Prospective Randomized Clinical Trial Comparing Hemiarthroplasty to Total Hip Arthroplasty in the Treatment of Displaced Femoral Neck Fractures: Winner of the Dorr Award

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Abstract

The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed “Up & Go” Test. Forty subjects were enrolled. At 24 months, THA patients had significantly less pain on the SF-36 subscale than hemiarthroplasty patients (54.8 ± 7.9 vs 44.7 ± 10.5, P = .04) and scored significantly better on the SF-36 mental health subscale (54.9 ± 9.4 vs 40.9 ± 10.3, P = .006). Total hip arthroplasty patients also had superior WOMAC function scores (81.8 ± 10.2 vs 65.1 ± 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.

Section snippets

Investigative Sites

Five US medical centers screened subjects for potential enrollment in the DFACTO trial. This trial was approved by the Western Institutional Review Board at the principal investigation site, as well as each institution's individual institutional review board. All patients provided informed consent after a detailed explanation of the risks and alternatives to participation in this study.

Eligibility Criteria

Inclusion criteria included (1) age of more than 50 years, (2) ability for independent ambulation before

Results

One hundred fourteen patients were screened for this study at 5 sites over 18 months. Forty-one patients were initially enrolled in the study; 23 were randomized to the hemiarthroplasty group, 18 were randomized to the THA group. Fourteen surgeons performed the 41 operations, 5 of whom are fellowship-trained adult reconstruction specialists. One THA patient withdrew immediately after surgery and refused to have her baseline data included, reducing the size of the THA group to 17 patients and

Discussion

This study demonstrates that THA can provide better outcomes than hemiarthroplasty as a treatment of displaced femoral neck fractures. Despite the limited statistical power of this study, significantly improved outcomes in the THA group were seen regarding pain and function at 2 years. The 10 or greater point difference between the groups in the subscales of the SF-36 and WOMAC at 12 and 24 months represents a both statistically and clinically significant outcome regarding pain, functional

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    Benefits or funds were received in partial or total support of the research material described in this article. These benefits or support were received from the following sources: American Association of Hip and Knee Surgeons and Orthopaedic Research and Education Foundation grants.

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    Other members of the DFACTO Consortium: Jeffrey A. Geller, MD, Justin Greisberg, MD, Christopher B. Michelsen, MD, Catherine A. Compito, MD, Ohannes A. Nercessian, MD, Howard A. Kiernan, MD, Richard S. Yoon, BS, Columbia University Medical Center, New York, NY; John F. Tilzey, MD, Michael S. Thompson, MD, Bernard A. Pfeifer, MD, Lawrence M. Specht, MD, Anthony H. Presutti, MD, Lahey Clinic, Burlington, MA; Brian S. Parsley, MD, Baylor College of Medicine, Houston, TX; Steven M. Teeny, MD, Julian S. Arroyo, MD, Dale L. Hirz, MD, Alan B. Thomas, MD, NorthWest Orthopaedic Institute, Tacoma, WA; Todd Sekundiak, MD, Matthew A. Morinino, MD, Edward V. Ferhringer, MD, Erik T. Otterberg, MD, University of Nebraska Medical Center, Omaha, NE.

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