Hemiarthroplasty Versus Total Hip Arthroplasty for Intracapsular Hip Fractures: A Retrospective Cohort Study of Outcomes and Patient Selection
Mohamed Mukhtar Hussein, Mohamed Dahir Osman, Muhammad Usman Ali, Mihika Joshi, Shaurya Aggarwal, Muhammad Hamid, Walid Dudin, Satvik Verma, Mohamed Antar, Kapilraj Ravendran, Ravikiran Shenoy, Pranav MishraBackground
The choice between hemiarthroplasty (HA) and total hip arthroplasty (THA) for intracapsular hip fracture remains debated. Randomised trials compare procedures in selected ambulant patients, but routine clinical practice is strongly influenced by baseline function, cognition and physiological reserve. We compared clinical outcomes and survival between THA and HA at a single UK major trauma centre, with pre-specified subgroup analysis by age ≤80 and ≥81 years.
Methods
Retrospective cohort study of 1,199 intracapsular hip fracture admissions (HA n=1,074; THA n=125) managed with arthroplasty at Lister Hospital between April 2020 and December 2024, using National Hip Fracture Database (NHFD) data. Continuous variables were compared by Mann-Whitney U test; categorical variables by Fisher’s. Survival was analysed by Kaplan-Meier with log-rank testing (IBM SPSS v22.0).
Results
Across the whole cohort (THA n=125, HA n=1,074) THA patients were on average 12 years younger (72.58 vs 84.38 years), had lower mean ASA grades (2.33 vs 3.03), were almost exclusively living at home before their fracture (99.2% vs 82.4%), and were predominantly freely mobile before their fracture (85.6% vs 35.7%). In the ≤80 group (THA n=110, HA n=286), THA was associated with shorter length of stay (median 7 vs 11 days; p<0.001), a higher rate of return to home from home (94.5% vs 78.0%), better post-fracture mobility, and superior survival (mean 359.6 vs 319.8 days; p<0.001). THA patients entered surgery with near ceiling AMTS scores (mean 9.86) and near zero post operative 4AT scores (mean 0.16), whereas HA patients had lower pre operative AMTS scores (mean 7.40) and higher post operative 4AT (mean 1.82). In the ≥81 group (THA n=15, HA n=788), no significant differences were found in survival (p=0.207), length of stay (p=0.663), discharge destination or time to surgery (p=0.077). Re-operations were more frequent in THA (13.3% vs 0.6%; p=0.007), based on two events in 15 patients.
Conclusions
THA patients had better unadjusted outcomes in the ≤80 group, but adjusted analyses suggest these differences were largely explained by baseline selection factors rather than procedure type alone. In patients ≥81 years, the THA sample was too small for firm conclusions.