Do hip replacements improve outcomes for hip fracture patients?

BACKGROUND. Hip fracture is a common problem among older Americans. Two typ es of procedures are available for repairing hip fractures: hip replacement and open or closed reduction with or without internal fixation. The assump tion has been that hip replacement produces better functional outcomes. Alt hough that is the common wisdom, outcome studies evaluating hip replacement for treatment of hip fracture are few and have not clearly documented its superiority. OBJECTIVES. TO compare outcomes of hip fracture patients who receive hip re placement versus another stabilizing procedure (open or closed reduction wi th or without internal fixation). DESIGN. Prospective cohort study. PARTICIPANTS. We studied 332 patients (age, > 65) who were hospitalized for a femoral neck fracture and discharged alive. MEASUREMENTS. We examined 2 treatment groups, hip replacement versus anothe r procedure, on 6 outcomes [Activities of Daily Living (ADLs), walking, liv ing situation (institutionalized or not), perceived health (excellent/good vs, fair/poor), rehospitalization, and mortality] at 3 postdischarge times (6 weeks, 6 months and I year). RESULTS. Mean age was 80, 80% were female, 96% White, 28% married, and 71% had a hip replacement. The treatment groups were similar at baseline (3 mon ths before admission as reported at discharge) on ADLs, walking, living sit uation and perceived health tall P > 0.24). After adjusting for demographic s, clinical characteristics, fracture characteristics, and prior ADLs, walk ing ability, living situation, and perceived health, patients with a hip re placement did not do better at 6 weeks,6 months, or I year post-discharge o n any of the 6 outcome measures tall 18 P > 0.10). A global test of all 6 o utcomes finds hip replacement patients doing less well at one year (P = 0.0 2). CONCLUSIONS. Despite the commonly held belief that hip replacement is a sup erior treatment for hip fracture, we found no suggestion of better outcomes for hip replacement on any of 6 key outcomes.