Better Short-term Outcomes after Total Hip Arthroplasty Compared to Hemiarthroplasty in Active Elderly Patients with Displaced Intracapsular Femoral Neck Fracture

Background: Hip fractures are a public health problem that disproportionately affects the elderly. Displaced femoral neck fractures were treated historically with hemiarthroplasty, but the use of total hip arthroplasty (THA) is increasing showing superior long-term results. Objectives: To assess whether THA has superior short-term results compared to bipolar hemiarthroplasty for displaced femoral neck fractures. Methods: Two groups of active older patients underwent either cementless bipolar hemiarthroplasty or THA for displaced femoral neck fracture. All patients were operated on using the direct lateral approach to the hip joint. Patients were assessed using the Harris Hip Score at hospital discharge and at 6 weeks follow-up. Results: We included 40 patients ages 65-85 years; 18 underwent bipolar hemiarthroplasty and 22 THA. The number of women in each group was similar, as was mean age: 73.1 +/- 4.2 years in the hemiarthroplasty group and 71.0 +/- 3.7 in THA. Harris Hip Score on hospital discharge was similar in both groups. Walking ability at discharge was better in the THA cohort and they were discharged sooner: 5.2 +/- 1.3 vs. 6.4 +/- 1.7 days following hemiarthroplasty (P= 0.021). At 6 weeks follow-up, the mean Harris Hip Score was higher in the THA group (78.6 +/- 11 vs. 61.5 +/- 17 for hemiarthroplasty, P< 0.001). Patients in the THA group walked longer distances, needed less support while walking, and reported less pain. Conclusions: Better short-term results at hospital discharge and at 6 weeks follow-up after THA contributed to earlier patient independence and shorter hospital stays.