No difference in unplanned secondary procedures after initial THA versus hemiarthroplasty for hip fractures in elderly

Reference

HEALTH Investigators, Bhandari M, Einhorn TA, et al. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med 2019;381(23):2199-2208.

Synopsis

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.