Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

Description

In this presentation, Emile Schemitsch discusses the results of a large randomized controlled trial published in the New England Journal of Medicine, which compares Total Hip Arthroplasty (THA) and Hemi-Arthroplasty for patients with displaced femoral neck fractures. Conducted across 80 sites worldwide and led by Mohit Bhandari from McMaster University, the study was initiated due to significant controversies surrounding the management of hip fractures. The primary goal was to examine the risk of unplanned secondary hip procedures within 24 months post-surgery across a diverse cohort of 1495 patients aged 50 and older.



The findings revealed no significant difference in the rate of secondary procedures between the two surgical options, each having an approximately 8% reoperation rate. Though Hemi-Arthroplasty exhibited a slight advantage in the first year, THA surpassed it in the second year, but overall differences remained marginal. Secondary outcomes, such as mortality and functional outcomes, indicated no notable advantages for one procedure over the other, with any statistically significant results not reaching clinical significance. The study concluded that the perceived benefits of Total Hip Arthroplasty may not be justified, particularly in resource-limited settings where such surgeries are less accessible or more expensive.

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