Who, if anyone, may benefit from a total hip arthroplasty after a displaced femoral neck fracture? a post hoc subgroup analysis of the HEALTH trial

Frede Frihagen, Marianne Comeau-Gauthier, HEALTH Investigators, Daniel Axelrod, Sofia Bzovsky, Rudolf Poolman, Diane Heels-Ansdell, Mohit Bhandari, Sheila Sprague, Emil Schemitsch

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AIMS: The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population.

METHODS: We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed.

RESULTS: There were 143 patients included in the fittest cohort. Mean age was 66 years (SD 4.5) and 103 were female (72%). No clinically relevant differences were found between the treatment groups in the primary and sensitivity analyses.

CONCLUSION: This analysis found no differences in functional outcomes between HA and THA within two years of displaced low-energy FNF in a subgroup analysis of the fittest HEALTH patients. These findings suggest that very few patients above 50 years of age benefit in a clinically meaningful way from a THA versus a HA early after injury.Cite this article: Bone Jt Open 2022;3(8):611-617.

Original languageEnglish
Pages (from-to)611-617
Number of pages7
JournalBone and Joint Open
Issue number8
Publication statusPublished - Aug 2022
Externally publishedYes

Bibliographical note

Funding statement
The authors disclose receipt of the following financial or material support for the research, authorship, and/or publication of this article: The HEALTH trial was supported by Canadian Institutes of Health Research (CIHR) (MCT-90168), National Institutes of Health (NIH) (1UM1AR063386-01), ZorgOnderzoek Nederland-medische wetensehappen (ZonMw) (17088.2503), Sophies Minde Foundation for Orthopaedic Research, McMaster Surgical Associates and Stryker Orthopaedics.
Open access funding

The open access fee was funded by Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Supplementary material
‍A full list of the HEALTH Investigators.


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