The HEALTH trial is a multicenter expertise-based RCT that randomly assigned 1,495 independently ambulatory patients (age ≥50) with displaced femoral neck fractures to THA or hemiarthroplasty across 80 centers in 10 countries. The primary endpoint was unplanned secondary hip procedure within 24 months. This is the largest and highest-quality trial directly comparing these two arthroplasty options for hip fracture.
Before HEALTH, AAOS and NICE guidelines broadly recommended THA for all independently ambulatory patients with displaced femoral neck fractures, supported by meta-analyses claiming THA reduces reoperations by 34-43%. Those meta-analyses were underpowered and heterogeneous — HEALTH enrolled nearly five times more patients than any prior trial and used an expertise-based design to eliminate surgeon learning-curve bias.
This trial forces a shift away from a universal procedural preference. Neither implant is clearly superior at 24 months. Choose based on patient-level risk. When your patient has elevated surgical risk, limited access to arthroplasty expertise, or lives in a setting where managing a dislocation is logistically difficult, hemiarthroplasty is a fully defensible choice.
When you do choose THA, counsel the patient explicitly: dislocation risk is double that of hemiarthroplasty (4.7% vs. 2.4%), and the functional benefit. While statistically real. Will likely not be perceptible to the patient.
The year-2 hazard ratio crossing (hemiarthroplasty HR 0.23 after year 1) is the open question from this trial. Acetabular erosion accrues slowly, and 24 months may not be enough to see it. Watch for longer-term registry data before concluding the two implants are equivalent beyond two years.
The HEALTH trial is a multicenter expertise-based RCT that randomly assigned 1,495 independently ambulatory patients (age ≥50) with displaced femoral neck fractures to THA or hemiarthroplasty across 80 centers in 10 countries. The primary endpoint was unplanned secondary hip procedure within 24 months. This is the largest and highest-quality trial directly comparing these two arthroplasty options for hip fracture.
Before HEALTH, AAOS and NICE guidelines broadly recommended THA for all independently ambulatory patients with displaced femoral neck fractures, supported by meta-analyses claiming THA reduces reoperations by 34-43%. Those meta-analyses were underpowered and heterogeneous — HEALTH enrolled nearly five times more patients than any prior trial and used an expertise-based design to eliminate surgeon learning-curve bias.
This trial forces a shift away from a universal procedural preference. Neither implant is clearly superior at 24 months. Choose based on patient-level risk. When your patient has elevated surgical risk, limited access to arthroplasty expertise, or lives in a setting where managing a dislocation is logistically difficult, hemiarthroplasty is a fully defensible choice.
When you do choose THA, counsel the patient explicitly: dislocation risk is double that of hemiarthroplasty (4.7% vs. 2.4%), and the functional benefit. While statistically real. Will likely not be perceptible to the patient.
The year-2 hazard ratio crossing (hemiarthroplasty HR 0.23 after year 1) is the open question from this trial. Acetabular erosion accrues slowly, and 24 months may not be enough to see it. Watch for longer-term registry data before concluding the two implants are equivalent beyond two years.