospective randomised study. Injury 31(10):793–797
Guyen O (2019) Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res 105(1S):S95–S101. https://doi.org/10.1016/j.otsr.2018.04.034
Von Roth P, Abdel MP, Harmsen WS, Berry DJ (2015) Cemented bipolar hemiarthroplasty provides definitive treatment for femoral neck fractures at 20 years and beyond. Clin Orthop Relat Res 473(11):3595–3599. https://doi.org/10.1007/s11999-015-4462-z
Murena L, Fattori R, Scamacca V, Cau P, Ratti C, Canton G (2016) Treatment of intracapsular fractures of the proximal femur with bipolar hemiarthroplasty in patients under the age of 70: clinical and radiographic results at mean 20 years follow-up. Acta Biomed 87(Suppl 1):53–59
van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, Goslings JC, van Dijk CN, Raaymakers EL (2010) A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Br 92(10):1422–1428. https://doi.org/10.1302/0301-620X.92B10.24899
Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 16:229. https://doi.org/10.1186/s12891-015-0696-x
Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, Tidermark J (2011) Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 93(5):445–450. https://doi.org/10.2106/JBJS.J.00474
Phillips TW (1989) Thompson hemiarthroplasty and acetabular erosion. J Bone Joint Surg Am 71(6):913–917
Van den Bekerom MPJ, Sierevelt IN, Bonke H, Raaymakers ELFB (2013) The natural history of the hemiarthroplasty for displaced intracapsular femoral neck fractures. Acta Orthop 84(6):555–560. https://doi.org/10.3109/17453674.2013.867763
Grosso MJ, Danoff JR, Murtaugh TS, Trofa DP, Sawires AN, Macaulay WB (2017) Hemiarthroplasty for displaced femoral neck fractures in the elderly has a low conversion rate. J Arthroplasty 32(1):150–154. https://doi.org/10.1016/j.arth.2016.06.048
Dolan P, Sutton M (1997) Mapping visual analogue scale health state valuations onto standard gamble and time trade-off values. Soc Sci Med 44(10):1519–1530
Robinson A, Dolan P (1997) Williams A (1997) valuing health status using VAS and TTO. Soc Sci Med 45(8):1289–1297
Bellamy NW, Buchannan WW, Goldsmith CH, Cambell J, Stitt LW (1988) Validation study of WOMAC. J Rheumatol 15(12):1833–1840
Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, Willems WJ, Heyligers IC, Voaklander DC, Kelly KD, Suarez-Almazor ME (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63(1):36–42
Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ (2019) Comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures: a propensity score-matched, population-based study. J Bone Joint Surg Am. 101(7):572–579. https://doi.org/10.2106/jbjs.18.00539
Moerman S, Mathijssen NMC, Tuinebreijer WE, Vochteloo AJH, Nelissen RGHH (2018) Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision. Acta Orthop 89(5):509–514. https://doi.org/10.1080/17453674.2018.1499069
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical statement
The procedures followed were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki Declaration and its later amendments.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Schmitz, P.P., van Susante, J.L.C. & Somford, M.P. Low conversion rates toward total hip arthroplasty after hemiarthroplasty in patients under 75 years of age. Eur J Orthop Surg Traumatol 29, 1687–1691 (2019). https://doi.org/10.1007/s00590-019-02498-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-019-02498-0