Keating, J Bone Joint Surg Am 2006 - Randomized Comparison of Reduction and Fixation, Bipolar Hemiarthroplasty, and Total Hip Arthroplasty. Treatment of Displaced Intracapsular Hip Fractures in Healthy Older Patients - Article Summary

Randomized Comparison of Reduction and Fixation, Bipolar Hemiarthroplasty, and Total Hip Arthroplasty. Treatment of Displaced Intracapsular Hip Fractures in Healthy Older Patients

Keating, Forbes, et al.·J Bone Joint Surg Am·2006·400 citations·RCT

Background

Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients. The aim of this investigation was to determine the functional, clinical, and resource consequences of three different types of surgical treatment.

Methods

The study was a multicenter randomized controlled trial.
Reduction and fixation was compared with bipolar hemiarthroplasty with cement and total hip replacement with cement.
Participating surgeons elected to randomize their patients to be treated with either one of the three types of procedures or with either fixation or bipolar hemiarthroplasty.
Functional outcomes were measured with a hip-rating questionnaire and the EuroQol health status measure.
Clinical outcomes included mortality and complications.
The direct health service costs were compared.
Participants were followed up for two years.

Results

207 patients were randomized to be treated with one of the 3 operations, and 91 were randomized to be treated with either fixation or bipolar hemiarthroplasty.
There were no differences in the mortality rates among the treatment groups.
The rate of secondary surgery was highest in the fixation group (39% compared with 5% in the group treated with bipolar hemiarthroplasty and 9% in the group treated with total hip replacement).
The fixation group had the worst hip-rating-questionnaire and EuroQol scores at 4 and 12 months.
The total hip replacement group had significantly better functional outcome scores at 24 months than the other 2 groups.
Although fixation was initially the least costly procedure, this short-term advantage was eroded by significantly higher costs for subsequent hip-related hospital admissions.

Conclusions

Arthroplasty is more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip. The long-term results of total hip replacement may be better than those of bipolar hemiarthroplasty.

Core

Randomized Comparison of Reduction and Fixation, Bipolar Hemiarthroplasty, and Total Hip Arthroplasty. Treatment of Displaced Intracapsular Hip Fractures in Healthy Older Patients.

Keating, Forbes, et al.J Bone Joint Surg Am2006400 citationsRCT