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Total Hip Replacement Versus Open Reduction and Internal Fixation of Displaced Femoral Neck Fractures: A Randomized Long-Term Follow-up Study

Chammout, Ghazi Khalil MD; Mukka, Sebastian Simon MD; Carlsson, Thomas MD; Neander, Gustaf Fredrik MD, PhD; Helge Stark, André Wilhelm MD, PhD; Sköldenberg, Olof Gustaf MD, PhD

Journal of Bone & Joint Surgery - American Volume: 7 November 2012 - Volume 94 - Issue 21 - p 1921–1928
doi: 10.2106/JBJS.K.01615
Scientific Articles
Supplementary Content
Disclosures

Background: Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of seventeen years.

Methods: We enrolled 100 patients who had sustained a femoral neck fracture in a single-center, randomized controlled trial; all patients had had a healthy hip before the injury. The study group included seventy-nine women and twenty-one men with a mean age of seventy-eight years (range, sixty-five to ninety years). The subjects were randomly assigned to either total hip replacement (the arthroplasty group) (n = 43) or internal fixation (the control group) (n = 57). The primary end point was hip function, evaluated with use of the Harris hip score. Secondary end points included mortality, reoperations, gait speed, and activities of daily life. Follow-up evaluations were performed at three months and at one, two, four, eleven, and seventeen years.

Results: The Harris hip score was higher in the total hip arthroplasty group, with a mean difference of 14.7 points (95% confidence interval, 9.2 to 20.1 points; p < 0.001 [analysis of covariance]) during the study period. We found no difference in mortality between the two groups. Four patients (9%) in the total hip replacement group and twenty-two patients (39%) in the internal fixation group had undergone a major reoperation (relative risk, 0.24; 95% confidence interval, 0.09 to 0.64). The overall reoperation rate was 23% (ten of forty-three) in the total hip replacement group and 53% (thirty of fifty-seven) in the internal fixation group (relative risk, 0.44; 95% confidence interval, 0.24 to 0.80). The results related to gait speed and activities of daily living favored the arthroplasty group during the first year.

Conclusions: Over a period of seventeen years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden. E-mail address for G.K. Chammout: ghazi.chammout@ds.se. E-mail address for T. Carlsson: thomas.carlsson@ds.se. E-mail address for G.F. Neander: gustaf.neander@ds.se. E-mail address for A.W.H. Stark: andreas.stark@ds.se. E-mail address for O.G. Sköldenberg: olof.skoldenberg@ki.se

2Department of Surgical and Perioperative Sciences, Sundsvall Hospital, Umeå universitet, SE-901 87, Umeå, Sweden. E-mail address: sebastian.mukka@gmail.com

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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