Research Articles

Primary Total Hip Arthroplasty versus Open Reduction and Internal Fixation in Displaced Fracture of Femoral Neck in Adults

Abstract

Background: Femoral neck fracture as a prevalent skeletal injury accounts for 7% of orthopedic hospital admission. The aim of the present study is to evaluate the functional outcome of patients with femoral neck fracture treated with total hip arthroplasty (THA) and compare them with those undergoing fixation treatment.

 

Methods: In this study, we reviewed patients in the age range of 45-60 years old with femoral neck fracture during 2007-2017. The subjects were assigned to either THA or fixation group. The primary outcome was hip function, evaluated with the Harris Hip Scale (HHS). Secondary outcomes included pain, local infection, avascular necrosis (AVN), thromboembolic event, loosening of the prosthetic and internal fixation device, prosthetic dislocation, non-union, and delayed-union.

 

Results: In this study, 34 patients with displaced fracture of femoral neck were treated with acute THA and 38 patients were treated with fixation. The HHS was higher in the THA group compared to the fixation group (P < 0.050). The results of the present study indicated no significant difference in early postoperative complications over the first month between the two groups, but frequency of complications such as non-union, AVN, pain and loosening of the internal fixation device in the fixation group were significantly higher than the THA group after six months (P < 0.050).

 

Conclusion: Over a period of six months, THA provided better hip function and significantly fewer postoperative complications compared to fixation.

1. Wani IH, Sharma S, Latoo I, Salaria AQ, Farooq M, Jan M. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa-and septuagenarians. J Orthop Traumatol. 2014;15(3):209-14. doi: 10.1007/s10195-013-0278-3. [PubMed: 24385140]. [PubMed Central: PMC4182619].

2. Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing complications and costs of total HIP arthroplasty and hemiarthroplasty for femoral neck fractures: A propensity score-matched, population-based study. J Bone Joint Surg Am. 2019;101(7):572-9. doi: 10.2106/JBJS.18.00539. [PubMed: 30946190].

3. Perry DC, Metcalfe D, Griffin XL, Costa ML. Inequalities in use of total hip arthroplasty for hip fracture: population based study. BMJ. 2016;353:i2021. doi: 10.1136/bmj.i2021. [PubMed: 27122469]. [PubMed Central: PMC4849171].

4. Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: Systematic review. BMJ. 2010;340:c2332. doi: 10.1136/bmj.c2332. [PubMed: 20543010].

5. Mariconda M, Costa G, Misasi M, Recano P, Balato G, Rizzo M. Ambulatory ability and personal independence after hemiarthroplasty and total arthroplasty for intracapsular hip fracture: A prospective comparative study. J Arthroplasty. 2017;32(2):447-52. doi: 10.1016/j.arth.2016.07.017. [PubMed: 27546471].

6. Sharma V, Awasthi B, Kumar K, Kohli N, Katoch P. Outcome analysis of hemiarthroplasty vs. total hip replacement in displaced femoral neck fractures in the elderly. J Clin Diagn Res. 2016;10(5):RC11-RC13. doi: 10.7860/JCDR/2016/18638.7877. [PubMed: 27437316]. [PubMed Central: PMC4948492].

7. Liodakis E, Antoniou J, Zukor DJ, Huk OL, Epure LM, Bergeron SG. Major Complications and Transfusion Rates After Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures. J Arthroplasty. 2016;31(9):2008-12. doi: 10.1016/j.arth.2016.02.019. [PubMed: 26975602].

8. Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4(1):16. doi: 10.1186/1754-9493-4-16. [PubMed: 20961437]. [PubMed Central: PMC2972258].

9. Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health. 2017;142:64-9. doi: 10.1016/j.puhe.2016.10.018. [PubMed: 28057200].

10. Cuckler JM, Tamarapalli JR. An algorithm for the management of femoral neck fractures. Orthopedics. 1994;17(9):789-92. [PubMed: 7800601].

11. Razik F, Alexopoulos AS, El-Osta B, Connolly MJ, Brown A, Hassan S, et al. Time to internal fixation of femoral neck fractures in patients under sixty years-does this matter in the development of osteonecrosis of femoral head? Int Orthop. 2012;36(10):2127-32. doi: 10.1007/s00264-012-1619-1. [PubMed: 22829122]. [PubMed Central: PMC3460095].

12. Lieberman JR, Romano PS, Mahendra G, Keyzer J, Chilcott M. The treatment of hip fractures: Variations in care. Clin Orthop Relat Res. 2006;442:239-44. doi: 10.1097/01.blo.0000188558.67172.4e. [PubMed: 16394767].

13. Gautam VK, Anand S, Dhaon BK. Management of displaced femoral neck fractures in young adults (a group at risk). Injury. 1998;29(3):215-8. doi: 10.1016/s0020-1383(97)00184-8. [PubMed: 9709424].

14. Wang W, Wei J, Xu Z, Zhuo W, Zhang Y, Rong H, et al. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: A meta-analysis. BMC Musculoskelet Disord. 2014;15:167. doi: 10.1186/1471-2474-15-167. [PubMed: 24885566]. [PubMed Central: PMC4047776].

15. Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr. Total hip arthroplasty after failed internal fixation of proximal 1. Wani IH, Sharma S, Latoo I, Salaria AQ, Farooq M, Jan M. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa-and septuagenarians. J Orthop Traumatol. 2014;15(3):209-14. doi: 10.1007/s10195-013-0278-3. [PubMed: 24385140]. [PubMed Central: PMC4182619].

2. Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing complications and costs of total HIP arthroplasty and hemiarthroplasty for femoral neck fractures: A propensity score-matched, population-based study. J Bone Joint Surg Am. 2019;101(7):572-9. doi: 10.2106/JBJS.18.00539. [PubMed: 30946190].

3. Perry DC, Metcalfe D, Griffin XL, Costa ML. Inequalities in use of total hip arthroplasty for hip fracture: population based study. BMJ. 2016;353:i2021. doi: 10.1136/bmj.i2021. [PubMed: 27122469]. [PubMed Central: PMC4849171].

4. Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: Systematic review. BMJ. 2010;340:c2332. doi: 10.1136/bmj.c2332. [PubMed: 20543010].

5. Mariconda M, Costa G, Misasi M, Recano P, Balato G, Rizzo M. Ambulatory ability and personal independence after hemiarthroplasty and total arthroplasty for intracapsular hip fracture: A prospective comparative study. J Arthroplasty. 2017;32(2):447-52. doi: 10.1016/j.arth.2016.07.017. [PubMed: 27546471].

6. Sharma V, Awasthi B, Kumar K, Kohli N, Katoch P. Outcome analysis of hemiarthroplasty vs. total hip replacement in displaced femoral neck fractures in the elderly. J Clin Diagn Res. 2016;10(5):RC11-RC13. doi: 10.7860/JCDR/2016/18638.7877. [PubMed: 27437316]. [PubMed Central: PMC4948492].

7. Liodakis E, Antoniou J, Zukor DJ, Huk OL, Epure LM, Bergeron SG. Major Complications and Transfusion Rates After Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures. J Arthroplasty. 2016;31(9):2008-12. doi: 10.1016/j.arth.2016.02.019. [PubMed: 26975602].

8. Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4(1):16. doi: 10.1186/1754-9493-4-16. [PubMed: 20961437]. [PubMed Central: PMC2972258].

9. Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health. 2017;142:64-9. doi: 10.1016/j.puhe.2016.10.018. [PubMed: 28057200].

10. Cuckler JM, Tamarapalli JR. An algorithm for the management of femoral neck fractures. Orthopedics. 1994;17(9):789-92. [PubMed: 7800601].

11. Razik F, Alexopoulos AS, El-Osta B, Connolly MJ, Brown A, Hassan S, et al. Time to internal fixation of femoral neck fractures in patients under sixty years-does this matter in the development of osteonecrosis of femoral head? Int Orthop. 2012;36(10):2127-32. doi: 10.1007/s00264-012-1619-1. [PubMed: 22829122]. [PubMed Central: PMC3460095].

12. Lieberman JR, Romano PS, Mahendra G, Keyzer J, Chilcott M. The treatment of hip fractures: Variations in care. Clin Orthop Relat Res. 2006;442:239-44. doi: 10.1097/01.blo.0000188558.67172.4e. [PubMed: 16394767].

13. Gautam VK, Anand S, Dhaon BK. Management of displaced femoral neck fractures in young adults (a group at risk). Injury. 1998;29(3):215-8. doi: 10.1016/s0020-1383(97)00184-8. [PubMed: 9709424].

14. Wang W, Wei J, Xu Z, Zhuo W, Zhang Y, Rong H, et al. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: A meta-analysis. BMC Musculoskelet Disord. 2014;15:167. doi: 10.1186/1471-2474-15-167. [PubMed: 24885566]. [PubMed Central: PMC4047776].

15. Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr. Total hip arthroplasty after failed internal fixation of proximal
16. Wani IH, Sharma S, Latoo I, Salaria AQ, Farooq M, Jan M. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa-and septuagenarians. J Orthop Traumatol. 2014;15(3):209-14. doi: 10.1007/s10195-013-0278-3. [PubMed: 24385140]. [PubMed Central: PMC4182619].

17. Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing complications and costs of total HIP arthroplasty and hemiarthroplasty for femoral neck fractures: A propensity score-matched, population-based study. J Bone Joint Surg Am. 2019;101(7):572-9. doi: 10.2106/JBJS.18.00539. [PubMed: 30946190].

18. Perry DC, Metcalfe D, Griffin XL, Costa ML. Inequalities in use of total hip arthroplasty for hip fracture: population based study. BMJ. 2016;353:i2021. doi: 10.1136/bmj.i2021. [PubMed: 27122469]. [PubMed Central: PMC4849171].

19. Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: Systematic review. BMJ. 2010;340:c2332. doi: 10.1136/bmj.c2332. [PubMed: 20543010].

20. Mariconda M, Costa G, Misasi M, Recano P, Balato G, Rizzo M. Ambulatory ability and personal independence after hemiarthroplasty and total arthroplasty for intracapsular hip fracture: A prospective comparative study. J Arthroplasty. 2017;32(2):447-52. doi: 10.1016/j.arth.2016.07.017. [PubMed: 27546471].

21. Sharma V, Awasthi B, Kumar K, Kohli N, Katoch P. Outcome analysis of hemiarthroplasty vs. total hip replacement in displaced femoral neck fractures in the elderly. J Clin Diagn Res. 2016;10(5):RC11-RC13. doi: 10.7860/JCDR/2016/18638.7877. [PubMed: 27437316]. [PubMed Central: PMC4948492].

22. Liodakis E, Antoniou J, Zukor DJ, Huk OL, Epure LM, Bergeron SG. Major Complications and Transfusion Rates After Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures. J Arthroplasty. 2016;31(9):2008-12. doi: 10.1016/j.arth.2016.02.019. [PubMed: 26975602].

23. Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4(1):16. doi: 10.1186/1754-9493-4-16. [PubMed: 20961437]. [PubMed Central: PMC2972258].

24. Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health. 2017;142:64-9. doi: 10.1016/j.puhe.2016.10.018. [PubMed: 28057200].

25. Cuckler JM, Tamarapalli JR. An algorithm for the management of femoral neck fractures. Orthopedics. 1994;17(9):789-92. [PubMed: 7800601].

26. Razik F, Alexopoulos AS, El-Osta B, Connolly MJ, Brown A, Hassan S, et al. Time to internal fixation of femoral neck fractures in patients under sixty years-does this matter in the development of osteonecrosis of femoral head? Int Orthop. 2012;36(10):2127-32. doi: 10.1007/s00264-012-1619-1. [PubMed: 22829122]. [PubMed Central: PMC3460095].

27. Lieberman JR, Romano PS, Mahendra G, Keyzer J, Chilcott M. The treatment of hip fractures: Variations in care. Clin Orthop Relat Res. 2006;442:239-44. doi: 10.1097/01.blo.0000188558.67172.4e. [PubMed: 16394767].

28. Gautam VK, Anand S, Dhaon BK. Management of displaced femoral neck fractures in young adults (a group at risk). Injury. 1998;29(3):215-8. doi: 10.1016/s0020-1383(97)00184-8. [PubMed: 9709424].

29. Wang W, Wei J, Xu Z, Zhuo W, Zhang Y, Rong H, et al. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: A meta-analysis. BMC Musculoskelet Disord. 2014;15:167. doi: 10.1186/1471-2474-15-167. [PubMed: 24885566]. [PubMed Central: PMC4047776].

30. Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr. Total hip arthroplasty after failed internal fixation of proximal16. Wani IH, Sharma S, Latoo I, Salaria AQ, Farooq M, Jan M. Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa-and septuagenarians. J Orthop Traumatol. 2014;15(3):209-14. doi: 10.1007/s10195-013-0278-3. [PubMed: 24385140]. [PubMed Central: PMC4182619].

17. Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing complications and costs of total HIP arthroplasty and hemiarthroplasty for femoral neck fractures: A propensity score-matched, population-based study. J Bone Joint Surg Am. 2019;101(7):572-9. doi: 10.2106/JBJS.18.00539. [PubMed: 30946190].

18. Perry DC, Metcalfe D, Griffin XL, Costa ML. Inequalities in use of total hip arthroplasty for hip fracture: population based study. BMJ. 2016;353:i2021. doi: 10.1136/bmj.i2021. [PubMed: 27122469]. [PubMed Central: PMC4849171].

19. Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: Systematic review. BMJ. 2010;340:c2332. doi: 10.1136/bmj.c2332. [PubMed: 20543010].

20. Mariconda M, Costa G, Misasi M, Recano P, Balato G, Rizzo M. Ambulatory ability and personal independence after hemiarthroplasty and total arthroplasty for intracapsular hip fracture: A prospective comparative study. J Arthroplasty. 2017;32(2):447-52. doi: 10.1016/j.arth.2016.07.017. [PubMed: 27546471].

21. Sharma V, Awasthi B, Kumar K, Kohli N, Katoch P. Outcome analysis of hemiarthroplasty vs. total hip replacement in displaced femoral neck fractures in the elderly. J Clin Diagn Res. 2016;10(5):RC11-RC13. doi: 10.7860/JCDR/2016/18638.7877. [PubMed: 27437316]. [PubMed Central: PMC4948492].

22. Liodakis E, Antoniou J, Zukor DJ, Huk OL, Epure LM, Bergeron SG. Major Complications and Transfusion Rates After Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures. J Arthroplasty. 2016;31(9):2008-12. doi: 10.1016/j.arth.2016.02.019. [PubMed: 26975602].

23. Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4(1):16. doi: 10.1186/1754-9493-4-16. [PubMed: 20961437]. [PubMed Central: PMC2972258].

24. Baidwan NK, Naranje SM. Epidemiology and recent trends of geriatric fractures presenting to the emergency department for United States population from year 2004-2014. Public Health. 2017;142:64-9. doi: 10.1016/j.puhe.2016.10.018. [PubMed: 28057200].

25. Cuckler JM, Tamarapalli JR. An algorithm for the management of femoral neck fractures. Orthopedics. 1994;17(9):789-92. [PubMed: 7800601].

26. Razik F, Alexopoulos AS, El-Osta B, Connolly MJ, Brown A, Hassan S, et al. Time to internal fixation of femoral neck fractures in patients under sixty years-does this matter in the development of osteonecrosis of femoral head? Int Orthop. 2012;36(10):2127-32. doi: 10.1007/s00264-012-1619-1. [PubMed: 22829122]. [PubMed Central: PMC3460095].

27. Lieberman JR, Romano PS, Mahendra G, Keyzer J, Chilcott M. The treatment of hip fractures: Variations in care. Clin Orthop Relat Res. 2006;442:239-44. doi: 10.1097/01.blo.0000188558.67172.4e. [PubMed: 16394767].

28. Gautam VK, Anand S, Dhaon BK. Management of displaced femoral neck fractures in young adults (a group at risk). Injury. 1998;29(3):215-8. doi: 10.1016/s0020-1383(97)00184-8. [PubMed: 9709424].

29. Wang W, Wei J, Xu Z, Zhuo W, Zhang Y, Rong H, et al. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: A meta-analysis. BMC Musculoskelet Disord. 2014;15:167. doi: 10.1186/1471-2474-15-167. [PubMed: 24885566]. [PubMed Central: PMC4047776].

30. Archibeck MJ, Carothers JT, Tripuraneni KR, White RE Jr. Total hip arthroplasty after failed internal fixation of proximal
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IssueVol 6, No 4 (2020) QRcode
SectionResearch Articles
DOI https://doi.org/10.18502/jost.v6i4.5562
Keywords
Total Hip Replacements; Femoral Neck Fracture; Internal Fixations; Fracture Open Reduction

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1.
Asadi K, Soleimanmanesh Y, Keymoradzadeh A, Soleimanmanesh N. Primary Total Hip Arthroplasty versus Open Reduction and Internal Fixation in Displaced Fracture of Femoral Neck in Adults. J Orthop Spine Trauma. 2021;6(4):82-5.