Johansson, J Bone Joint Surg Am 2014 - Internal Fixation Compared with Total Hip Replacement for Displaced Femoral Neck Fractures: A Minimum Fifteen-Year Follow-Up Study of a Previously Reported Randomized Trial - Article Summary

Internal Fixation Compared with Total Hip Replacement for Displaced Femoral Neck Fractures: A Minimum Fifteen-Year Follow-Up Study of a Previously Reported Randomized Trial

Johansson·J Bone Joint Surg Am·2014·80 citations·RCT

Background

Prospective randomized studies comparing internal fixation and a cemented hip replacement in the treatment of displaced femoral neck fractures have shown favorable short-term results for prosthetic replacement. The present report compares the results after a minimum of 15 years.

Methods

From 1994 to 1998, 143 patients (146 hips) were randomized to closed reduction and internal fixation with 2 screws (n = 78) or a cemented total hip replacement (n = 68).
The average age of the patients was 84 years (range, 75 to 101 years), and 38% were classified as mentally impaired.
Failure after internal fixation was defined as early redisplacement, nonunion, symptomatic segmental collapse, or deep infection.
In the arthroplasty group, failure was defined as 2 dislocations or more, implant loosening, deep infection, or a periprosthetic fracture.

Results

For the lucid patients, the failure rate was 55% after internal fixation compared with 5% after total hip replacement.
For patients with mental impairment, it was 16% in both groups.

Conclusions

Total hip replacement is superior to internal fixation in the treatment of a displaced femoral neck fracture.

Supplemental

Internal Fixation Compared with Total Hip Replacement for Displaced Femoral Neck Fractures: A Minimum Fifteen-Year Follow-Up Study of a Previously Reported Randomized Trial.