Total Hip Arthroplasty is Less Painful at 12 Months Compared with Hemiarthroplasty in Treatment of Displaced Femoral Neck Fracture

Objectives The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO) study compared total hip arthroplasty (THA) to hemiarthroplasty in the treatment of displaced femoral neck fractures. Design This study was designed as a prospective, randomized clinical trial. Setting The study was conducted in five US academic and private medical centers. Patients Patients were composed of independent, mentally competent individuals, >50 years old who suffered a displaced femoral neck fracture without existing arthritis at the hip. Forty-one patients were enrolled. Main outcome measures Functional outcomes and quality of life were assessed at 6 and 12 months post-fracture using the SF-36, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Harris Hip Score, and the Timed “Up & Go” Test (TUG test). Results Groups were equivalent at baseline in terms of age, comorbid conditions, and functional status. At 6 months, there were no significant differences between the groups using the outcome measures or overall rates of complications. There was one dislocation in the THA group (5.8% of patients). At 12 months, the THA group reported significantly less pain (53.2 ± 10.2) than the hemiarthroplasty group (42.4 ± 11.5) using the SF-36 (p = 0.02). Using the TUG Test, we observed a greater proportion of THA patients remain functionally independent 1 year after surgery compared the hemiarthroplasty group (p = 0.08, controlling for age and sex). Conclusions These differences in pain and functional outcomes suggest THA is a viable treatment option for the active elderly displaced femoral neck fracture population. Level of Evidence: Level I: Randomized controlled trial. DFACTO Consortium: Christopher B. Michelsen, Catherine A. Compito, Justin Greisberg, Ohannes A. Nercessian, Howard A. Kiernan, Columbia University Medical Center, New York, NY; John F. Tilzey, Michael S. Thompson, Bernard A. Pfeifer, Lawrence M. Specht, Anthony H. Presutti, Lahey Clinic, Burlington, MA; Brian S. Parsley, Baylor College of Medicine, Houston, TX; Steven M. Teeny, Julian S. Arroyo, Dale L. Hirz, Alan B. Thomas, NorthWest Orthopaedic Institute, Tacoma, WA; Kevin L. Garvin, Todd Sekundiak, Matthew A. Morinino, Edward V. Ferhringer, Erik T. Otterberg, Univ. of Nebraska Medical Center, Omaha, NE.