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Choosing Between Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: Patient Selection is the Key

Q: Is there a general consensus among orthopaedic surgeons about how best to choose between total hip arthroplasty (THA) versus hemiarthroplasty for their patients with femoral neck fractures?

Davis: No. There are conflicting opinions about which of these procedures is best suited to particular patients. Studies from individual centers tend to emphasize the improved functional outcomes in patients who have a THA, while national registry data tends to demonstrate the lower complication rate with hemiarthroplasty. The differences may relate to the patient populations in each study and the technical skills of the surgeons. Outcomes from each type of study are valuable. Surgeons and patients should balance the risks and benefits to determine the best approach for each individual patient.

Q: Based on your interpretation of the available registry data, what are the main advantages and disadvantages of THA?

Davis: Compared to hemiarthroplasty, THA yields better pain relief and patients are able to walk farther, on average. Disadvantages, however, include longer surgical time, increased dislocation risk, and potential for acetabular component loosening. Several countries have registry data that suggest rates of complications, including dislocation, are higher with THA versus hemiarthroplasty. Also in most hip fracture cases, the acetabular bone stock is softer and the acetabular fixation is less secure than in arthritic hips with denser bone. In my opinion, the literature supports THA as the procedure of choice for younger more active patients and those with pre-existing arthritis. (Figure 1)

Total Hip Arthroplasty (THA)

FIGURE 1A: Patient with femoral neck fracture for THA. FIGURE 1B: Patient X-ray after surgery. FIGURE 2: Appropriate candidate for hemiarthroplasty; 64-year-old man who fell on ice.

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