This systematic review and meta-analysis compared THA to hemiarthroplasty for displaced femoral neck fractures in patients over 60. It pooled 15 studies (4 RCTs, 3 quasi-randomized, 8 cohort) totaling 1,890 patients. The central question: does THA deliver better outcomes than hemiarthroplasty in the acute fracture setting?
The operative debate for displaced femoral neck fractures in older patients is not THA vs. Fixation — arthroplasty is already established as superior. The harder question is which arthroplasty: a faster, simpler hemiarthroplasty or a more complete THA.
This meta-analysis gives you the numbers to counsel patients: THA offers roughly 4% lower absolute reoperation risk and modestly better function, at the cost of a higher (though not statistically significant) dislocation rate. Mortality and infection risk are equivalent.
When you have a physiologically fit, community-ambulatory patient over 60 with a displaced femoral neck fracture, THA is defensible. The functional benefit accrues in active patients who will actually load the hip. For the frail, limited-ambulatory patient, hemiarthroplasty's lower complexity and comparable mortality profile make it the safer choice.
The key caveat from this paper: the reoperation benefit for THA was driven by lower-quality non-randomized data. Do not overweight it. Patient pre-fracture mobility and cementation status of the hemiarthroplasty stem are confounders that matter when interpreting any individual study.
This systematic review and meta-analysis compared THA to hemiarthroplasty for displaced femoral neck fractures in patients over 60. It pooled 15 studies (4 RCTs, 3 quasi-randomized, 8 cohort) totaling 1,890 patients. The central question: does THA deliver better outcomes than hemiarthroplasty in the acute fracture setting?
The operative debate for displaced femoral neck fractures in older patients is not THA vs. Fixation — arthroplasty is already established as superior. The harder question is which arthroplasty: a faster, simpler hemiarthroplasty or a more complete THA.
This meta-analysis gives you the numbers to counsel patients: THA offers roughly 4% lower absolute reoperation risk and modestly better function, at the cost of a higher (though not statistically significant) dislocation rate. Mortality and infection risk are equivalent.
When you have a physiologically fit, community-ambulatory patient over 60 with a displaced femoral neck fracture, THA is defensible. The functional benefit accrues in active patients who will actually load the hip. For the frail, limited-ambulatory patient, hemiarthroplasty's lower complexity and comparable mortality profile make it the safer choice.
The key caveat from this paper: the reoperation benefit for THA was driven by lower-quality non-randomized data. Do not overweight it. Patient pre-fracture mobility and cementation status of the hemiarthroplasty stem are confounders that matter when interpreting any individual study.