Total Hip Arthroplasty is Less Painful at 12 Months Compared with Hemiarthroplasty in Treatment of Displaced Femoral Neck Fracture

William Macaulay, MD
Center of Hip and Knee Replacement, Columbia University

Kate W. Nellans, MD, MPH
Doris Duke Clinical Research, Columbia University

Richard Iorio, MD
Department of Orthopaedic Surgery, Lahey Clinic

Kevin L. Garvin, MD
Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center

William L. Healy, MD
Department of Orthopaedic Surgery, Lahey Clinic

Melvin P. Rosenwasser, MD
Orthopaedic Hand Trauma Service, Columbia University

DFACTO Consortium


Abstract
Objectives  The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO) study compared total hip arthroplasty (THA) to hemiarthroplasty in the treatment of displaced femoral neck fractures.

Design  This study was designed as a prospective, randomized clinical trial.

Setting  The study was conducted in five US academic and private medical centers.

Patients  Patients were composed of independent, mentally competent individuals, >50 years old who suffered a displaced femoral neck fracture without existing arthritis at the hip. Forty-one patients were enrolled.

Main outcome measures  Functional outcomes and quality of life were assessed at 6 and 12 months post-fracture using the SF-36, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Harris Hip Score, and the Timed "Up & Go" Test (TUG test).

Results  Groups were equivalent at baseline in terms of age, comorbid conditions, and functional status. At 6 months, there were no significant differences between the groups using the outcome measures or overall rates of complications. There was one dislocation in the THA group (5.8% of patients). At 12 months, the THA group reported significantly less pain (53.2  ±  10.2) than the hemiarthroplasty group (42.4  ±  11.5) using the SF-36 (p  =  0.02). Using the TUG Test, we observed a greater proportion of THA patients remain functionally independent 1 year after surgery compared the hemiarthroplasty group (p  =  0.08, controlling for age and sex).

Conclusions  These differences in pain and functional outcomes suggest THA is a viable treatment option for the active elderly displaced femoral neck fracture population.

This article appears in HSS Journal: Volume 4, Number 1.
View the full article at springerlink.com.


About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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