- Email: [email protected]
The role of total hip replacement in the treatment of displaced intracapsular hip fractures in the elderly
Injury, Int. J. Care Injured 43 (2012) 1621–1622
Contents lists available at SciVerse ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Editorial
The role of total hip replacement in the treatment of displaced intracapsular hip fractures in the elderly Replacement arthroplasty is the treatment of choice in patients sustaining a displaced intracapsular fragility hip fracture.1 Recently, total hip replacement (THR) has been advocated for ‘‘fit’’ patients with this injury.1–5 Presently in the UK, 46% of the total hip fractures are recorded in the National Hip Fracture Database as displaced intracapsular of which 92% are treated by replacement arthroplasty including 12.5% treated by THR (5.75% of the total hip fracture population).6 However, several questions remain unanswered. What is the definition of the ‘‘fit’’ patient? What is the optimal fixation method of the implant? What is the optimal diameter of the femoral head prosthesis and material of the bearing surface? What is the best surgical approach? This article aims to examine the current evidence pertaining to these questions and thus clarify the value of THR in this patient population. The present literature comprises eight randomised control trials (RCTs), as well as meta-analyses of prospective and retrospective studies.4,5,7–17 The number of hip fractures is increasing worldwide, yet the number of patients studied is small, with just over 1500 patients reported in the eight RCTs performed. The studies are often biased by inclusion and exclusion criteria and report differing outcomes and lengths of follow up. It is also recognised that the initial cost of a total hip replacement is greater than other treatment modalities (such as fixation or hemiarthroplasty) yet many studies do not include any health economics or cost-effectiveness analysis.11 The eight randomised control trials comparing THR with other treatment modalities in fragility hip fractures involving the neck of femur, reported that THR led to better function with increased walking distance compared to hemiarthroplasty (2.23 miles vs. 1.09 miles,10 57% walking independently vs. 41%13) and an improvement in the Harris Hip Score (ranging from 80 to 87 for THA group and from 55 to 79 in HA group). In addition, decreased re-operation rates were reported, but with a higher dislocation rate (ranging from 012 to 20%9) and a slightly longer operation time.10,15 All but one study supports the use of THR in the selected population.15 Only one study included a health economic analysis, which showed THR to be cost effective when compared to other treatments, when revision surgery was included.11 This has led to the current guidance in the UK and other countries that THR should be offered as treatment in this selected patient group (independently mobile patients, no cognitive impairment and medically fit for the anaesthesia and operation).1 It is important to highlight the inclusion and exclusion criteria for these trials. All studies excluded those who had cognitive or physical impairment (previous arthritis, unable to walk with more than one aid or medically unfit) but only one study randomised patients over the age of 90.15 Other RCTS had patients with a mean age of 65 years (range 60–90 years), but with far fewer older patients. This suggests there may have been recruitment bias favouring the younger patient. 0020–1383/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.injury.2012.07.189
What about the fixation method used? It is contentious whether to use fully cemented or uncemented implants or a combination (hybrid). Despite concerns about the use of cement in hip fracture patients with co-morbidities,18 this may not be applicable to the ‘‘fitter’’ patients undergoing THR. Furthermore, a recent analysis has shown decreased mortality with the use of cement compared with uncemented arthroplasties in hip fractures, as well as better walking distances, less pain and decreased revision rates.19 Results from the UK National Joint Registry of 1302 THRs performed for trauma showed a five year revision rate to be significantly increased in uncemented components of 4.1%, compared with 2.2% for hybrid and 0.9% for fully cemented prostheses.20 This correlates with the results of THR for arthritis which have a lower revision rates for fully cemented implants in patients over the age of 70.21 When modern uncemented replacements have been evaluated, periprosthetic fracture and subsidence rates have been reported as just over 6%.22–23 As the majority of the RCTs only reported on fully cemented prostheses,10,14,15 it is really this technique on which conclusions have been drawn. The literature lacks trials directly comparing the modern cemented and uncemented prosthesis. The main concerns of total hip replacement involve the risk of dislocation, which is reported to be between 0 and 20%.9,12 This may be influenced by femoral head diameter, patient characteristics and surgical approach. Two RCTs routinely employed a femoral head diameter of 28 mm,7,10 yet there has recently been an increased use of larger femoral heads. In the arthritis literature this has lead to a decrease in dislocation rate when heads of 36 mm or greater are implanted.24–25 In contrast, experienced hip surgeons have reported dislocation rates of 6.7% with the use of larger heads in hip fracture patients.26 The increased head sizes are more costly, may be more difficult to insert in the small acetabulum and it is not clear whether their use results in better patient outcomes and decreased dislocation and revision rates. Another option recently reported is the use of a dual mobility cup where one study has shown a dislocation rate of 1.4% in 214 patients27 – further results are awaited. The use of harder bearing surfaces, such as ceramic, has been considered in this patient group. However, although relatively fit, they tend to have low functional demands and in the RCTs described, mortality rates vary between 30 and 50% at 10 years28 and 80–90% at 13 years.9 The increased cost of ceramics may not, therefore, be warranted, as most standard implants should survive the patient’s lifetime. The surgical approach is also contentious; the two commonest approaches being posterior or anterolateral. Risks and benefits vary between approaches, but is generally accepted that the posterior approach has an increased risk of dislocation29 (which is further increased when performing THR for acute trauma). Four of
1622
Editorial / Injury, Int. J. Care Injured 43 (2012) 1621–1622
the reported RCTs used solely anterolateral approaches with a reported dislocation rate of 0–7.5% compared to 5.8–20% with the posterior approach, reported in the other RCTs. This is consistent with results of retrospective cohort studies, which includes both hemiarthroplasty and THR treatment. Furthermore, the recent UK NJR analysis demonstrated a three-year revision rate of 3.5% when the implants were inserted through a posterior approach compared to 1.3% when inserted via an anterolateral approach.21 These results have led to national recommendations supporting the anterolateral approach in arthroplasty for hip fracture.1 The change of practice is not only driven by the evidence-based clinical practice but also by patients. In a survey of 81 elderly patients age-matched to the hip fracture population, 93% would elect for a THR following full explanation of the risks and benefits of both hemiarthroplasty and total arthroplasty.30 Whilst prompt, expert surgical treatment is a vital component of hip fracture care, it is only part of a complex treatment pathway, which is essential for optimal patient recovery and rehabilitation. These patients suffer from a fragility hip fracture as result of a low velocity fall (often from standing height). Bone health assessment and falls prevention should not, therefore, be forgotten in this fitter population. In conclusion, the use of THR, in the treatment of displaced intracapsular fractures of the proximal femur, is supported by evidence in those who are fit, not cognitively impaired and can walk prior to their injury. The use of a cemented prosthesis inserted through an anterolateral approach appears to have a better outcome. It remains unclear whether there should be an upper age limit for this treatment option or how this ‘‘fit’’ population can be better defined. When used appropriately, THR for hip fracture should be considered a more cost-effective treatment. Whilst the arthritis literature may help us study the optimal bearing surface and head size, the higher risk of dislocation in trauma will remain. Larger femoral heads may or may not help reduce this risk. All future studies should include health economic assessments and cost-effectiveness analysis as part of their study protocols as well as outcomes scores, which include measurement of quality of life.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21. 22.
23. 24.
25.
References
26.
1. NICE. Guidelines for hip fracture management. www.nice.org.uk/CG124. 2. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database of Systematic Reviews )2010;(6). http://dx.doi.org/10.1002/14651858.CD001706.pub4. Art. No.: CD001706. 3. SIGN. Management of hip fracture in the older people. www.sign.ac.uk/pdf/ sign111. 4. 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(June):c2332. 5. Carroll C, Stevenson M, Scope A, Evans P, Buckley S. Hemiarthroplasty and total hip arthroplasty for treating primary intracapsular fracture of the hip: a systematic review and cost-effectiveness analysis. Health Technology Assessment 2011;15(October (36)):1–74. 6. NHFD. 2011 report. www.nhfd.co.uk/003/hipfracturer.nsf/NHFDNationalReport2011. 7. Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. Journal of Arthroplasty 1986;1(1):21–8. 8. Skinner P, Riley D, Ellery J, Beaumont A, Coumine R, Shafighian B. Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement. Injury 1989;20(September (5)):291–3. 9. Ravikumar KJ, 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 2000;31(December (10)):793–7. 10. Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. Journal of Bone and Joint Surgery 2006;88(December (12)):2583–9. 11. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and
27.
28.
29.
30.
fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technology Assessment 2005;9(October (41)):1–65. iii–iv, ix–x. Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A randomised trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck in the elderly. Journal of Bone and Joint Surgery British Volume 2007;89B:160–5. Macaulay W, Nellans KW, Iorio R, Garvin KL, Healy WL, Rosenwasser MP. Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture. HSS Journal 2008;4(February (1)):48–54. Mouzopoulos G, Stamatakos M, Arabatzi H, Vasiliadis G, Batanis G, Tsembeli A, et al. The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options. International Orthopaedics 2008;32(June (3)):367–73. van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. Journal of Bone and Joint Surgery British Volume 2010;92(October (10)):1422–8. Liao L, Zhao JM, Su W, Ding XF, Chen LJ, Luo SX. A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures. Archives of Orthopaedic and Trauma Surgery 2012;132(July (7)):1021–9. Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clinical Orthopaedics and Related Research 2012;470(August (8)):2235–43. Cleary K. National Patient Safety Report: mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur; 2009 (NPSA/ 2009/RRR001). http://www.nrls.npsa.nhs.uk/resources/. Costa ML, Griffin XL, Pendleton N, Pearson M, Parsons N. Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur? Data from the National Hip Fracture Database. Journal of Bone and Joint Surgery British Volume 2011;93(October (10)):1405–10. Stafford GH, Charman SC, Borroff MJ, Newell C, Tucker JK. Total hip replacement for the treatment of acute femoral neck fractures: results from the National Joint Registry of England and Wales at 3–5 years after surgery. Annals of the Royal College of Surgeons of England 2012;94(April (3)):193–8. NJR Annual report 2011. www.njrcentre.org.uk. Kim YH, Oh JH. A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck. Journal of Bone and Joint Surgery British Volume 2012;94(June (6)):774–81. Pentlow AK, Heal JS. Subsidence of collarless uncemented femoral stems in total hips replacements performed for trauma. Injury 2012;43(June (6)):882–5. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. .Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. Journal of Bone and Joint Surgery 2005;87(November (11)):2456–63. Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, et al. Lower rates of dislocation with increased femoral head size after primary total hip replacement: a five-year analysis of NHS patients in England. Journal of Bone and Joint Surgery British Volume 2011;93(July (7)):876–80. Low AK, Gursel AC. Mid-term outcome of total hip replacement using the posterior approach for displaced femoral neck fractures. Hip International 2012;22(March–April (2)):203–8. Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Mole´ D, et al. Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthopaedics & Traumatology Surgery & Research 2012;98(May (3)):296–300. Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, et al. Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. Journal of Bone and Joint Surgery British Volume 2011;93(August (8)):1045–8. Enocson A, Tidermark J, Tornkvist H, Lapidus LJ. Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthopaedica 2008;79(April (2)):211–7. Alolabi N, Alolabi B, Mundi R, Karanicolas PJ, Adachi JD, Bhandari M. Surgical preferences of patients at risk of hip fractures: hemiarthroplasty versus total hip arthroplasty. BMC Musculoskeletal Disorders 2011;12(December):289.
Tim J.S. Chesser* Vijaya M. Budnar Mehool R. Acharya Department of Trauma and Orthopaedics, Frenchay Hospital, North Bristol NHS Trust, Bristol BS16 1LE, UK *Corresponding author E-mail address: [email protected] (Tim J.S. Chesser)
Contents lists available at SciVerse ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Editorial
The role of total hip replacement in the treatment of displaced intracapsular hip fractures in the elderly Replacement arthroplasty is the treatment of choice in patients sustaining a displaced intracapsular fragility hip fracture.1 Recently, total hip replacement (THR) has been advocated for ‘‘fit’’ patients with this injury.1–5 Presently in the UK, 46% of the total hip fractures are recorded in the National Hip Fracture Database as displaced intracapsular of which 92% are treated by replacement arthroplasty including 12.5% treated by THR (5.75% of the total hip fracture population).6 However, several questions remain unanswered. What is the definition of the ‘‘fit’’ patient? What is the optimal fixation method of the implant? What is the optimal diameter of the femoral head prosthesis and material of the bearing surface? What is the best surgical approach? This article aims to examine the current evidence pertaining to these questions and thus clarify the value of THR in this patient population. The present literature comprises eight randomised control trials (RCTs), as well as meta-analyses of prospective and retrospective studies.4,5,7–17 The number of hip fractures is increasing worldwide, yet the number of patients studied is small, with just over 1500 patients reported in the eight RCTs performed. The studies are often biased by inclusion and exclusion criteria and report differing outcomes and lengths of follow up. It is also recognised that the initial cost of a total hip replacement is greater than other treatment modalities (such as fixation or hemiarthroplasty) yet many studies do not include any health economics or cost-effectiveness analysis.11 The eight randomised control trials comparing THR with other treatment modalities in fragility hip fractures involving the neck of femur, reported that THR led to better function with increased walking distance compared to hemiarthroplasty (2.23 miles vs. 1.09 miles,10 57% walking independently vs. 41%13) and an improvement in the Harris Hip Score (ranging from 80 to 87 for THA group and from 55 to 79 in HA group). In addition, decreased re-operation rates were reported, but with a higher dislocation rate (ranging from 012 to 20%9) and a slightly longer operation time.10,15 All but one study supports the use of THR in the selected population.15 Only one study included a health economic analysis, which showed THR to be cost effective when compared to other treatments, when revision surgery was included.11 This has led to the current guidance in the UK and other countries that THR should be offered as treatment in this selected patient group (independently mobile patients, no cognitive impairment and medically fit for the anaesthesia and operation).1 It is important to highlight the inclusion and exclusion criteria for these trials. All studies excluded those who had cognitive or physical impairment (previous arthritis, unable to walk with more than one aid or medically unfit) but only one study randomised patients over the age of 90.15 Other RCTS had patients with a mean age of 65 years (range 60–90 years), but with far fewer older patients. This suggests there may have been recruitment bias favouring the younger patient. 0020–1383/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.injury.2012.07.189
What about the fixation method used? It is contentious whether to use fully cemented or uncemented implants or a combination (hybrid). Despite concerns about the use of cement in hip fracture patients with co-morbidities,18 this may not be applicable to the ‘‘fitter’’ patients undergoing THR. Furthermore, a recent analysis has shown decreased mortality with the use of cement compared with uncemented arthroplasties in hip fractures, as well as better walking distances, less pain and decreased revision rates.19 Results from the UK National Joint Registry of 1302 THRs performed for trauma showed a five year revision rate to be significantly increased in uncemented components of 4.1%, compared with 2.2% for hybrid and 0.9% for fully cemented prostheses.20 This correlates with the results of THR for arthritis which have a lower revision rates for fully cemented implants in patients over the age of 70.21 When modern uncemented replacements have been evaluated, periprosthetic fracture and subsidence rates have been reported as just over 6%.22–23 As the majority of the RCTs only reported on fully cemented prostheses,10,14,15 it is really this technique on which conclusions have been drawn. The literature lacks trials directly comparing the modern cemented and uncemented prosthesis. The main concerns of total hip replacement involve the risk of dislocation, which is reported to be between 0 and 20%.9,12 This may be influenced by femoral head diameter, patient characteristics and surgical approach. Two RCTs routinely employed a femoral head diameter of 28 mm,7,10 yet there has recently been an increased use of larger femoral heads. In the arthritis literature this has lead to a decrease in dislocation rate when heads of 36 mm or greater are implanted.24–25 In contrast, experienced hip surgeons have reported dislocation rates of 6.7% with the use of larger heads in hip fracture patients.26 The increased head sizes are more costly, may be more difficult to insert in the small acetabulum and it is not clear whether their use results in better patient outcomes and decreased dislocation and revision rates. Another option recently reported is the use of a dual mobility cup where one study has shown a dislocation rate of 1.4% in 214 patients27 – further results are awaited. The use of harder bearing surfaces, such as ceramic, has been considered in this patient group. However, although relatively fit, they tend to have low functional demands and in the RCTs described, mortality rates vary between 30 and 50% at 10 years28 and 80–90% at 13 years.9 The increased cost of ceramics may not, therefore, be warranted, as most standard implants should survive the patient’s lifetime. The surgical approach is also contentious; the two commonest approaches being posterior or anterolateral. Risks and benefits vary between approaches, but is generally accepted that the posterior approach has an increased risk of dislocation29 (which is further increased when performing THR for acute trauma). Four of
1622
Editorial / Injury, Int. J. Care Injured 43 (2012) 1621–1622
the reported RCTs used solely anterolateral approaches with a reported dislocation rate of 0–7.5% compared to 5.8–20% with the posterior approach, reported in the other RCTs. This is consistent with results of retrospective cohort studies, which includes both hemiarthroplasty and THR treatment. Furthermore, the recent UK NJR analysis demonstrated a three-year revision rate of 3.5% when the implants were inserted through a posterior approach compared to 1.3% when inserted via an anterolateral approach.21 These results have led to national recommendations supporting the anterolateral approach in arthroplasty for hip fracture.1 The change of practice is not only driven by the evidence-based clinical practice but also by patients. In a survey of 81 elderly patients age-matched to the hip fracture population, 93% would elect for a THR following full explanation of the risks and benefits of both hemiarthroplasty and total arthroplasty.30 Whilst prompt, expert surgical treatment is a vital component of hip fracture care, it is only part of a complex treatment pathway, which is essential for optimal patient recovery and rehabilitation. These patients suffer from a fragility hip fracture as result of a low velocity fall (often from standing height). Bone health assessment and falls prevention should not, therefore, be forgotten in this fitter population. In conclusion, the use of THR, in the treatment of displaced intracapsular fractures of the proximal femur, is supported by evidence in those who are fit, not cognitively impaired and can walk prior to their injury. The use of a cemented prosthesis inserted through an anterolateral approach appears to have a better outcome. It remains unclear whether there should be an upper age limit for this treatment option or how this ‘‘fit’’ population can be better defined. When used appropriately, THR for hip fracture should be considered a more cost-effective treatment. Whilst the arthritis literature may help us study the optimal bearing surface and head size, the higher risk of dislocation in trauma will remain. Larger femoral heads may or may not help reduce this risk. All future studies should include health economic assessments and cost-effectiveness analysis as part of their study protocols as well as outcomes scores, which include measurement of quality of life.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21. 22.
23. 24.
25.
References
26.
1. NICE. Guidelines for hip fracture management. www.nice.org.uk/CG124. 2. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database of Systematic Reviews )2010;(6). http://dx.doi.org/10.1002/14651858.CD001706.pub4. Art. No.: CD001706. 3. SIGN. Management of hip fracture in the older people. www.sign.ac.uk/pdf/ sign111. 4. 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(June):c2332. 5. Carroll C, Stevenson M, Scope A, Evans P, Buckley S. Hemiarthroplasty and total hip arthroplasty for treating primary intracapsular fracture of the hip: a systematic review and cost-effectiveness analysis. Health Technology Assessment 2011;15(October (36)):1–74. 6. NHFD. 2011 report. www.nhfd.co.uk/003/hipfracturer.nsf/NHFDNationalReport2011. 7. Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. Journal of Arthroplasty 1986;1(1):21–8. 8. Skinner P, Riley D, Ellery J, Beaumont A, Coumine R, Shafighian B. Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement. Injury 1989;20(September (5)):291–3. 9. Ravikumar KJ, 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 2000;31(December (10)):793–7. 10. Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. Journal of Bone and Joint Surgery 2006;88(December (12)):2583–9. 11. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and
27.
28.
29.
30.
fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technology Assessment 2005;9(October (41)):1–65. iii–iv, ix–x. Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J. A randomised trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck in the elderly. Journal of Bone and Joint Surgery British Volume 2007;89B:160–5. Macaulay W, Nellans KW, Iorio R, Garvin KL, Healy WL, Rosenwasser MP. Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasty in treatment of displaced femoral neck fracture. HSS Journal 2008;4(February (1)):48–54. Mouzopoulos G, Stamatakos M, Arabatzi H, Vasiliadis G, Batanis G, Tsembeli A, et al. The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options. International Orthopaedics 2008;32(June (3)):367–73. van den Bekerom MP, Hilverdink EF, Sierevelt IN, Reuling EM, Schnater JM, Bonke H, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. Journal of Bone and Joint Surgery British Volume 2010;92(October (10)):1422–8. Liao L, Zhao JM, Su W, Ding XF, Chen LJ, Luo SX. A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures. Archives of Orthopaedic and Trauma Surgery 2012;132(July (7)):1021–9. Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clinical Orthopaedics and Related Research 2012;470(August (8)):2235–43. Cleary K. National Patient Safety Report: mitigating surgical risk in patients undergoing hip arthroplasty for fractures of the proximal femur; 2009 (NPSA/ 2009/RRR001). http://www.nrls.npsa.nhs.uk/resources/. Costa ML, Griffin XL, Pendleton N, Pearson M, Parsons N. Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur? Data from the National Hip Fracture Database. Journal of Bone and Joint Surgery British Volume 2011;93(October (10)):1405–10. Stafford GH, Charman SC, Borroff MJ, Newell C, Tucker JK. Total hip replacement for the treatment of acute femoral neck fractures: results from the National Joint Registry of England and Wales at 3–5 years after surgery. Annals of the Royal College of Surgeons of England 2012;94(April (3)):193–8. NJR Annual report 2011. www.njrcentre.org.uk. Kim YH, Oh JH. A comparison of a conventional versus a short, anatomical metaphyseal-fitting cementless femoral stem in the treatment of patients with a fracture of the femoral neck. Journal of Bone and Joint Surgery British Volume 2012;94(June (6)):774–81. Pentlow AK, Heal JS. Subsidence of collarless uncemented femoral stems in total hips replacements performed for trauma. Injury 2012;43(June (6)):882–5. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. .Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. Journal of Bone and Joint Surgery 2005;87(November (11)):2456–63. Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, et al. Lower rates of dislocation with increased femoral head size after primary total hip replacement: a five-year analysis of NHS patients in England. Journal of Bone and Joint Surgery British Volume 2011;93(July (7)):876–80. Low AK, Gursel AC. Mid-term outcome of total hip replacement using the posterior approach for displaced femoral neck fractures. Hip International 2012;22(March–April (2)):203–8. Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Mole´ D, et al. Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthopaedics & Traumatology Surgery & Research 2012;98(May (3)):296–300. Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, et al. Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. Journal of Bone and Joint Surgery British Volume 2011;93(August (8)):1045–8. Enocson A, Tidermark J, Tornkvist H, Lapidus LJ. Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthopaedica 2008;79(April (2)):211–7. Alolabi N, Alolabi B, Mundi R, Karanicolas PJ, Adachi JD, Bhandari M. Surgical preferences of patients at risk of hip fractures: hemiarthroplasty versus total hip arthroplasty. BMC Musculoskeletal Disorders 2011;12(December):289.
Tim J.S. Chesser* Vijaya M. Budnar Mehool R. Acharya Department of Trauma and Orthopaedics, Frenchay Hospital, North Bristol NHS Trust, Bristol BS16 1LE, UK *Corresponding author E-mail address: [email protected] (Tim J.S. Chesser)