WHiTE 3: HEMI

A randomized controlled trial comparing the Thompson hemiarthroplasty with the Exeter polished tapered stem and Unitrax modular head in the treatment of displaced intracapsular fractures of the hip: the WHiTE 3: HEMI Trial.

Sims AL, Parsons N, Achten J, et al. The bone & joint journal 2018 · PMID 29589786 · doi:10.1302/0301-620x.100b3.bjj-2017-0872.r2

Question

Does a modern polished tapered cemented hemiarthroplasty stem improve outcomes compared with a cemented Thompson hemiarthroplasty for displaced intracapsular hip fracture?

Design

Pragmatic multicentre RCT embedded in the WHiTE comprehensive cohort study in NHS trauma hospitals in England.

Patients

Patients over 60 years with a displaced intracapsular hip fracture needing hemiarthroplasty.

Intervention

Exeter polished tapered stem with Unitrax modular head

Comparison

Cemented Thompson hemiarthroplasty

Primary outcome

Health-related quality of life (EQ-5D-5L) at 4 months

Key result

Quality of life at four months did not differ significantly between implants, and any difference was below the minimum clinically important threshold. Mortality and mobility were also similar.

Limitations

Around half of participants died or were lost to follow-up, follow-up was short for late revision or periprosthetic fracture, and only two specific implant designs were compared.

Impact on practice

Showed that the inexpensive cemented Thompson remains an acceptable choice, so implant choice can be guided by cost and surgeon familiarity; the WHiTE platform model is now widely used for UK trauma trials.