Low conversion rates toward total hip arthroplasty after hemiarthroplasty in patients under 75 years of age
- 57 Downloads
An intracapsular fracture of the femoral neck is frequent in the elderly. Patients can be treated with either total hip arthroplasty or hemiarthroplasty. There is a continuous discussion about the treatment in elderly patients who are still healthy, active and mentally untroubled. A potential consequence of hemiarthroplasty, especially in the relatively young elderly, could be conversion to total hip arthroplasty. The conversion rate must be acceptable, and clinical outcome must be sufficient to justify the treatment with hemiarthroplasty in this group of patients. This study evaluates the conversion rate of hemiarthroplasty to total hip arthroplasty and clinical outcome in patients under 75 years of age.
This study identified 248 patients, younger than 75 years at time of operation, with a fracture of the femoral neck treated with hemiarthroplasty. Patient-reported outcome measurements (VAS pain during rest and activity and WOMAC) were assessed by telephone interviews. Furthermore, radiographic evaluation for the presence of acetabular wear was performed.
At a follow-up of 5.1 (0.9–9.6) years, the conversion rate was 7.3%. Mean VAS pain in rest was 0.89 (0–10), the mean VAS pain during activity was 2.2 (0–10), and the WOMAC showed a mean of 16.51 (0–64). At time of follow-up, 38.7% of patients had died. Radiographic evaluation of the unrevised group showed in one patient signs of acetabulum wear.
Hemiarthroplasty in the relatively young elderly after a fracture of the femoral neck demonstrates an acceptable conversion rate. Furthermore, unrevised patients show low complaints of pain. To prevent one conversion to total hip arthroplasty, 13.7 patients should be treated with total hip arthroplasty that will not undergo a conversion at a later stage. Therefore, hemiarthroplasty remains a viable treatment of femoral neck fractures in relatively young patients. There seems to be no space for standardized decision making concerning the choice of treatment. An individual approach is required.
KeywordsFemoral neck fractures Hemiarthroplasty Conversion Under 75 years
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
The procedures followed were in accordance with the ethical standards of the institutional and/or research committee and with the 1964 Helsinki Declaration and its later amendments.
- 2.Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, Bannister GC (2011) Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br 93(8):1045–1048. https://doi.org/10.1302/0301-620X.93B8.27132 CrossRefPubMedGoogle Scholar
- 4.Baker RP, Squires B, Gargan MF, Bannister GC (2006) Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Br. 93(8):1045–1048. https://doi.org/10.1302/0301-620x.93b8.27132 CrossRefGoogle Scholar
- 9.van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, Goslings JC, van Dijk CN, Raaymakers EL (2010) A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Br 92(10):1422–1428. https://doi.org/10.1302/0301-620X.92B10.24899 CrossRefPubMedGoogle Scholar
- 10.Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 16:229. https://doi.org/10.1186/s12891-015-0696-x CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, Tidermark J (2011) Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 93(5):445–450. https://doi.org/10.2106/JBJS.J.00474 CrossRefPubMedGoogle Scholar
- 18.Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, Willems WJ, Heyligers IC, Voaklander DC, Kelly KD, Suarez-Almazor ME (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63(1):36–42CrossRefGoogle Scholar
- 19.Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ (2019) 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. 101(7):572–579. https://doi.org/10.2106/jbjs.18.00539 CrossRefPubMedGoogle Scholar
- 20.Moerman S, Mathijssen NMC, Tuinebreijer WE, Vochteloo AJH, Nelissen RGHH (2018) Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision. Acta Orthop 89(5):509–514. https://doi.org/10.1080/17453674.2018.1499069 CrossRefPubMedPubMedCentralGoogle Scholar