Femoral neck fracture: hip arthroplasty, hemiarthroplasty similarly effective

  • Bhandari M & al.
  • N Engl J Med
  • 26.09.2019

  • von Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Hemiarthroplasty is comparable to total hip arthroplasty for femoral neck fracture, with similar rates of reoperation.
  • The randomized trial enrolled patients who had been independently ambulatory before fracture.

Why this matters

  • The authors conclude that "the advantages of total hip arthroplasty may not be compelling," thus questioning the current guidelines of the American Academy of Orthopedic Surgeons and National Institute for Health and Care Excellence, which recommend total hip arthroplasty for this group of patients.

Study design

  • HEALTH trial of 1495 patients who were aged ≥50 years and were independently ambulatory before fracture occurred.
  • Primary outcome was reoperation rate (i.e., secondary hip procedure) within 24 months of follow-up.
  • Funding: Canadian Institutes of Health; NIH; Stryker Orthopedics; others.

Key results

  • Similar rates of reoperation after total hip vs hemiarthroplasty (7.9% vs 8.3%; HR, 0.95, P=.79).
  • Similar rates of hip instability or dislocation (4.7% vs 2.4%, respectively; HR, 2.00; 95% CI, 0.97-4.09).
  • Total hip arthroplasty performed slightly better on 4 of 8 secondary outcomes.
  • Similar mortality rates between groups (14.3% vs 13.1%; P=.48).
  • Total hip arthroplasty had higher rates of serious adverse events (41.8% vs 36.7%).

Limitations

  • Almost 15% of patients were lost to follow-up.
  • Unblinded assessment of function, suggesting bias.