Outcomes Similar With Hip Arthroplasty, Hemiarthroplasty
FRIDAY, Sept. 27, 2019 -- The incidence of secondary hip procedures does not differ for independently ambulating patients with displaced femoral neck fractures who undergo total hip arthroplasty or hemiarthroplasty, according to a study published online Sept. 26 in the New England Journal of Medicine. The research was published to coincide with the annual meeting of the Orthopaedic Trauma Association, held from Sept. 25 to 28 in Denver.
Mohit Bhandari, M.D., Ph.D., from McMaster University in Hamilton, Canada, and colleagues randomly assigned 1,495 patients aged 50 years or older and with a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty (718 and 723 patients, respectively). Patients were followed for the primary end point of secondary hip procedure within 24 months.
The researchers found that the primary end point occurred in 7.9 and 8.3 percent of patients randomized to total hip arthroplasty or hemiarthroplasty, respectively (hazard ratio [HR], 0.95; 95 percent confidence interval [CI], 0.64 to 1.40; P = 0.79). Hip instability or dislocation occurred in 4.7 and 2.4 percent, respectively (HR, 2.00; 99 percent CI, 0.97 to 4.09). Function was measured with the total Western Ontario and McMaster Universities Osteoarthritis Index total score, pain score, stiffness score, and function score, and modestly favored total hip arthroplasty. The treatment groups had similar mortality (14.3 and 13.1 percent, respectively; HR, 1.10; 95 percent CI, 0.77 to 1.58; P = 0.48), while serious adverse events occurred in 41.8 and 36.7 percent of patients, respectively (HR, 1.16; 95 percent CI, 0.90 to 1.51; P = 0.13).
"Our findings suggest that the advantages of total hip arthroplasty may not be compelling," the authors write.
The study was partially funded by McMaster Surgical Associates and Stryker Orthopaedics.
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Posted: September 2019
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