Skip to main content

Advertisement

SpringerLink
Log in

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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights® to this article was published on 26 September 2013

Abstract

Background

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.

Questions/purposes

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.

Methods

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).

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Baker RP, Squires B, Gargan MF, Bannister GC. 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 Am. 2006;88:2583–2589.

    Article  CAS  PubMed  Google Scholar 

  2. Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P III, Obremskey W, Koval KJ, Nork S, Sprague S, Schemitsch EH, Guyatt GH. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003;85:1673–1681.

    PubMed  Google Scholar 

  3. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22:465–475.

    Article  PubMed  Google Scholar 

  4. Carroll C, Stevenson M, Scope A, Evans P, Buckley S. Hemiarthroplasty and total hip arthroplasty for treating primary intracapsular fracture of the hip: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2011;15:1–74.

    CAS  Google Scholar 

  5. Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997;103:12S–17S.

    Article  CAS  PubMed  Google Scholar 

  6. Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285–289.

    Article  CAS  PubMed  Google Scholar 

  7. EurQol. EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16:199–208.

  8. Figved W, Dahl J, Snorrason F, Frihagen F, Rohrl S, Madsen JE, Nordsletten L. Radiostereometric analysis of hemiarthroplasties of the hip—a highly precise method for measurements of cartilage wear. Osteoarthritis Cartilage. 2012;20:36–42.

    Article  CAS  PubMed  Google Scholar 

  9. Finnes TE, Meyer HE, Falch JA, Medhus AW, Wentzel-Larsen T, Lofthus CM. Secular reduction of excess mortality in hip fracture patients >85 years. BMC Geriatr. 2013;13:25.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordsletten L. Outcome after femoral neck fractures: a comparison of Harris Hip Score, Eq-5D and Barthel Index. Injury. 2008;39:1147–1156.

    Article  PubMed  Google Scholar 

  11. Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ. 2007;335:1251–1254.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Garden RS. Low angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–663.

    Google Scholar 

  13. Gjertsen JE, Vinje T, Engesaeter LB, Lie SA, Havelin LI, Furnes O, Fevang JM. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am. 2010;92:619–628.

    Article  PubMed  Google Scholar 

  14. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380–390.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Harris WH. 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. J Bone Joint Surg Am. 1969;51:737–755.

    CAS  PubMed  Google Scholar 

  16. Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Tornkvist H, Ponzer S, Tidermark J. 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. 2011;93:445–450.

    PubMed  Google Scholar 

  17. Heetveld MJ, Rogmark C, Frihagen F, Keating J. Internal fixation versus arthroplasty for displaced femoral neck fractures: what is the evidence? J Orthop Trauma. 2009;23:395–402.

    Article  PubMed  Google Scholar 

  18. Hinchey JJ, Day PL. Primary prosthetic replacement in fresh femoral neck fractures. A review of 294 cpnsecutive cases. J Bone Joint Surg Am. 1964;46:223–240.

    CAS  PubMed  Google Scholar 

  19. Hwang KT, Kim YH, Kim YS, Choi IY. Is bipolar hemiarthroplasty a reliable option for Ficat stage III osteonecrosis of the femoral head? 15- to 24-year follow-up study. Arch Orthop Trauma Surg. 2012;132:1789–1796.

    Article  PubMed  Google Scholar 

  20. Kanis JA, Oden A, Johnell O, DeLaet C, Jonsson B, Oglesby AK. The components of excess mortality after hip fracture. Bone. 2003;32:468–473.

    Article  CAS  PubMed  Google Scholar 

  21. Kim YS, Kim YH, Hwang KT, Choi IY. The cartilage degeneration and joint motion of bipolar hemiarthroplasty. Int Orthop. 2012;36:2015–2020.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Leonardsson O, Sernbo I, Carlsson A, Akesson K, Rogmark C. Long-term follow-up of replacement compared with internal fixation for displaced femoral neck fractures: results at ten years in a randomised study of 450 patients. J Bone Joint Surg Br. 2010;92:406–412.

    Article  CAS  PubMed  Google Scholar 

  23. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65.

    CAS  PubMed  Google Scholar 

  24. Muraki M, Sudo A, Hasegawa M, Fukuda A, Uchida A. Long-term results of bipolar hemiarthroplasty for osteoarthritis of the hip and idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2008;13:313–317.

    Article  PubMed  Google Scholar 

  25. Osnes EK, Lofthus CM, Meyer HE Falch JA, Nordsletten L, Cappelen I, Kristiansen IS. Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int. 2004;15:567–574.

    CAS  PubMed  Google Scholar 

  26. Panula J, Pihlajamaki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio,P, Kivela SL. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord. 2011;12:105.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Parker MJ, Gurusamy K. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;4:CD001708.

    PubMed  Google Scholar 

  28. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;6:CD001706.

    PubMed  Google Scholar 

  29. Parker MJ, Khan RJ, Crawford J, Pryor GA. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients. J Bone Joint Surg Br. 2002;84:1150–1155.

    Article  CAS  PubMed  Google Scholar 

  30. Parker MJ, Pryor G, Gurusamy K. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures: a long-term follow-up of a randomised trial. Injury. 2010;41:370–373.

    Article  PubMed  Google Scholar 

  31. Pawaskar SS, Ingham E, Fisher J, Jin Z. Fluid load support and contact mechanics of hemiarthroplasty in the natural hip joint. Med Eng Phys. 2011;33:96–105.

    Article  PubMed  Google Scholar 

  32. Pellegrini VD Jr, Heiges BA, Bixler B, Lehman EB, Davis CM III. Minimum ten-year results of primary bipolar hip arthroplasty for degenerative arthritis of the hip. J Bone Joint Surg Am. 2006;88:1817–1825.

    Article  PubMed  Google Scholar 

  33. Rogmark C, Carlsson A, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years. J Bone Joint Surg Br. 2002;84:183–188.

    Article  CAS  PubMed  Google Scholar 

  34. Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop. 2006;77:359–367.

    Article  PubMed  Google Scholar 

  35. Shi N, Foley K, Lenhart G, Badamgarav E. Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures. Bone. 2009;45:1084–1090.

    Article  PubMed  Google Scholar 

  36. Stoen RO, Nordsletten L, Meyer HE, Frihagen JF, Falch JS, Lofthus CM. Hip fracture incidence is decreasing in the high incidence area of Oslo, Norway. Osteoporos Int. 2012;23:2527–2534.

    Article  CAS  Google Scholar 

  37. Tidermark J, Bergstrom G, Svensson O, Tornkvist H, Ponzer S. Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fractures. Qual Life Res. 2003;12:1069–1079.

    Article  CAS  PubMed  Google Scholar 

  38. Tsumura H, Torisu T, Kaku N, Higashi T. Five- to fifteen-year clinical results and the radiographic evaluation of acetabular changes after bipolar hip arthroplasty for femoral head osteonecrosis. J Arthroplasty. 2005;20:892–897.

    Article  PubMed  Google Scholar 

  39. van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, Goslings JC, van Dijk CN, Raaymakers EL. 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. 2010;92:1422–1428.

    Article  PubMed  Google Scholar 

  40. Waaler Bjornelv GM, Frihagen F, Madsen JE, Nordsletten L, Aas E. Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial. Osteoporos Int. 2012;23:1711–1719.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

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

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway

    Ragnhild Øydna Støen MD, Lars Nordsletten MD, PhD, Jan Erik Madsen MD, PhD & Frede Frihagen MD, PhD

  2. University of Oslo, Oslo, Norway

    Ragnhild Øydna Støen MD, Lars Nordsletten MD, PhD, Jan Erik Madsen MD, PhD & Frede Frihagen MD, PhD

  3. Department of Orthopaedics, Ringerike Hospital, Vestre Viken Hospital Trust, 3500, Hønefoss, Norway

    Ragnhild Øydna Støen MD & Frede Frihagen MD, PhD

  4. Department of Endocrinology, Oslo University Hospital, Oslo, Norway

    Cathrine M. Lofthus MD, PhD

Authors
  1. Ragnhild Øydna Støen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cathrine M. Lofthus MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars Nordsletten MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Erik Madsen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frede Frihagen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ragnhild Øydna Støen MD.

Additional information

Funding was provided by the South-Eastern Norway Regional Health Authority.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Data collection was performed at Oslo University Hospital, Ullevål, Norway.

About this article

Cite this article

Støen, R.Ø., Lofthus, C.M., Nordsletten, L. et al. Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years. Clin Orthop Relat Res 472, 360–367 (2014). https://doi.org/10.1007/s11999-013-3245-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3245-7

Keywords

Search

Navigation