Chammout, J Bone Joint Surg Am 2012 - Total Hip Replacement versus Open Reduction and Internal Fixation of Displaced Femoral Neck Fractures: A Randomized Long-Term Follow-Up Study - Article Summary

Total Hip Replacement versus Open Reduction and Internal Fixation of Displaced Femoral Neck Fractures: A Randomized Long-Term Follow-Up Study

Chammout, Skoldenberg, et al.·J Bone Joint Surg Am·2012·142 citations·RCT

Background

Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of 17 years.

Methods

We enrolled 100 patients who had sustained a femoral neck fracture in a single-center, randomized controlled trial;all patients had had a healthy hip before the injury.
The study group included 79 women and 21 men with a mean age of 78 years (range, 65 to 90 years).
The subjects were randomly assigned to either total hip replacement (the arthroplasty group) (n = 43) or internal fixation (the control group) (n = 57).
The primary end point was hip function, evaluated with use of the Harris hip score.
Secondary end points included mortality, reoperations, gait speed, and activities of daily life.
Follow-up evaluations were performed at 3 months and at one, 2, 4, 11, and 17 years.

Results

The Harris hip score was higher in the total hip arthroplasty group, with a mean difference of 14.7 points (95%confidence interval, 9.2 to 20.1 points; p < 0.001 [analysis of covariance]) during the study period.
We found no difference in mortality between the 2 groups.
4 patients (9%) in the total hip replacement group and 22 patients (39%) in the internal fixation group had undergone a major reoperation (relative risk, 0.24; 95% confidence interval, 0.09 to 0.64).The overall reoperation rate was 23% (10 of 43) in the total hip replacement group and 53% (30 of 57) in the internal fixation group (relative risk, 0.44; 95% confidence interval, 0.24 to 0.80).
The results related to gait speed and activities of daily living favored the arthroplasty group during the first year.

Conclusions

Over a period of 17 years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality.

Level of evidence: Therapeutic Level I. Copyright remains with the authors and publisher.

Supplemental

Total Hip Replacement versus Open Reduction and Internal Fixation of Displaced Femoral Neck Fractures: A Randomized Long-Term Follow-Up Study.

Chammout, Skoldenberg, et al.J Bone Joint Surg Am2012142 citationsRCT