The Journal of Bone and Joint Surgery (American). 2006;88:2583-2589.
doi:10.2106/JBJS.E.01373
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Total Hip Arthroplasty and Hemiarthroplasty in Mobile, Independent Patients with a Displaced Intracapsular Fracture of the Femoral Neck

A Randomized, Controlled Trial

R.P. Baker, MRCS1, B. Squires, FRCS(Tr&Orth)2, M.F. Gargan, FRCS(Orth)3 and G.C. Bannister, MD, FRCS Ed(Orth)1

1 Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom. E-mail address for G.C. Bannister: janet.wood{at}north-bristol.swest.nhs.uk
2 Taunton and Somerset NHS Trust, Musgrove Park, Taunton, Somerset, TA1 5DA, United Kingdom
3 Bristol Royal Infirmary, Maudlin Street, Bristol, BS2 8HW, United Kingdom

Investigation performed at Southmead Hospital, Frenchay Hospital, and Bristol Royal Infirmary, Bristol, United Kingdom

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive 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: Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial.

Methods: In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total hip arthroplasty or a hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford hip score, and final radiographs were assessed.

Results: After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23 mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group. Patients in the total hip arthroplasty group walked farther (p = 0.039) and had a lower (better) Oxford hip score (p = 0.033) than those in the hemiarthroplasty group. Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the hips in the hemiarthroplasty group dislocated, whereas three hips in the total hip arthroplasty group dislocated. In the hemiarthroplasty group, two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision. In the total hip arthroplasty group, one hip was revised because of subsidence of the femoral component.

Conclusions: Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.

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


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Letters to the Editor:

Read all Letters to the Editor

Surgical Treatment of Displaced Intracapsular Fracture of the Femoral Neck
William Macaulay, M.D.
JBJS Online, 10 Jan 2007 [Full text]
Dr. Bannister et al. respond to Dr. Macaulay
Gordon C. Bannister, M.D., FRCS Ed(Orth), et al.
JBJS Online, 10 Jan 2007 [Full text]
Walking Distance Following Total Hip Arthroplasty Or Hemiarthroplasty
Jeffrey O. Anglen, M.D.
JBJS Online, 25 Jul 2007 [Full text]