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Patients undergoing total hip arthroplasty are more likely to experience persistent pain than those undergoing internal fixation
1%
14/2597
Patients undergoing total hip arthroplasty are less likely to require reoperation than those undergoing internal fixation
90%
2333/2597
There is no difference in functional outcome scores between internal fixation and total hip arthroplasty
5%
126/2597
Patients undergoing internal fixation perform activities of daily living better than those undergoing total hip arthroplasty
30/2597
Mortality rates are higher following total hip arthroplasty than internal fixation
3%
70/2597
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Elderly patients with femoral neck fractures (FNF) undergoing total hip arthroplasty (THA) are less likely to require reoperation than those undergoing internal fixation. Intracapsular FNF are common in elderly patients after a fall from standing height. Treatment depends on physiological age and displacement (Garden's classification). For displaced fractures, physiologically young patients are treated with internal fixation while physiologically old patients are treated with either hemiarthroplasty (debilitated, less active patients) or THA (more active patients, those with acetabular disease or preexisting inflammatory arthritis). Chammout et al. retrospectively compared the long term (17 years) results of THA (cemented both component) and ORIF (2 cannulated screws) in elderly patients (>65 years). They found no difference in mortality. But hip scores were higher and pain was better in the THA group, while reoperation rates were higher in the ORIF group. Walking speed was initially faster in the THA group, but later did not differ between groups. They recommend THA for elderly patients with displaced FNF. Rogmark et al. prospectively compared closed reduction and internal fixation (CRIF) with arthroplasty (combining hemiarthroplasty and THA) at 2 years in elderly patients (>70 years). Failure rates were higher, pain was worse, and walking was more impaired after CRIF. They recommend arthroplasty for patients >70 with FNF. Incorrect Answers: Answer 1: Patients undergoing THA are more likely to have less pain than internal fixation. Answer 3: Patients undergoing THA have superior functional outcome scores. Answer 4: Patients undergoing THA perform ADL better in the short term. In the long term, there is no difference in ADL between the groups. Answer 5: Mortality rates are similar after the two procedures.
4.3
(11)
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