This systematic review and meta-analysis pools 16 RCTs (n = 3,084) comparing THA to HA for displaced femoral neck fracture. It was prompted by four newly published RCTs adding ~1,780 patients to the evidence base, including the landmark 1,495-patient HEALTH trial. The central question: does THA offer clinically meaningful advantages over HA in revision, function, dislocation, or quality of life?
For a decade, surgeons debated whether THA was worth the extra operative risk in elderly hip fracture patients, with earlier meta-analyses suggesting THA reduced reoperations but increased dislocations. The HEALTH trial and three additional RCTs changed the evidentiary landscape entirely.
With 3,084 patients across 16 RCTs, the current best evidence shows THA and HA are equivalent for every outcome that matters clinically: revision, dislocation, function, and survival through 5 years. The HRQoL signal favoring THA is real but trivially small — below the threshold patients can perceive.
In practice: when choosing between THA and HA for a displaced femoral neck fracture, neither implant is safer or more durable based on current evidence. Individualize the decision using patient factors. Activity level, acetabular health, anesthetic risk, and surgeon experience.
The authors note that younger, more active patients with longer life expectancy remain understudied, and this population may be where THA's theoretical advantages eventually show up with longer follow-up.
This systematic review and meta-analysis pools 16 RCTs (n = 3,084) comparing THA to HA for displaced femoral neck fracture. It was prompted by four newly published RCTs adding ~1,780 patients to the evidence base, including the landmark 1,495-patient HEALTH trial. The central question: does THA offer clinically meaningful advantages over HA in revision, function, dislocation, or quality of life?
For a decade, surgeons debated whether THA was worth the extra operative risk in elderly hip fracture patients, with earlier meta-analyses suggesting THA reduced reoperations but increased dislocations. The HEALTH trial and three additional RCTs changed the evidentiary landscape entirely.
With 3,084 patients across 16 RCTs, the current best evidence shows THA and HA are equivalent for every outcome that matters clinically: revision, dislocation, function, and survival through 5 years. The HRQoL signal favoring THA is real but trivially small — below the threshold patients can perceive.
In practice: when choosing between THA and HA for a displaced femoral neck fracture, neither implant is safer or more durable based on current evidence. Individualize the decision using patient factors. Activity level, acetabular health, anesthetic risk, and surgeon experience.
The authors note that younger, more active patients with longer life expectancy remain understudied, and this population may be where THA's theoretical advantages eventually show up with longer follow-up.