QuickScan Reviews in Orthopaedic Surgery, April 30 2009

Objective: To establish whether hip replacement or hemiarthroplasty is a superior treatment of displaced femoral neck fractures in a meta-analysis of prospective, randomized, controlled trials. Methods: A search of the orthopaedic literature was utilized to extract all randomized, controlled studies comparing total hip arthroplasty (THA) to hemiarthroplasty in elderly patients with displaced femoral neck fractures. Outcome measurements including time to revision hip surgery, mortality, pain, function, and mobility were assessed. Results: With regard to the comparison of rates of all subsequent surgeries (eg, revision surgery, drainage of infected implants, periprosthetic fractures), there was no significant difference between 1 and 4 years of follow-up. However, one study showed a lower revision rate at long-term follow-up in THA patients. No significant reduction was found in long-term mortality rates; however, patients who underwent THA had significantly less pain at both shortand long-term follow-up. Patients undergoing THA were also more likely to be ambulatory but, as expected, had a higher dislocation rate than did the hemiarthroplasty group. Reviewer's Comments: The optimal treatment of a displaced femoral neck fracture in an elderly patient is somewhat controversial. However, this meta-analysis puts forth a compelling argument for hip arthroplasty in selected patients, that is, those with relatively good health, good pre-fracture mobility, and reasonable life expectancy. The presence of significant medical comorbid conditions should be considered. The possibility of an increased dislocation rate can be minimized with good surgical technique. Nevertheless, hip arthroplasty comes at an increased implant cost over unipolar or bipolar hemiarthroplasty, but the long-term benefits to the patient have been demonstrated in this meta-analysis of these randomized studies.