Figure 1. Radiograph of the right hip.
Figure 2. Lateral view of the right hip.
A 69-year-old man presents to the emergency department (ED) with right hip pain after a fall on ice a few hours earlier. He notes that he was unable to get up and walk after the fall and was transported to the ED via ambulance. The patient notes that he is a healthy, active person who enjoys playing tennis on a near-daily basis. Radiographs of the hip are taken and reveal a displaced femoral neck fracture (Figure 1 and 2).
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Hemiarthroplasty, or replacement of the femoral head, is the most common procedure performed in older (>65 years of age) patients with displaced femoral neck fractures. However, over the last decade, total hip arthroplasty (THA) has become an increasingly popular treatment option for these patients.1,2
The most common indications for THA after a displaced femoral neck fracture include pre-existing hip arthritis and a fracture in an active elderly patient. One meta-analysis reported fewer complications associated with THA compared with hemiarthroplasty for displaced femoral neck fractures, although most patients who have a hemiarthroplasty were older and sicker patients.3
In general, THA has been shown to offer better hip function and quality of life compared with hemiarthroplasty. Elderly patients and frail individuals with low functional demands are more appropriate candidates for a hemiarthroplasty, which is generally associated with less operative time and blood loss.1,2 Percutaneous screw fixation is used for nondisplaced or minimally displaced fractures in elderly patients and for displaced fractures in younger patients after closed reduction.
This patient in this case is very active and has pre-existing osteoarthritis (note the sclerosis on the acetabulum) making him a good candidate for THA.
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
1. Bhandari M, Einhorn TA, Guyatt G, et al; HEALTH Investigators. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med. 2019;381(23):2199-2208. doi:10.1056/NEJMoa1906190
2. Stronach BM, Bergin PF, Perez JL, et al. The rising use of total hip arthroplasty for femoral neck fractures in the United States. Hip Int. 2020;30(1):107-113. doi:10.1177/1120700019832989
3. Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ. 2010;340:c2332. doi:10.1136/bmj.c2332