Session I - Geriatrics

Thurs., 10/20/05 Geriatrics, Paper #2, 3:06 pm

·A Four-year Follow-up of a Randomized Controlled Trial Comparing Internal Fixation with Total Hip Replacement in Elderly Patients with Displaced Femoral Neck Fractures

Richard Blomfeldt, MD; Sari Ponzer, MD; Hans Törnkvist, MD;
Jan Tidermark, MD; (all authors a-Trygg-Hansa Insurance Company,
Swedish Orthopaedic Association, Stockhold County Council)
Stockholm Soder Hospital, Department of Orthopaedics, Stockholm, Sweden

Background: An increasingly popular opinion is that the outcome after a displaced femoral neck fracture in the elderly patient would be improved by a more patient-related, rather than strictly diagnosis-related, approach. Consequently, the treatment should be based on the patient's age, functional demands and individual risk profile. Recent randomized controlled trials have shown that a primary total hip replacement (THR) is superior to internal fixation (IF) in the relatively healthy elderly lucid patient with a displaced femoral neck fracture during the first 2 years after the operation. Because this selected group of relatively healthy elderly patients is likely to have a longer life expectancy, it is important to evaluate the outcome within a longer time perspective. The primary aim of the study was to determine if the better outcome for a primary THR compared to IF persists with a 4-year follow-up.

Methods: 102 patients, mean age 80 years, with an acute displaced femoral neck fracture were randomly allocated to THR or IF. The inclusion criteria were age 70 years, absence of severe cognitive dysfunction, independent living status, and independent walking ability. Follow-ups were done at 4, 12, 24, and 48 months. The main outcome measurements were: hip complications, reoperations, hip function (Charnley score), and health-related quality of life (HRQoL, EQ-5D).

Results: At the 48-month follow-up the rate of hip complications was 4% for THR and 42% for IF (P<0.001) and the rate of reoperated patients 4% for THR and 47% for IF (P<0.001). In the THR group there were no further hip complications or reoperations between the 24- and 48-month follow-up, in contrast to the IF group, in which the percentage of hip complications increased from 36% to 42% and reoperations from 42% to 47% during the same period. In general, the hip function was better in the THR group. At the 48-month follow-up, the numerical values were higher in the THR group with a trend towards reduced pain compared to the IF group (P=0.082). The HRQoL according to EQ-5D index score was assessed to be better in the THR group at each follow-up, but the differences were statistically significant only at 4 and 12 months.

Conclusion/Significance: The results of this study confirm that compared to IF, a primary THR provides a better outcome for a lucid elderly patient with a displaced femoral neck fracture. The complication and reoperation rates were significantly lower, and the outcome in hip function and HRQoL were at least as good, even with a 4-year perspective.

· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). uFDA information not available at time of printing.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.