Alternative approaches to the management of displaced subcapital hip fractures have been compared in this multicentre randomised trial. Previously fit patients were randomised to either bipolar hemiarthroplasty, total hip arthroplasty or reduction and fixation. Recruitment ended in June 2000 with a total of 298 participants recruited in 11 centres in Scotland. Participants have been followed up for a minimum of two years. Functional outcome was assessed using a hip rating questionnaire and the EQ-5D questionnaire. Clinical outcomes include mortality and reoperation. A cost-effectiveness and cost utility analysis was integrated into the clinical evaluation. In fit, older patients the results of the study showed a clear advantage for arthroplasty over fixation; arthroplasty was more clinically effective and probably less costly over a 2-year period postsurgery. The results suggested that total hip replacement has long-term advantages over bipolar hemiarthroplasty, but these findings are less definite.
Keating JF, Grant A, Masson A, Scott NW, Forbes J, Scottish Orthopaedic Trial Network. Randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip replacement: treatment of displaced intracapsular hip fracture in healthy older patients. J Bone Joint Surg Br 2006;88:149-260.