The Journal of Bone and Joint Surgery (American). 2005;87:1680-1688.
doi:10.2106/JBJS.D.02655
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 CME 3: July, August, September 2005
Adult Hip Reconstruction Test 15: Fall 2005
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Letters to the Editor: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Blomfeldt, R.
Right arrow Articles by Tidermark, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Blomfeldt, R.
Right arrow Articles by Tidermark, J.
Related Collections
Right arrow Adult Hip
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Comparison of Internal Fixation with Total Hip Replacement for Displaced Femoral Neck Fractures

Randomized, Controlled Trial Performed at Four Years

Richard Blomfeldt, MD1, Hans Törnkvist, MD, PhD1, Sari Ponzer, MD, PhD1, Anita Söderqvist, RN1 and Jan Tidermark, MD, PhD1

1 Karolinska Institutet, Department of Orthopaedics, Stockholm Söder Hospital, S-118 83 Stockholm, Sweden. E-mail address for J. Tidermark: jan.tidermark{at}ortoped.sos.sll.se

Investigation performed at the Karolinska Institutet, Department of Orthopaedics, Stockholm Söder Hospital, Stockholm, Sweden

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Trygg-Hansa Insurance Company, the Swedish Society for Medical Research, the Swedish Orthopaedic Association, and the Stockholm County Council. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Recent randomized, controlled trials performed at two years postoperatively have shown that a primary total hip replacement is superior to internal fixation for the treatment of a displaced femoral neck fracture in a relatively healthy, mentally competent, elderly patient. The primary aim of the present study was to evaluate the outcomes at four years.

Methods: One hundred and two patients (mean age, eighty years) who had an acute displaced femoral neck fracture were randomly allocated to be treated with total hip replacement or internal fixation. The inclusion criteria were an age of at least seventy years, absence of severe cognitive dysfunction, an independent living status, and the ability to walk independently. The main outcome measurements were hip complications, reoperations, hip function, and health-related quality of life.

Results: The mortality rate was 25% in both groups. At the forty-eight-month follow-up evaluation, the rate of hip complications was 4% in the patients treated with total hip replacement and 42% in those treated with internal fixation (p < 0.001) and the reoperation rates were 4% and 47%, respectively (p < 0.001). The arthroplasty group had no additional hip complications or reoperations between the twenty-four and forty-eight-month follow-up visits. In the fixation group, the percentage of hip complications increased from 36% to 42% and the percentage of reoperations increased from 42% to 47% during the same period. The hip function was significantly better and the decline in health-related quality of life was less pronounced in the arthroplasty group than it was in the fixation group at the four, twelve, and twenty-four-month follow-up evaluations. Ninety-seven percent of the patients in the arthroplasty group and 57% of the patients in the fixation group who were available for follow-up at forty-eight months had no hip complications (p < 0.001).

Conclusions: Compared with internal fixation, primary total hip replacement provides a better outcome for mentally competent elderly patients with a displaced femoral neck fracture. The complication and reoperation rates were significantly lower and hip function and health-related quality of life were at least as good at four years after the surgery.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 J Am Acad Orthop SurgHome page
R. G. Miyamoto, K. M. Kaplan, B. R. Levine, K. A. Egol, and J. D. Zuckerman
Surgical Management of Hip Fractures: An Evidence-based Review of the Literature. I: Femoral Neck Fractures
J. Am. Acad. Ortho. Surg., October 1, 2008; 16(10): 596 - 607.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
F. Frihagen, L. Nordsletten, and J. E. Madsen
Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial
BMJ, December 15, 2007; 335(7632): 1251 - 1254.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
R.P. Baker, B. Squires, M.F. Gargan, and G.C. Bannister
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., December 1, 2006; 88(12): 2583 - 2589.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
P. A. Cole and M. Bhandari
What's New in Orthopaedic Trauma
J. Bone Joint Surg. Am., November 1, 2006; 88(11): 2545 - 2561.
[Full Text] [PDF]

Home page
 JBJSHome page
M. H. Huo, J. Parvizi, and N. F. Gilbert
What's New in Hip Arthroplasty
J. Bone Joint Surg. Am., September 1, 2006; 88(9): 2100 - 2113.
[Full Text] [PDF]

Letters to the Editor:

Read all Letters to the Editor

Dr Tidermark responds to Dr. Berry's Commentary
Jan Tidermark, et al.
JBJS Online, 7 Dec 2005 [Full text]