Total Hip Replacement is Preferred for Displaced Femoral Neck Fracture in Selected Elderly Patients

Abstract

This interesting and remarkable study presents previously unpublished data from a randomized controlled trial of treatment of femoral neck fractures with either total hip replacement or internal fixation. The investigators evaluated outcomes at eleven and seventeen years after enrollment, providing long-term data on fracture treatment that is rarely available, particularly in a randomized study design. The basic conclusion was that in active patients in the age group studied, total hip replacement is better. This conclusion would have been groundbreaking and controversial in the early 1990s, when this study began enrolling patients. This conclusion is now well known and accepted on the basis of studies published during the prolonged follow-up period of this study. However, the comparisons between the two treatment groups, performed well over a decade after the injury and treatment, provide a more definitive assessment of expected lifetime patient function and hip survival after the treatment of a femoral neck fracture. Despite the early follow-up evidence that total hip replacement has fewer complications, there was reason for clinicians to be concerned about this treatment because of the …