HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians: A Randomized Controlled Trial

Abstract

Background: The choice of primary hemiarthroplasty or total hip arthroplasty in patients ≥80 years of age with a displaced femoral neck fracture has not been adequately studied. As the number of healthy, elderly patients ≥80 years of age is continually increasing, optimizing treatments for improving outcomes and reducing the need for secondary surgery is an important consideration. The aim of the present study was to compare the results of hemiarthroplasty with those of total hip arthroplasty in patients ≥80 years of age.

Methods: This prospective, randomized, single-blinded trial included 120 patients with a mean age of 86 years (range, 80 to 94 years) who had sustained an acute displaced femoral neck fracture <36 hours previously. The patients were randomized to treatment with hemiarthroplasty (n = 60) or total hip arthroplasty (n = 60). The primary end points were hip function and health-related quality of life at 2 years. Secondary end points included hip-related complications and reoperations, mortality, pain in the involved hip, activities of daily living, surgical time, blood loss, and general complications. The patients were reviewed at 3 months and 1 and 2 years.

Results: We found no differences between the groups in terms of hip function, health-related quality of life, hip-related complications and reoperations, activities of daily living, or pain in the involved hip. Hip function, activities of daily living, and pain in the involved hip deteriorated in both groups compared with pre-fracture values. The ability to regain previous walking function was similar in both groups.

Conclusions: We found no difference in outcomes after treatment with either hemiarthroplasty or total hip arthroplasty in active octogenarians and nonagenarians with a displaced femoral neck fracture up to 2 years after surgery. Hemiarthroplasty is a suitable procedure in the short term for this group of patients.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Fig. 1

CONSORT flowchart of the patients in the study. One patient in the hemiarthroplasty group was managed with total hip arthroplasty because of the surgeon’s choice during surgery. Two patients in the total hip arthroplasty group were managed with closed reduction and internal fixation because of a suspected urinary tract infection. Another 3 patients in the total hip arthroplasty group were managed with hemiarthroplasty because of the surgeon’s choice during surgery.

Fig. 2

Line graph showing the mean HHS (and 95% CIs) for hip function during the study period.

Fig. 3

Line graph showing the mean EQ-5D index scores (and 95% CIs) for health-related quality of life during the study period.

Fig. 4

Bar graph showing the mean HHS (and 95% CIs) for hip function at the 2-year follow-up for the patients who correctly guessed their allocation (n = 30) as compared with those who did not (n = 66).