Comparison of Total Hip Arthroplasty (THA) and Hemiarthroplasty (HA) in Femoral Neck Fractures of Elderly Patients

Salim Khani, Mohammad Emami Tehrani Moghadam, Gholam Hussein Kazemian, Mohammad Reza Ebrahiminia


Femoral neck fracture is a common problem among the elderly. There is no cure for these fractures until now. Internal fixation, hemi arthroplasty and total arthroplasty are widely used methods for treating these fractures. The purpose of this study was to compare two techniques of arthroplasty and total hemiarthroplasty in femoral neck fractures in the elderly. This clinical trial had been performed among the elderly over 65 years with a diagnosis of femoral neck fracture, hip replacement surgery. They were randomly assigned to two groups (n = 50) of hemiarthroplasty and total hip arthroplasty. Duration of surgery, intraoperative blood loss, and duration of hospitalization were analyzed. Patients Follow up were performed once a month for six months and then quarterly for a year after study. Hip function of patients were assessed using the Harris hip score in the fourth and twelve months after surgery. The rate of intraoperative bleeding and the mean duration of surgery was lower in hemiarthroplasty than THA group (P = 0.01). The mean pain score in patients with total hip arthroplasty after 6month was 38 and after 12 months was 43. In Hemiarthroplasty group, the pain intensity score after 6 months was 40 and after 12 month was 42 (P = 0.04). Average functional score and activity of hip joint in total arthroplasty group was 31.5 (47-5) after six months, and 35.3 (47-8) in yearly follow up, and in hemiarthroplasty group, it was 28 (45-5) and 32 (47-8), respectively (P = 0.028). This study results shows that treatment of femoral neck fractures in elderly through total hip arthroplasty surgery lead to a better results in terms of knee function and also less pain and fewer complications in the one-year follow-up.

Full Text:



Sterling RS. Gender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function. Clin Orthop Relat Res. 2011;469:1913-8.

Giannoudis PV, Kontakis G, Christoforakis Z, Akula M, Tosounidis T, Koutras C. Management, complications and clinical results of femoral head fractures. Injury. 2009;40:1245-51.

Butler M, Forte M, Kane RL, Joglekar S, Duval SJ, Swiontkowski M, et al. Treatment of common hip fractures. Evid Rep Technol Assess. 2009;184:1-85.

Schneider EL, Guralnik JM. The aging of America. Impact on health care costs. JAMA. 1990;263:2335-40.

Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg. 2008;16:596-607.

Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726-33.

Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007;89:160-5.

Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res. 2012;470:2235-43.

Bhandari M, Devereaux PJ, Tornetta P, 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87:2122-30.

Parker MJ, Khan RJ, Crawford J, Pryor GA. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients. J Bone Joint Surg Br. 2002;84:1150-5.

Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg. 1961;43:647-63.

Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994;76:15-25.

Macaulay W, Nellans KW, Iorio R, Garvin KL, Healy WL, Rosenwasser MP, et al. Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture. HSS J. 2008;4:48-54.

Papandrea RF, Froimson MI. Total hip arthroplasty after acute displaced femoral neck fractures. Am J Orthop (Belle Mead NJ). 1996;25:85-8.

Kofoed H, Kofod J. Moore prosthesis in the treatment of fresh femoral neck fractures. A critical review with special attention to secondary acetabular degeneration. Injury. 1983;14:531-40.

Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am. 2006;88:249-60.

Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am. 2005;87:1680-8.

Ravikumar K, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur: 13 year results of a prospective randomised study. . Injury. 2003;31:793-7.

The Swedish National Hip Arthroplasty Registry. 2006 [23 December 2006]. Available from:

Tidermark J, Ponzer S, Svensson O, Soderqvist A, Tornkvist H. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br. 2003;85:380-8.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Nova Journal of Medical and Biological Sciences ISSN 2292-793X (Online) Published by Nova Pub inc.

Nova Explore Publications
is a member of CrossRef.
DOI Prefix: 10.20286