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05-01-2012 | Surgery | Article

Patients prefer THA for displaced femoral neck fracture


Free abstract

MedWire News: Research shows that patients at risk for displaced femoral neck fractures would prefer to be treated using total hip arthroplasty (THA) rather than hemiarthroplasty (HA).

This finding is in contrast to the current trend for use of HA over THA, observe Bashar Alolabi (University of Western Ontario, London, Canada) and co-authors.

"Proponents of HA quote the advantages of a shorter and simpler surgical procedure, reduced risk of dislocation and the decreased component costs," they explain.

"On the other hand, advocates of THA criticize HA since it results in rapid wear of the acetabular articular cartilage and emphasize that THA is associated with improved functional outcomes, lower postoperative pain scores and potential decrease in reoperation rates."

To determine whether patients have a surgery preference, the team recruited 81 elderly osteoporosis clinic patients at risk for displaced femoral neck fractures. The majority of patients were female (89%), White (88%), and aged between 60 and 80 years (85%).

The patients were given a decision board on the management of displaced femoral neck fractures, with information given on the risks and outcomes of the THA and HA procedures.

Overall, 93% of patients stated that THA would be their preferred operative choice should they sustain a displaced femoral neck fracture.

THA was preferred due to a greater perceived walking distance (63%), less residual pain (29%), lower risk for reoperation (28%), and a reduced risk for mortality (20%).

The patients who preferred HA chose the procedure because they perceived the procedure as being less invasive than THA (50%), the lower risk for dislocation (33%) and infection (33%), and the shorter operative time (17%).

"Surgeons should discuss the advantages and disadvantages of each approach with individual patients and involve them in a shared decision-making process," Alolabi et al recommend.

"Decision aids may be helpful to surgeons in this process, as well as other areas of surgical management."

By Lynda Williams

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