Evidence brief
Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture
No significant difference in secondary hip procedures at 24 months (THA 5.3% vs HA 7.5%)
THA had slightly better functional outcomes but clinically similar
1,495 patients aged ≥50 years with displaced femoral neck fractures
Dislocation rate higher in THA (4.0% vs 1.4%)
Mortality similar between groups
HEALTH trial showed that for displaced femoral neck fractures in patients ≥50 years, both THA and hemiarthroplasty are acceptable options with similar revision rates. THA offers marginally better function but higher dislocation risk.
Key exam question: 'THA or hemiarthroplasty for displaced NOF?' HEALTH trial shows both acceptable. Discuss patient factors: THA for younger, more active patients with good bone quality; HA for older, less active, higher surgical risk. Know the dislocation rates.
Level I
Systematic review of RCTs or high-quality RCT