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Acta Orthopaedica

Total hip replacement linked to better hip fracture outcomes

Partial hip replacement and repair with screws, pins or nails were linked to 2.5 and 2.3 times the one-year odds of death, respectively, versus total hip replacement.

Paper by Pierre Campenfeldt, Margareta Hedström, Olle Olofsson, Karin Modig, Amer N. Al-Ani · Karolinska Institutet
Figure 1. Flow diagram of patient inclusion and follow-up.
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Figure 1. Flow diagram of patient inclusion and follow-up.Flow diagram of patient inclusion and follow-up.Campenfeldt et al.
Cohort study of 3,325 patients with displaced femoral neck fractures, 1 yearInterventions

Limit: Healthier patients were selected for total hip replacement, potentially explaining its apparent benefits

Edited by Boris Djordjevic · AgingResearch.News

Paper
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An observational cohort study examined 3,325 patients aged 60–69 with displaced femoral neck fractures—breaks near the top of the thighbone with bone ends out of alignment. Researchers used Swedish registry data to compare total hip replacement, partial hip replacement and internal fixation, which holds broken bone together with screws, pins or nails. They assessed deaths over one year and function at four months.

Overall, 8.3% died within one year. Survival analyses found lower survival after partial replacement or fixation than after total replacement among patients in poorer baseline health, but not among healthier patients. Total replacement was linked to better maintenance of independent living and outdoor walking among healthier patients who had those abilities before the fracture. Functional differences between operations were smaller among patients in poorer health.

Why it matters

Preserving mobility and independence after hip fracture matters for functioning later in life. This study addresses whether links between the operation and recovery differ according to patients’ baseline health.

Caveats

Surgery was not randomized and depended strongly on baseline health, so these associations do not establish cause and effect. Functional follow-up covered only 1,850 patients (56%), and the results may not apply outside ages 60–69.

From the paper

Limitation

Treatment allocation was not randomized but strongly influenced by baseline health, functional status, and comorbidity, introducing a risk of residual confounding.

Limitations

Quoted word for word from the full text on PubMed Central.

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