Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture.
HEALTH Investigators, Bhandari M, Einhorn TA, et al. The New England journal of medicine 2019 · PMID 31557429 · doi:10.1056/nejmoa1906190
- Question
- In older, previously independent patients with a displaced intracapsular hip fracture, does total hip arthroplasty reduce secondary procedures compared with hemiarthroplasty?
- Design
- International multicentre RCT across centres in several countries.
- Patients
- Adults aged 50 or over who could walk independently before sustaining a displaced femoral neck fracture.
- Intervention
- Total hip arthroplasty
- Comparison
- Hemiarthroplasty
- Primary outcome
- Unplanned secondary hip procedure within 24 months
- Key result
- There was no significant difference in the rate of secondary procedures at 24 months. THA gave a small functional and quality-of-life advantage that was unlikely to be clinically important, while dislocation was more common after THA.
- Limitations
- Follow-up of two years may be too short to show late acetabular wear after hemiarthroplasty, and many participants were fitter than the typical UK hip fracture population.
- Impact on practice
- Weakened the case for routine THA in all independent patients; UK practice still offers THA to selected fit, cognitively intact, independently mobile patients as per NICE, but with tempered expectations of benefit.