Hemiarthroplasty of the hip is usually carried out through either
a direct lateral or posterior approach. The aim of this prospective
observational study was to determine any differences in patient-reported
outcomes between the two surgical approaches. From the Swedish Hip Arthroplasty Register we identified patients
of 70 years and above who were recorded as having had a hemiarthroplasty
during 2009. Only patients who had been treated with modern prostheses
were included. A questionnaire was posted to those who remained
alive one year after surgery. A total of 2118 patients (78% of those
available) with a mean age of 85 years (70 to 102) returned the
questionnaire. Aims
Patients and Methods
In Sweden approximately 6000 patients yearly sustain displaced femoral neck fractures. During the last decade there has been a shift towards more arthroplasties at the expense of internal fixation. In 2008 approximately 75% of the dislocated femoral neck fractures in Sweden were treated with arthroplasties. Those patients are typically elderly and frail and the vast majority of them receive hemiarthroplasties. In 2005 a national hemiarthroplasty registration was established as part of the Swedish Hip Arthroplasty Register (SHAR). The SHAR aims to register all hemiarthroplasties performed in Sweden, including primary and salvage procedures. Surgical and patient details are recorded and re-operations are registered.Background
Material & Method
In a series of 450 patients over 70 years of age with displaced fractures of the femoral neck sustained between 1995 and 1997 treatment was randomised either to internal fixation or replacement. Depending on age and level of activity the latter was either a total hip replacement or a hemiarthroplasty. Patients who were confused or bed-ridden were excluded, as were those with rheumatoid arthritis. At ten years there were 99 failures (45.6%) after internal fixation compared with 17 (8.8%) after replacement. The rate of mortality was high at 75% at ten years, and was the same in both groups at all times. Patient-reported pain and function were similar in both groups at five and ten years. Those with successfully healed fractures had more hip pain and reduction of mobility at four months compared with patients with an uncomplicated replacement, and they never attained a better outcome than the latter patients regarding pain or function. Primary replacement gave reliable long-term results in patients with a displaced fracture of the femoral neck.
