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