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Do Hip Replacements Improve Outcomes for Hip Fracture Patients?

Burns, Risa B. MD, MPH; Moskowitz, Mark A. MD; Ash, Arlene PhD; Kane, Robert L. MD; Finch, Michael PhD; McCarthy, Ellen P. PhD

Original Articles
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Background. Hip fracture is a common problem among older Americans. Two types of procedures are available for repairing hip fractures: hip replacement and open or closed reduction with or without internal fixation. The assumption has been that hip replacement produces better functional outcomes. Although that is the common wisdom, outcome studies evaluating hip replacement for treatment of hip fracture are few and have not clearly documented its superiority.

Objectives. To compare outcomes of hip fracture patients who receive hip replacement versus another stabilizing procedure (open or closed reduction with or without internal fixation).

Design. Prospective cohort study.

Participants. We studied 332 patients (age, > 65) who were hospitalized for a femoral neck fracture and discharged alive.

Measurements. We examined 2 treatment groups, hip replacement versus another procedure, on 6 outcomes [Activities of Daily Living (ADLs), walking, living situation (institutionalized or not), perceived health (excellent/good vs. fair/poor), rehospitalization, and mortality] at 3 post-discharge times (6 weeks, 6 months and 1 year).

Results. Mean age was 80, 80% were female, 96% White, 28% married, and 71% had a hip replacement. The treatment groups were similar at baseline (3 months before admission as reported at discharge) on ADLs, walking, living situation, and perceived health (all P > 0.24). After adjusting for demographics, clinical characteristics, fracture characteristics, and prior ADLs, walking ability, living situation, and perceived health, patients with a hip replacement did not do better at 6 weeks, 6 months, or 1 year post-discharge on any of the 6 outcome measures (all 18 P > 0.10). A global test of all 6 outcomes finds hip replacement patients doing less well at one year (P = 0.02).

Conclusions. Despite the commonly held belief that hip replacement is a superior treatment for hip fracture, we found no suggestion of better outcomes for hip replacement on any of 6 key outcomes.

From the Section of General Internal Medicine, Evans Department of Medicine, Boston University Medical Center, Boston, Massachusetts.

From the Institute for Health Services Research, University of Minnesota School of Public Health, Minneapolis, Minnesota.

The research has been funded through a cooperative agreement from the Health Care Financing Administration and the Office of the Assistant Secretary of Health and Human Services for Planning and Evaluation (ASPE) to the University of Minnesota (17-C988891/5).

Presented at the Society of General Internal Medicine annual meeting, May, 1995, Seattle, WA.

The research has been funded through a cooperative agreement from the Health Care Financing Administration and the Office of the Assistant Secretary of Health and Human Services for Planning and Evaluation (ASPE) to the University of Minnesota (17-C988891/5).

The statements contained in this report are solely those of the author and do not necessarily reflect the views or policies of the Health Care Financing Administration or ASPE.

Address correspondence to: Mark A. Moskowitz, MD, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, 720 Harrison Avenue, Suite 1108, Boston, MA 02118-2334.

Received July 1, 1997; initial review completed January 21, 1998; accepted September 14, 1998.

© 1999 Lippincott Williams & Wilkins, Inc.