Hip fractures are a common injury, especially among older adults, and can have significant implications for mobility and overall quality of life. The goal of surgical intervention for hip fractures is to restore function and alleviate pain.

Two commonly performed procedures for hip fractures are partial hip arthroplasty (PHA) and total hip arthroplasty (THA). This article aims to compare the outcomes of these two procedures and determine which one is associated with better results.

Partial Hip Arthroplasty (PHA)

Partial hip arthroplasty, also known as hemiarthroplasty, involves replacing only the femoral head while preserving the patient’s own acetabulum.

This procedure is most commonly performed in patients with a fracture limited to the femoral head or neck. The advantages of PHA include shorter surgical time, reduced blood loss, and potentially faster recovery compared to THA.

Total Hip Arthroplasty (THA)

Total hip arthroplasty is a more extensive procedure involving the replacement of both the femoral head and the acetabulum. In this procedure, the patient’s native femoral head and acetabulum are removed and replaced with prosthetic components.

THA is typically the preferred procedure for patients with more complex fractures or pre-existing hip arthritis.

Outcomes Comparison

Several studies have investigated the outcomes of PHA and THA for hip fractures.

A systematic review and meta-analysis published in the Journal of Orthopaedic Surgery found no significant difference in functional outcomes between PHA and THA in elderly patients with displaced femoral neck fractures. Both procedures were found to improve pain relief and functional status effectively.

Another study published in the Journal of Bone and Joint Surgery compared the outcomes of PHA and THA in elderly patients with an intracapsular hip fracture.

The results showed similar functional outcomes and patient-reported satisfaction between the two procedures. However, THA was associated with a higher risk of complications and revision surgery.

Complication Rates

Complication rates are an important consideration when comparing surgical interventions.

A study published in the British Medical Journal analyzed data from over 9,000 hip fracture patients and found that THA was associated with a higher risk of dislocation compared to PHA. Dislocation rates were 3.6% for THA and 0.4% for PHA. The study also reported higher rates of deep infection, nerve injury, and pulmonary embolism in THA patients.

Recovery and Rehabilitation

Recovery and rehabilitation play a crucial role in the outcomes of hip fracture surgery. In general, partial hip arthroplasty has been associated with a faster recovery compared to total hip arthroplasty.

The shorter surgical time and reduced tissue trauma in PHA may allow for an earlier initiation of postoperative rehabilitation. However, individual patient factors such as age, preexisting conditions, and fracture complexity can influence the speed of recovery and rehabilitation outcomes.

Long-Term Survival

Long-term survival rates are another important aspect to consider when evaluating the outcomes of hip fracture surgeries.

A study published in the Journal of the American Medical Association compared the long-term survival rates of PHA and THA in elderly patients with hip fractures. The findings showed no significant difference in survival rates between the two procedures over a ten-year follow-up period.

Shared Decision-Making

It is essential for both patients and healthcare providers to engage in shared decision-making when determining the most appropriate surgical intervention for a hip fracture.

Factors such as patient age, functional status, fracture characteristics, and overall health should be considered. The preferences and goals of the patient should also be taken into account to ensure the best possible outcomes.

Conclusion

Partial hip arthroplasty (PHA) and total hip arthroplasty (THA) are both viable treatment options for hip fractures, each with its own set of advantages and considerations.

Both procedures have been shown to improve pain relief and functional outcomes effectively. PHA may offer faster recovery and lower complication rates, but THA is more suitable for complex fractures and pre-existing hip arthritis.

Shared decision-making between patients and healthcare providers is crucial in determining the most appropriate procedure for each individual.