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

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HSS Journal

Abstract

Objectives

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.

Design

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

Setting

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

Patients

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).

Results

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).

Conclusions

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

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References

  1. Stevens, J, Hasbrouck LM, Durant TM, et al. (1999) Surveillance for injuries and violence among older adults. MMWR CDC Surveill Summ 48:27–50

    PubMed  CAS  Google Scholar 

  2. Schneider, E., Guralnik JM (1990) The aging of America-impact on health care costs. JAMA 263:2335–2340

    Article  PubMed  CAS  Google Scholar 

  3. Magaziner, J, Fredman L, Hawkes W, Hebel JR, Zimmerman S, Orwig DL, Wehren L (2003) Changes in Functional Status Attributable to Hip Fracture: A Comparison of Hip Fracture Patients to Community-dwelling Aged. Am J Epidemiol 157(11):1023–1031

    Article  PubMed  Google Scholar 

  4. Lu-Yao, G, Keller RB, Littenberg B, Wennberg JE (1994) Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. JBJs 76(A)(1):15–25

    Google Scholar 

  5. Keating, J, Grant A, Masson M, Scott NW, Forbes JF (2006) Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. JBJS 88A(2’):249–260

    Google Scholar 

  6. Ravikumar, K, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur—13 year results of a prospective randomized study. Injury 31(10):793–797

    Article  PubMed  CAS  Google Scholar 

  7. Rodriguez-Merchan, E (2002) Displaced Intracapsular Hip Fractures: Hemiarthroplasty or Total Arthroplasty? Clin Orthop 399:72–77

    Article  PubMed  Google Scholar 

  8. Papandrea, R, Froimson MI (1996) Total hip arthroplasty after acute displaced femoral neck fracture. Am J Orthop 25:85–88

    PubMed  CAS  Google Scholar 

  9. Kofoed, H., Kofod, J (1983) Moore prosthesis in the treatment of fresh femoral neck fractures. A critical review with special attention to secondary acetabular degeneration. Injury 14:531–540

    Article  PubMed  CAS  Google Scholar 

  10. Healy, W, Iorio R (2004) Total Hip Arthoplasty: Optimal Treatment for displaced femoral neck fractures in elderly patients. Clin Orthop 429:42–48

    Google Scholar 

  11. Garden, R (1961) Low-Angele Fixation in Fractures of the Femoral Neck. JBJA 43B(4):647–663

    Google Scholar 

  12. Folstein, M, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  PubMed  CAS  Google Scholar 

  13. Bellamy, N (1989) Pain assessment in osteoarthritis, experience with WOMAC osteoarthritis index. Semin Arthritis Rheum 2(supplement 2):14–17

    Google Scholar 

  14. Beaton D, Schemitsch E (2003) Measures of health-related quality of life and physical function. Clin Orthop 413:90–105

    Article  PubMed  Google Scholar 

  15. McHorney, C, Ware Jr JE, Rogers W, Raczek AE, Lu JF (1992) The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Med Care 309 (supplement 5):247–263

    Google Scholar 

  16. Lyons, R, Perry HM, Littlepage BN (1994) Evidence for the validity of the Short-form 36 Questionnaire (SF-36) in an elderly population. Age Ageing 23(3):182–184

    Article  PubMed  CAS  Google Scholar 

  17. Podsiadlo, D, Richardson, S (1991) The Timed “Up & Go”: A test of basic functional mobility of frail elderly persons. J Am Geriatr Soc 39:142–148

    PubMed  CAS  Google Scholar 

  18. Okumiya, K, Matsubayashi K, Nakamura T, Fujisawa M, Osaki Y, Doi Y, Ozawa T (1999) The timed “Up & Go” test and manual button score are useful predictors of functional decline in basic and instrumental ADL in community-dwelling older people. J Am Geriatr Soc 47(4):497–498

    PubMed  CAS  Google Scholar 

  19. Bischoff, H, Stahelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, Akos R, Conzelmann M, Dick W, Theiler R (2003) Identifying a cut-off point for normal mobility: a comparison of the timed ‘up and go’ test in community-dwelling and institutionalised elderly women. Age Ageing 32(3):315–320

    Article  PubMed  Google Scholar 

  20. Harris, W (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. JBJS(A) 51(4):737–755

    CAS  Google Scholar 

  21. Wolinsky, F, Fitzgerald JF, Stump TE (1997) The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health 87(3):398–403

    Article  PubMed  CAS  Google Scholar 

  22. Raia, F, Chapman CB, Herrera MF, Schweppe MW, Michelsen CB, Rosenwasser MP (2003) Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res 414:259–265

    Article  PubMed  Google Scholar 

  23. Bhandari, M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, Schemitsch EH, Hanson BP, Koval K, Dirschl D, Leece P, Keel M, Petrisor B, Heetveld M, Guyatt GH (2005) Operative management of displaced femoral neck fractures in elderly patients. An international survey. JBJS 87A(9):2122–2130

    Google Scholar 

  24. Blomfeldt, R., Tornkvist H, Ponzer S, Soderqvist A, Tidermark J (2005) Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. JBJS 87A(8):1680–1688

    Google Scholar 

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Acknowledgment

We gratefully acknowledge the ongoing, invaluable contributions of the Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO). The members’ thoughtful comments and ideas have not only led to the completion of this work but greatly influenced the initiation and continuation of the DFACTO trial. The authors would also like to acknowledge the research coordinators at each study site for their exceptional efforts in obtaining patient follow-up information: Roberto Bertolusso, Connie Feschuk, and Rosemary Immig, Maureen Sheahan, and Sally York. We would especially like to thank Richard S. Yoon, whose assistance was integral in maintaining the records at the principal site and in the completion of this manuscript. We are grateful to Dr. Louis U. Bigliani for his departmental support of this project. This project was funded with grants from the OREF and AAHKS.

Author information

Authors and Affiliations

  1. Center of Hip and Knee Replacement, Columbia University, 622 W 168 St, PH-1146, New York, NY, 10032, USA

    William Macaulay MD

  2. Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 981080 Nebraska Medical Center, Omaha, NE, 68198-1080, USA

    Kevin L. Garvin MD

  3. Department of Orthopaedic Surgery, Lahey Clinic, 41 Mall Road, Burlington, MA, 01805, USA

    Richard Iorio MD & William L. Healy MD

  4. Doris Duke Clinical Research, Columbia University, 622 W 168 St, PH-1155, New York, NY, 10032, USA

    Kate W. Nellans MD, MPH

  5. Orthopaedic Hand and Trauma Service, Columbia University, 622 W 168 St, PH-1119, New York, NY, 10032, USA

    Melvin P. Rosenwasser MD

Authors
  1. William Macaulay MD
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  2. Kate W. Nellans MD, MPH
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  3. Richard Iorio MD
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  4. Kevin L. Garvin MD
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  5. William L. Healy MD
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  6. Melvin P. Rosenwasser MD
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Consortia

DFACTO Consortium

Corresponding author

Correspondence to William Macaulay MD.

Additional information

Level of Evidence: Level I: Randomized controlled trial.

DFACTO Consortium: Christopher B. Michelsen, Catherine A. Compito, Justin Greisberg, Ohannes A. Nercessian, Howard A. Kiernan, Columbia University Medical Center, New York, NY; John F. Tilzey, Michael S. Thompson, Bernard A. Pfeifer, Lawrence M. Specht, Anthony H. Presutti, Lahey Clinic, Burlington, MA; Brian S. Parsley, Baylor College of Medicine, Houston, TX; Steven M. Teeny, Julian S. Arroyo, Dale L. Hirz, Alan B. Thomas, NorthWest Orthopaedic Institute, Tacoma, WA; Kevin L. Garvin, Todd Sekundiak, Matthew A. Morinino, Edward V. Ferhringer, Erik T. Otterberg, Univ. of Nebraska Medical Center, Omaha, NE.

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Macaulay, W., Nellans, K.W., Iorio, R. et al. Total Hip Arthroplasty is Less Painful at 12 Months Compared with Hemiarthroplasty in Treatment of Displaced Femoral Neck Fracture. HSS Jrnl 4, 48–54 (2008). https://doi.org/10.1007/s11420-007-9061-4

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  • DOI: https://doi.org/10.1007/s11420-007-9061-4

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