The NEJM reports on a randomized comparison of hemiarthroplasty and total hip arthroplasty in displaced femoral neck fractures and shows no difference in function and quality of life over 24 months.

This Canadian, multicenter trial included 1495 patients, over age 50 years, who had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. The primary end point was a secondary hip procedure within 24 months of follow-up.

The need for a secondary hip procedure was the same with total hip arthroplasty (7.9%) and hemiarthroplasty (8.3%)  (hazard ratio, 0.95; 95% confidence interval [CI], 0.64 to 1.40; P=0.79).

Hip instability or dislocation occurred in 4.7% and 2.4%, respectively. Function (measured by the WOMAC total score), pain score, stiffness score, and function score, modestly favored total hip arthroplasty over hemiarthroplasty.

Mortality over 24 months was similar (14.3% vs 13.1%) and serious adverse events were high but equal (41.8% vs. 36.7%). 

Despite a slight edge for total hip arthroplasty (over hemiarthroplasty) in function and quality of life over 24 months, the outcomes were the same regardless of surgical procedure chosen.