A TRIAL OF IMMEDIATE TOTAL HIP ARTHROPLASTY VERSUS INTERNAL FIXATION FOR DISPLACED FEMORAL NECK FRACTURES IN ACTIVE ELDERLY PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Displaced femoral neck fractures in elderly individuals are associated with substantial morbidity, functional decline, and increased healthcare utilization. While internal fixation has traditionally been favored for preserving the native joint, high failure and reoperation rates have raised concerns, particularly in elderly patients who remain physically active. Total hip arthroplasty offers a more definitive solution but involves greater surgical complexity, leading to ongoing debate regarding the optimal management strategy for this population.

Objective: To compare reoperation rates, functional recovery, and one-year mortality between immediate total hip arthroplasty and internal fixation in active elderly patients with displaced femoral neck fractures.

Methods: A randomized controlled trial was conducted in the Islamabad–Rawalpindi region over six months. Eighty patients aged 65 years or older, independently ambulatory prior to injury, were randomized to undergo either immediate total hip arthroplasty or internal fixation. Functional outcomes were assessed using the Harris Hip Score, Barthel Index, and EQ-5D at one year. Reoperation and mortality rates were recorded through clinical follow-up and hospital records. Comparative statistical analyses were performed using appropriate parametric tests.

Results: Patients treated with total hip arthroplasty demonstrated significantly better functional outcomes at one year, with higher mean Harris Hip Scores and greater independence in activities of daily living compared with the internal fixation group. Quality-of-life scores were also superior in the arthroplasty group. Reoperation rates were markedly lower following total hip arthroplasty, whereas internal fixation was associated with a higher incidence of secondary surgical procedures. One-year mortality did not differ significantly between the two treatment strategies.

Conclusion: Immediate total hip arthroplasty provided superior functional recovery and reduced reoperation risk without adversely affecting short-term survival in active elderly patients. These findings support a function-oriented surgical approach for displaced femoral neck fractures in this growing patient population.