Treatment of displaced intracapsular hip fractures in older patients

In the linked systematic review (doi:10.1136/bmj.c2332), Hopley and colleagues compare outcomes after total hip replacement versus hemiarthroplasty when treating displaced femoral neck fractures in older patients.1 Hip fractures cause considerable death and disability in elderly people. Worldwide, 1.6 million new hip fractures occurred in 2000, and these accounted for the loss of 2.35 million disability adjusted life years (DALYs) annually and 1.4% of the burden of disease in women in the Western world.2 The incidence of hip fractures is estimated to rise to more than six million in 2050, around half of which will be femoral neck fractures.3

Displaced femoral neck fractures in elderly people are treated by internal fixation or prosthetic replacement, with either a hemiarthroplasty replacing the femoral head and neck or a total hip arthroplasty which also includes acetabular replacement. These treatments are associated with different complication rates, function, and independency of living. Hemiarthroplasty produces consistently better function than internal fixation,4 5 6 and lower reoperation rates (10% v 40%).7 No significant differences …