Review Question - QID 9002

When comparing patients treated with internal fixation or arthroplasty, there is no difference in failure rates between these groups between 2 and 10 years postoperatively.

Options for operative intervention for the treatment of displaced femoral neck fractures include fracture reduction with internal fixation, and arthroplasty. Failure and revision rates with internal fixation techniques have historically been higher compared to arthroplasty in the postoperative period. However, most of the failures occur in the first two-years of follow-up. After this point, the failure rates become similar.

Leonardsson et al. randomized a series of 470 patients over 70 years of age with displaced femoral neck fractures to internal fixation or arthroplasty. At ten years there were 99 failures (45.6%) after internal fixation compared with 17 (8.8%) after replacement. However, most of these failures occurred by the 2-year follow-up (43% internal fixation; 6% arthroplasty).

Gjertsen et al. reviewed the Norweigen registry to assess patient satisfaction, pain and quality of life 4 months after displaced femoral neck fracture. They showed that patients operated with hemiarthroplasty had less pain (VAS 27 vs. 41), were more satisfied with the result of the operation (VAS 33 vs. 48), and had better EQ-5D index score 4 months postoperatively (0.51 vs. 0.42) than patients who were operated with internal fixation.

Incorrect Answers:
Answers 1,2: There is no difference in revision surgery rates between fixation and arthroplasty after the 2-year follow up.
Answer 4,5: There is no difference in mortality rates at all time points between fixation and arthroplasty techniques.