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Hip Replacement Best for Displaced Hip Fracture

Doctors know displaced fractures of the femoral neck must be operated on. But what's the best method of treatment? Should the bones get reset and pinned together with screws? Is it better to remove the top part of the broken bone and replace it with a partial joint replacement? Maybe a complete hip joint replacement works best.

These are the comparisons made in this study from the Department of Orthopedic Surgery at the Lahey Clinic Medical Center (Burlington, Massachusetts). Doctors there compared two groups of patients. The first group had 120 patients who were treated for displaced hip fracture with internal fixation. The second group had 66 patients treated with partial or full joint replacement.

A displaced hip fracture means the bone is broken and separated. Internal fixation is a way to line up the two pieces of bone and hold them together with screws until healing takes place.

Partial hip replacement is called hemiarthroplasty. Usually the head, neck, and upper part of the thigh bone (femur) are replaced in a hemiarthroplasty. A total replacement also includes putting in a new cup or socket.

Doctors compared the results of these two groups. They used number of reoperations, deaths, function, living status, and cost as the measures of success. The authors report no difference in rates of reoperation or death between the groups. The arthroplasty did give patients much more time before either of these events occurred.

Arthroplasty also gave each patient more function. They could live alone longer. Patients treated with internal fixation needed nursing home care sooner and more often. The arthroplasty also cost less than internal fixation.

All in all, the authors conclude that a complete joint replacement was the best treatment for displaced femoral fractures in older adults.

References: William L. Healy, MD, and Richar Iorio, MD. Total Hip Arthroplasty. In Clinical Orthopaedics and Related Research. December 2004. Vol. 429. Pp. 43-48.

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