How does internal fixation compared with arthroplasty affect quality of life for patients who have suffered femoral neck fractures?

Objectives: To evaluate functional outcomes amongst femoral neck fracture trial participants who did not undergo reoperation. Design: Secondary analysis of 2 randomized controlled trials. Setting: Ninety hospitals in 5 continents. Participants: Patients aged 50 years or older with a femoral neck fracture. Intervention: Arthroplasty, including total hip arthroplasty and hemiarthroplasty, or internal fixation, including sliding hip screw or multiple cancellous screws. Main Outcome Measurement: The Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-item Short Form Health Survey (SF-12) physical component summary (PCS). Results: Data from 716 arthroplasty patients and 549 internal fixation patients were included in our propensity score weighting model. Internal fixation patients had higher WOMAC stiffness scores (leading to poorer function) at 24 months postoperatively compared with total hip arthroplasty patients (adjusted mean difference [AMD] 0.42 points, 99% confidence interval [CI] 0.09-0.75; P < 0.001) and hemiarthroplasty patients (AMD 0.39 points, 99% CI 0.04-0.74; P = 0.004). However, this statistically significant difference did not reach the 7-point threshold for a minimal clinically important difference. No statistically significant differences were found in the other WOMAC scales, nor with the SF-12 PCS. In participants aged 70 years or younger, no difference was found in any of the functional outcomes at 24 months. Conclusion: While stiffness is worse following internal fixation, our results show similar functional outcomes in femoral neck fracture patients undergoing modern methods of internal fixation versus arthroplasty. These results, however, may not be applicable to a younger, more active hip fracture population. Level of Evidence: Prognostic Level II.