Hemiarthroplasty vs. total hip arthroplasty in the treatment of femoral neck fractures. Is hemiarthroplasty only a half measure?

BackgroundIn Germany the treatment of choice for dislocated medial femoral neck fractures in older patients is arthroplasty of the hip within 24h. Operative options include total hip arthroplasty (THA) and hemiarthroplasty (HA).ObjectiveDifferentiated patient selection for THA or HA, is HA only ahalf measure, cemented or cementless (stem) implantation, altered approach due to new surgical access routes?Material and methodsAnalysis of the national prosthesis registers worldwide and the German Arthroplasty Register (EPRD) with presentation of the rates of arthroplasty options THA vs. HA for dislocated medial femoral neck fractures.ResultsThe review of the national registries showed that acemented technique was favored in older patients and confirmed the lower revision rate for HA. The data from the EPRD showed that in 2017 atotal of 9.5% of all hip arthroplasty surgeries were performed with HA. There was ahigher revision rate for patients undergoing non-elective THA (7.0%) compared to HA (4.5%).ConclusionThe choice of implant in hip arthroplasty for medial femoral neck fractures depends on avariety of patient, surgeon and implant-specific factors. The significantly lower revision rate of the HA disproves the assumption that HA is only ahalf measure. Anterior or lateral approaches seem to be superior compared to posterior approaches, particularly with respect to the dislocation rate. National differences are evident in cementation of the prosthesis.