Clinical Outcomes for Hemiarthroplasty Versus Total Hip Arthroplasty in Patients With Femoral Neck Fracture Who Meet Published National Criteria for Total Hip Arthroplasty

Objectives To examine outcome for hip fracture patients treated by a hemiarthroplasty (HA) but who actually met the United Kingdom, National Institute for Health and Care Excellence (NICE) criteria for receiving a total hip arthroplasty (THA). Design Match Cohort Study. Setting Level 1, Academic Trauma Centre (UK Major Trauma Centre)Patients/Participants: 398 patients underwent either a HA or THA for a non-pathological displaced intra-capsular fractured neck of femur (OTA/AO 31 B3 (garden 3-4), having met the NICE criteria for THA. Intervention HA versus THA. Two analyses were performed, the first comparing the outcome in a cohort of patients who either received a THA or HA, but who all had met the NICE criteria to receive a THA (n=398). The second analysis assessed the outcome of THA versus HA, in a matched cohort of patients who all met the NICE criteria for a THA (n=44 matched pairs). All patients in the matched cohort were able to walk independently outdoors (WIO) prior to injury. Main outcome Mobility and functional outcome, one year following surgery. Results Of the 398 patients who met the criteria for THA, only 78 (19.6%) patients actually received a THA. Within the matched cohort, significantly more THA patients (92.9%, 39/42) maintained the ability to walk independently outdoors at 1-year compared to HA patients (56.4%. 22/39; p=0.001). There was no difference in mortality, re-operation or complication rates for our matched population at 1 year. Conclusion Patients who meet the NICE criteria for THA and are able to walk independently outdoors pre-injury are more likely to have a higher level of independent mobility and a better functional outcome at 1-year if they receive a THA, as opposed to receiving a HA. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.