The HEALTH trial randomized 1495 independently ambulating patients with displaced femoral neck fractures to THA vs hemiarthroplasty at 80 centers in 10 countries. The primary question: does THA reduce the need for secondary hip procedures compared to hemiarthroplasty over 24 months?
Both AAOS and NICE guidelines recommended THA for all independently ambulatory patients with displaced femoral neck fractures, based largely on prior meta-analyses suggesting THA reduced reoperations by 34–43% and improved function substantially. The HEALTH trial, the largest RCT on this question, found neither benefit holds up at 2 years.
When you see an active, independently walking 75-year-old with a displaced femoral neck fracture, do not assume THA is automatically superior. The HEALTH data show equivalent reoperation rates, a clinically unimportant functional difference, higher dislocation risk, and more serious adverse events with THA.
Hemiarthroplasty remains a defensible choice even in active patients — particularly where THA resources, surgeon experience, or patient comorbidities make the added complexity of acetabular reconstruction a meaningful risk.
The time-dependent hazard pattern is worth knowing: THA's dislocation risk drives early reoperations, while hemiarthroplasty's late failures (acetabular erosion, revision) may emerge beyond the 2-year window — meaning longer follow-up may yet favor THA in younger, more active patients.
The HEALTH trial randomized 1495 independently ambulating patients with displaced femoral neck fractures to THA vs hemiarthroplasty at 80 centers in 10 countries. The primary question: does THA reduce the need for secondary hip procedures compared to hemiarthroplasty over 24 months?
Both AAOS and NICE guidelines recommended THA for all independently ambulatory patients with displaced femoral neck fractures, based largely on prior meta-analyses suggesting THA reduced reoperations by 34–43% and improved function substantially. The HEALTH trial, the largest RCT on this question, found neither benefit holds up at 2 years.
When you see an active, independently walking 75-year-old with a displaced femoral neck fracture, do not assume THA is automatically superior. The HEALTH data show equivalent reoperation rates, a clinically unimportant functional difference, higher dislocation risk, and more serious adverse events with THA.
Hemiarthroplasty remains a defensible choice even in active patients — particularly where THA resources, surgeon experience, or patient comorbidities make the added complexity of acetabular reconstruction a meaningful risk.
The time-dependent hazard pattern is worth knowing: THA's dislocation risk drives early reoperations, while hemiarthroplasty's late failures (acetabular erosion, revision) may emerge beyond the 2-year window — meaning longer follow-up may yet favor THA in younger, more active patients.