Hemiarthroplasty or total hip arthroplasty in fracture neck of femur? A dilemma in young elderly

Author(s): Dr. Ashwini Gaurav and Dr. Ranjit Kumar Singh

Abstract: The debate over the preference of total hip arthroplasty (THA) over hemi hip arthroplasty (HHA) for displaced fracture neck of femur has been going on for decades, with studies in favour and against of both. We have done a study with three years follow up in fracture neck of femur patients. We have divided all patients into early and late presenters (cut off 6 weeks) and then observed the results of THA and HHA in all four groups. This could be a more specific deciding factor in choosing a correct implant for surgery. The shortcoming of our study was the small sample size and the short observation period. The early presenters (< 6 weeks) and late presenters (>6 weeks) were randomly allocated to undergo THA or HHA. These were then followed up for 3 years to observe the effectiveness of the operative procedure, assess the post-operative radiographs, functional outcome, the rate and cause of revision surgeries and the rate and cause of mortality of patient. In comparison to HHA, THA had longer duration of surgery and more blood loss. But, both the surgery had almost similar mortality rates (10% vs. 8.57%). Limb lengthening was more common in THA group in both early and late presenters. Although more THA patient were ambulant immediately after surgery, but after 3 years the rates were similar in both THA and HHA group. The Harris Hip Score was always better in THA than HHA group in both early (mean 78.69 vs 70.72) (p=0.0005) and late (mean 73.58 vs 64.75) (p=0.041) presenters. In our study there was no progression of osteolysis in Early THA and Early HHA group at the end of 3 years. In the Late THA group 50% and late HHA group 18% of patients migrated from adequate cementation to inadequate cementation at the end of 3 years. It was concluded that THA had better results in early presenting cases with one having some advantage over the other; but, in late presenting patients THA definitely had advantage of more pain relief, better function and less revisions.

DOI: https://doi.org/10.22271/ortho.2019.v5.i4g.1706