hip replacement

Mohit Bhandari, MD, on Total Hip Arthroplasty vs Hemiarthroplasty for Fractures

The incidence of secondary procedures does not differ between patients undergoing total hip arthroplasty (THA) compared with hemiarthroplasty (HA), according to findings from new research.1

The study was conducted among 1495 patients who were age 50 years or older and had a displaced femoral neck fracture. The patients were randomly assigned to undergo either THA or HA and were then followed closely after the procedure.

To find out more about the study’s findings, Consultant360 reached out to lead author Mohit Bhandari, MD, PhD, who is a professor and the academic head of the Division of Orthopaedic Surgery at McMaster University in Ontario, Canada.

C360: What prompted you to conduct the study?

Mohit Bhandari: This decade-long study was part of 2 partner trials. The first examined optimal ways to repair hip fracture2 and optimal ways to replace the hip1 just published now. We were fueled, at that time, by our careful review of the literature, which suggested we did not have appropriate answers to these important questions for surgeons and patients.

C360: What are the most important findings from your study?

MB: The HEALTH trial found that THA within 2 years had similar rates of operative secondary hip procedures, trivial (if any) improvements in patient function and quality of life, and possibly more serious complications than a simpler HA. Given the increased cost of THA, it seems as though HA is a better alternative (at least in the first 2 years).

C360: The results of your study suggest that THA may not be as advantageous as once thought. Do you think there still is a role for THA in the field for this patient population?

MB: Our study did not examine the longer-term impact of THA on patient outcomes. It is possible that there may be a role for THA in select patients over a longer term. There has been increasing popularity (and health care guidelines have supported this) of THA for hip fractures. Our findings suggest that the enthusiasm for THA for hip fractures may require some re-evaluation. Ultimately, surgeons and patients will need to consider all options and be aware of the risks of and advantages. The HEALTH trial is the largest and most rigorous clinical trial ever conducted on this topic—and we anticipate will have a large impact on the care of patients.

C360: What are the next steps of your research?

MB: Our research over the past decade has resolved the optimal approach to fixing and replacing a hip fracture. Then we conducted the HIP ATTACK3 (with PJ Deveraux, MD) study to find out how quickly patients with hip fractures should be treated. Current guidelines suggest within 48 hours is acceptable, and our analysis from HIP ATTACK showed that accelerated surgery (within 6 hours of diagnosis) did not significantly lower the risk of mortality or a composite of major complications. However, we did learn that a subgroup of patients with elevated troponins experienced significant reductions in mortality with accelerated care. We are currently planning the HIP ATTACK-2 to confirm whether accelerated surgical procedures in this group of patients improves survival.

 

References:

  1. The HEALTH Investigators. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med. 2019;381:2199-2208. doi:10.1056/NEJMoa1906190.
  2. Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet. 2017;389(10078):1519-1527. https://doi.org/10.1016/s0140-6736(17)30066-1.
  3. The HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30058-1/fulltext