Prospective Randomized Clinical Trial Comparing Hemiarthroplasty toTotal Hip Arthroplasty: Functional Outcomes in the Treatment of Displaced Femoral Neck Fractures

Session X - Geriatrics

Sat., 10/7/06 Geriatrics & Injury Prevention, Paper #55, 9:39 am

Prospective Randomized Clinical Trial Comparing Hemiarthroplasty to Total Hip Arthroplasty: Functional Outcomes in the Treatment of Displaced Femoral Neck Fractures

William Macaulay, MD¹(*); Kate W. Nellans, BS¹(*);
Kevin L. Garvin, MD²(*); Richard Iorio, MD³(*); William L. Healy, MD³(*); Richard S. Yoon, BS¹(*); Jeffrey A. Geller, MD¹(*); Melvin P. Rosenwasser, MD¹(*);
¹Columbia University Medical Center, New York, New York, USA;
²University of Nebraska Medical Center, Omaha, Nebraska, USA;
³Lahey Clinic, Burlington, Massachusetts, USA

Purpose: With 300,000 hip fractures occurring annually in the US, the loss of functional independence and quality of life for previously active individuals following a hip fracture is a prime area to optimize outcomes. The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO) study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures.

Methods: Following the patients' hospital course, primary outcomes were measured at 6, 12, and 24 months using validated quality of life and functional status measures. Patient-reported measures include the SF-36, WOMAC, and the Harris Hip Score. The Timed'"Up & Go" Test (TUG) was used as a performance measure.

Results: 40 subjects were enrolled in this pilot. To date, we have collected 6-month data for 39 subjects, 12-month data on 36 subjects, and 24-month data on 11 subjects. Using an intention to treat analysis, 6-month data show mean SF-36 results favoring THA over hemiarthroplasty in bodily pain subscores (39.3 vs. 27.0), physical component summary (31.6 vs. 23.1), and mental component summary (39.7 vs. 28.1). Additionally, the stiffness component of the WOMAC index suggests THA subjects had less postoperative stiffness than hemiarthroplasty subjects (57.8 vs. 44.3). Average TUG results also favor THA over hemiarthroplasty (14.2 sec vs. 20.7 sec). 12-month data demonstrate mean differences again favoring THA over hemiarthroplasty in the SF-36 bodily pain subscores (32.7 vs. 20.1), physical component summary (24.1 vs. 18.0), and mental component summary (34.5 vs. 24.8). Additionally, we found 57% of THA subjects walked independently or with a cane occasionally at 1 year, while only 41% of the subjects in the hemiarthroplasty group were able to do so. Due to the pilot nature of our study, statistically significant results have yet to be achieved.

Conclusion/Significance: These results suggest a possible sustained, superior result in terms of pain, stiffness, and functional results for subjects receiving a THA for the treatment of a displaced femoral neck fracture. Following these subjects through 2 years will be important to fully assess the risks and benefits of THA vs. hemiarthroplasty and best define the criteria for treatment decisions.

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.

· 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). · · FDA information not available at time of printing.