Chammout, JB JS Open Access 2019 - HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians: A Randomized Controlled Trial - Article Summary

HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians: A Randomized Controlled Trial

Chammout, Sköldenberg, et al.·JB JS Open Access·2019·112 citations·RCT

Background

The choice of primary hemiarthroplasty or total hip arthroplasty in patients ≥80 years of age with a displaced femoral neck fracture has not been adequately studied. As the number of healthy, elderly patients ≥80 years of age is continually increasing, optimizing treatments for improving outcomes and reducing the need for secondary surgery is an important consideration. The aim of the present study was to compare the results of hemiarthroplasty with those of total hip arthroplasty in patients ≥80 years of age.

Methods

This prospective, randomized, single-blinded trial included 120 patients with a mean age of 86 years (range, 80 to 94 years) who had sustained an acute displaced femoral neck fracture <36 hours previously.
The patients were randomized to treatment with hemiarthroplasty (n = 60) or total hip arthroplasty (n = 60).
The primary end points were hip function and health-related quality of life at 2 years.
Secondary end points included hip-related complications and reoperations, mortality, pain in the involved hip, activities of daily living, surgical time, blood loss, and general complications.
The patients were reviewed at 3 months and 1 and 2 years.

Results

We found no differences between the groups in terms of hip function, health-related quality of life, hip-related complications and reoperations, activities of daily living, or pain in the involved hip.
Hip function, activities of daily living, and pain in the involved hip deteriorated in both groups compared with pre-fracture values.
The ability to regain previous walking function was similar in both groups.

Conclusions

We found no difference in outcomes after treatment with either hemiarthroplasty or total hip arthroplasty in active octogenarians and nonagenarians with a displaced femoral neck fracture up to 2 years after surgery. Hemiarthroplasty is a suitable procedure in the short term for this group of patients.

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

Supplemental

HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians: A Randomized Controlled Trial

Chammout, Sköldenberg, et al.JB JS Open Access2019112 citationsRCT