A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck A RANDOMISED CONTROLLED MULTICENTRE TRIAL IN PATIENTS AGED 70 YEARS AND OVER

作者：van den Bekerom M P J; Hilverdink E F; Sierevelt I N; Reuling E M B P; Schnater J M; Bonke H; Goslings J C; van Dijk C N; Raaymakers E L F B^*

来源：Journal of Bone and Joint Surgery-British Volume, 2010, 92B(10): 1422-1428.

DOI：10.1302/0301-620X.92B10.24899

The aim of this study was to analyse the functional outcome after a displaced intracapsular fracture of the femoral neck in active patients aged over 70 years without osteoarthritis or rheumatoid arthritis of the hip, randomised to receive either a hemiarthroplasty or a total hip replacement (THR). We studied 252 patients of whom 47 (19%) were men, with a mean age of 81.1 years (70.2 to 95.6). They were randomly allocated to be treated with either a cemented hemiarthroplasty (137 patients) or cemented THR (115 patients). At one- and five-year follow-up no differences were observed in the modified Harris hip score, revision rate of the prosthesis, local and general complications, or mortality. The intra-operative blood loss was lower in the hemiarthroplasty group (7% > 500 ml), THR group (26% > 500 ml) and the duration of surgery was longer in the THR group (28% > 1.5 hours versus 12% > 1.5 hours). There were no dislocations of any bipolar hemiarthroplasty than in the eight dislocations of a THR during follow-up.
Because of a higher intra-operative blood loss (p < 0.001), an increased duration of the operation (p < 0.001) and a higher number of early and late dislocations (p = 0.002), we do not recommend THR as the treatment of choice in patients aged >= 70 years with a fracture of the femoral neck in the absence of advanced radiological osteoarthritis or rheumatoid arthritis of the hip.

• 出版日期2010-10