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Question clinique
Does total hip arthroplasty lead to better outcomes than hemiarthroplasty for the treatment of hip fractures in the elderly?
L’Essentiel
For previously ambulatory patients with hip fractures, there is no difference in the number of unplanned hip procedures at 2 years of follow-up when comparing initial total hip arthroplasty (THA) with hemiarthroplasty. Although THA led to a modest improvement in function scores, the difference was not clinically important. A longer follow-up period is needed to evaluate the durability of these surgeries over time. 1b
Référence
Plan de l'etude: Randomized controlled trial (nonblinded)
Financement: Government
Cadre: Outpatient (any)
Sommaire
For the management of hip fractures, THA - as compared with hemiarthroplasty - may result in increased function and quality of life, but can be associated with greater surgical morbidity and higher risk of dislocation leading to additional procedures. In this international, multicenter study, investigators randomized 1495 patients, 50 years or older, with a displaced femoral neck fracture, to undergo THA or hemiarthroplasty. The 2 groups were balanced at baseline. Overall, 70% of the patients were women, 80% were 70 years or older, and 74% were able to ambulate prior to the fracture without the use of an assistive device. There was crossover between groups, with 7.5% of patients assigned to THA receiving hemiarthroplasty and 2.9% of patients assigned to hemiarthroplasty receiving THA. Additionally, 14.9% of patients were lost to follow-up at 24 months. For the primary outcome of an unplanned secondary hip procedure within 24 months of follow-up, there was no significant difference between the 2 groups (7.9% in the THA group vs 8.3% in the hemiarthroplasty group; P = .79). The risk for secondary hip procedure was noted to be higher in the first year in the THA group, but higher between years 1 and 2 in the hemiarthroplasty group. The most common secondary procedure in the THA group was open or closed reduction of a hip dislocation, whereas the most common procedure in the hemiarthroplasty group was implant revision. The THA group had a statistically significant improvement in functional assessment scores at 2 years; however, the difference was not clinically meaningful.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL