The HOPE Trial is a Level I RCT comparing hemiarthroplasty (HA) to total hip arthroplasty (THA) specifically in patients ≥80 years with displaced femoral neck fractures. It enrolled 120 cognitively intact, ambulatory patients (mean age 86) and followed them for 2 years. The central question: does replacing a healthy acetabulum with a cup actually benefit the oldest patients?
Prior RCTs showing THA superiority over hemiarthroplasty mostly enrolled patients under 80 — a younger, more active cohort where replacing the acetabulum translates into measurable functional gain.
For octogenarians, those gains disappear. When your patient is 83, cognitively intact, and comes in with a Garden 4 femoral neck fracture, this trial says HA is the right call: equivalent function, equivalent quality of life, 22 fewer minutes on the table, and no difference in complication burden through 2 years.
Frame the decision this way: THA's theoretical advantage (avoiding acetabular erosion) requires time and activity to manifest. At age 86, neither may be present in sufficient quantity.
One nuance worth knowing: the 2-year window almost certainly misses late acetabular erosion. Longer follow-up data from this cohort are pending, and for a patient expected to live well into their 90s, that question is not yet settled.
The HOPE Trial is a Level I RCT comparing hemiarthroplasty (HA) to total hip arthroplasty (THA) specifically in patients ≥80 years with displaced femoral neck fractures. It enrolled 120 cognitively intact, ambulatory patients (mean age 86) and followed them for 2 years. The central question: does replacing a healthy acetabulum with a cup actually benefit the oldest patients?
Prior RCTs showing THA superiority over hemiarthroplasty mostly enrolled patients under 80 — a younger, more active cohort where replacing the acetabulum translates into measurable functional gain.
For octogenarians, those gains disappear. When your patient is 83, cognitively intact, and comes in with a Garden 4 femoral neck fracture, this trial says HA is the right call: equivalent function, equivalent quality of life, 22 fewer minutes on the table, and no difference in complication burden through 2 years.
Frame the decision this way: THA's theoretical advantage (avoiding acetabular erosion) requires time and activity to manifest. At age 86, neither may be present in sufficient quantity.
One nuance worth knowing: the 2-year window almost certainly misses late acetabular erosion. Longer follow-up data from this cohort are pending, and for a patient expected to live well into their 90s, that question is not yet settled.