Abstract
Introduction: Arthroplasty is the most effective management of displaced intracapsular femoral neck fracture. Hemiarthroplasty (HEMI) is associated with acetabular erosion and loosening in mobile active patients and total hip arthroplasty (THA) with instability.
We sought to establish whether HEMI or THA gave better results in independent mobile patients with displaced femoral neck fracture.
Method: Eighty-one patients were randomised into two groups. One arm received a modular HEMI, the second a THA using the same femoral stem. Patients were followed for a mean of three years after surgery.
Results: After HEMI, eight patients died, two were revised to THA and there is intention to revise three. One patient had a Peri-prosthetic fracture. Mean walking distance was 1.08 miles and Oxford Hip Score (OHS) 22.5. Twenty patients (64.5% of survivors) had radiological evidence of acetabular erosion.
After THA, three patients died, three dislocated, one required revision. Mean walking distance was 2.23 miles and OHS was 18.8. There was no radiological evidence of polyethylene wear
Patients with THAs after three years walked further (p=0.039) and had a lower OHS (p=0.033).
Discussion: HEMI is associated with a higher actual and potential revision rate than THA because of acetabular erosion, higher OHS after three years and shorter walking distances.
THA is a preferable option to HEMI in independent mobile elderly patients with displaced intracapsular femoral neck fracture.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
