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Cemented bipolar hemiarthroplasty
2%
35/1692
Uncemented bipolar hemiarthroplasty
1%
21/1692
Hip resurfacing
0%
7/1692
Total hip arthroplasty (THA)
95%
1606/1692
Open reduction internal fixation (ORIF)
14/1692
Select Answer to see Preferred Response
Active, elderly (>65-years-old) patients with displaced femoral neck fractures have better functional outcomes at 7-10 years when treated with total hip arthroplasty. Displaced femoral neck fractures in elderly patients are generally treated with arthroplasty given the high likelihood of femoral head avascular necrosis (AVN). While indications may vary in regards to hemiarthroplasty vs total hip arthroplasty (THA), THA provides more predictable pain relief and improved functional outcomes when compared to hemiarthroplasty for active patients. Burgers et al. reviewed the outcomes of randomized controlled trials evaluating THA vs hemiarthroplasty in the healthy elderly. They reported a lower revision rate (4 vs 7%), equal one-year mortality (13 vs 15%), and equal major and minor complication rates between THA and hemiarthroplasty, respectively. The dislocation rate, however, was higher for THA (9%) compared to HA (3%). Functional outcomes were also improved with THA, including Harris Hip Scores (81 vs 77), patients reporting mild to no pain (75 vs 56%), and WOMAC scores (94 vs 78). They concluded that THA provides superior patient-based outcomes, but a higher dislocation rate in the active elderly patient with a displaced femoral neck fracture when compared to hemiarthroplasty. Yu et al. reviewed THA vs hemiarthroplasty for displaced femoral neck fractures. They reported nearly the same results as the Burgers study – lower risk of reoperation with THA, similar mortality rates between THA and hemiarthroplasty, and a higher dislocation rate with THA. Similarly, there was no difference in major complication rates between groups. They concluded that despite dislocations, THA for the treatment of displaced femoral neck fractures in the elderly provides improved functional scores and a lower risk of re-operation. Incorrect Answers: Answers 1 and 2: Hemiarthroplasty, cemented or uncemented, has been shown to provide lower functional outcomes following displaced femoral neck fractures in healthy, active elderly patients. Answer 3: Hip resurfacing should not be performed in the setting of femoral neck fractures. Answer 5: Displaced femoral neck fractures in elderly patients should be treated with arthroplasty, not ORIF.
3.7
(3)
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