Arthroplasty options in femoral-neck fracture: answers from the national registries

Femoral-neck fracture in the elderly population is a problem that demands the attention of the orthopaedic community as life expectancy continues to increase. There are several different treatment options in use, and this variety in and of itself indicates the absence of an ideal single treatment option. Recent debate has focussed on the probable superiority of total hip arthroplasty (THA) over hemiarthroplasty for femoral-neck fracture. Clinical trials and systematic reviews of such trials have not provided a convincing answer to this question. We analysed data from national registries evaluating prosthetic replacements for femoral-neck fracture in the elderly. We compared revision and reoperation rates of hemiarthroplasty and THA, analysed the prognostic variables that influenced implant survival and the major causes of failure. Data from the Australian and Italian registries indicate that THA has an increased revision rate compared with bipolar hemiarthroplasty in femoral-neck fracture in the elderly. The registries identify that age over 75 years and the use of the anterior surgical approach are associated with better survivorship in patients who have a hemiarthroplasty. Cemented fixation of the femoral stem in hemiarthroplasty and THA is supported by registry data. Acetabular erosion accounted for a very low percentage of hemiarthroplasty revisions and reoperations. Our review of data from national registries supports the continued use of bipolar hemiarthroplasty in femoral-neck fracture in the elderly and identifies age, method of fixation and surgical approach as important prognostic variables in determining implant survival.