At a minimum 15-year follow-up, researchers of this study discovered a lower failure rate among lucid patients with a displaced femoral neck fracture who were treated with cemented total hip arthroplasty rather than closed reduction and internal fixation using two screws.
“The present report shows that many patients live long after surgery, and it may be difficult to select different treatment methods on the basis of factors such as age and mental impairment,” Torsten Johansson, MD, PhD, wrote in the study. “The absence of long-term complications after total hip arthroplasty strengthens the conclusion that total hip arthroplasty is superior to internal fixation in the treatment of a displaced femoral neck fracture.”
Johansson studied 143 patients who were randomized to undergo either treatment between1994 to 1998. Thirty-eight percent of the patients were classified as having a mental impairment.
Failure for the internal fixation group was defined as early redisplacement, nonunion, symptomatic segmental collapse or deep infection, while failure was defined in the arthroplasty group as two or more dislocations, implant loosening, deep infection or a periprosthetic fracture.
At 5 years, 65% of the 89 lucid patients were still alive vs. 13% of the 54 patients with mental impairment. Among lucid patients, the failure rate was 55% for the internal fixation group vs. 5% for the hip replacement cohort. For patients with mental impairment, the failure rate was 16% in both treatment groups. Local complications occurred in 54% of hips in the internal fixation group and 35 patients underwent further surgery, according to study results. Researchers also found 69% of reoperations after internal fixation occurred within the first year and 25% during the second postoperative year.
Disclosure: The researchers have no relevant financial disclosures.