A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck.

One hundred sixty-six acute, nonpathologic displaced femoral neck fractures in elderly patients were treated with either unipolar hemiarthroplasty (122 operations; 77 cemented, 45 uncemented) or total hip arthroplasty (THA) (44 operations; all cemented). The average age, (75.2 years of age in the THA group 76.2 years of age in the hemiarthroplasty group), anesthesia risk classification, in-hospital mortality, early complications, and dislocation rates were comparable in each treatment group. In an average long-term follow-up period of 56 months, pain, walking, and function scores were higher with THA than with cemented or uncemented hemiarthroplasty. Revision rates were 2.2% after THA, versus 7.9% for cemented hemiarthroplasty and 13% for uncemented hemiarthroplasty. Hemiarthroplasty is recommended for the older patient, who may be occasionally active outside of the household. The healthy, active patient, however, may benefit from THA rather than hemiarthroplasty.