Do Total Hip Replacements Improve Outcomes for Patients With Neck of Femur Fractures?

TL;DR

This study examines whether total hip replacements improve outcomes for elderly patients with femur neck fractures, finding good functional results but notable complications.

Contribution

The study provides empirical evidence on THR outcomes for displaced femur neck fractures in the elderly, highlighting risks and functional scores.

Findings

THR patients had an average Oxford Hip Score of 39.8/48, indicating good functional outcomes.

Complications included periprosthetic fractures and dislocations, but no 30-day mortality was observed.

THR for NOF fractures showed increased mortality compared to THR for osteoarthritis.

Abstract

Introduction

Neck of femur (NOF) fractures are a significant challenge in the elderly population, with high morbidity and mortality rates. Total hip replacement (THR) is a well-established treatment for displaced intracapsular NOF fractures. However, THR carries a higher risk of complications such as dislocation and periprosthetic fractures in elderly patients. This study aims to assess the management, complications, and functional outcomes of THR in displaced NOF fractures in the elderly.

Methods

A retrospective review was conducted on patients with displaced intracapsular NOF fractures treated at a major teaching hospital from January 2014 to November 2017. Patient data was collected from the National Hip Fracture Database. Functional outcomes were assessed using the Oxford Hip Questionnaire at least one year postoperatively.

Results

A total of 1,831 patients with NOF fractures were included, with 134 (16.1%) undergoing THR. The mean time to surgery for THR was 1.8 days. Complications included two acetabular periprosthetic fractures, four periprosthetic shaft fractures, and five dislocations. No 30-day mortality was observed, but four patients died within one year, primarily from unrelated causes. The average Oxford Hip Score was 39.8/48, indicating good functional outcomes in most patients.

Conclusions

THR provides favorable functional outcomes for displaced NOF fractures in selected elderly patients, although complications such as periprosthetic fractures and dislocations remain a concern. Careful patient selection is key, as increased mortality was seen in THR for NOF versus THR for osteoarthritis.

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