Patient satisfaction, pain, and quality of life 4 months after displaced femoral neck fractures: A comparison of 663 fractures treated with internal fixation and 906 with bipolar hemiarthroplasty reported to the Norwegian Hip Fracture Register

Abstract

Background Primary arthroplasty and internal fixation are the two main options for treatment of displaced femoral neck fractures. Despite the fact that there have been several randomized studies, the optimal treatment in the elderly is still controversial. In the present study, based on data from the Norwegian Hip Fracture Register, we compared satisfaction, pain, and quality of life 4 months after surgery in patients over 70 years of age with a displaced femoral neck fracture operated with internal fixation or with a bipolar hemiarthroplasty.

Patients and methods Data on 1,569 fractures in patients over 70 years of age operated with internal fixation (n = 663) or hemiarthroplasty (n = 906) were registered in the hip fracture register. The register also included data on patient satisfaction, pain, and quality of life (EQ-5D) assessed 4 months after surgery using VAS scales and EQ-5D health questionnaires.

Results Patients operated with hemiarthroplasty had less pain (VAS 27 vs. 41), were more satisfied with the result of the operation (VAS 33 vs. 48), and had better EQ-5D index score 4 months postoperatively (0.51 vs. 0.42) than patients who were operated with internal fixation.

Interpretation Our findings suggest that elderly patients with displaced femoral neck fracture should be treated with arthroplasty.

Contributions of authors

This study represents close teamwork by the orthopedic surgeons JEG, TV, LBE, LIH, OF, and JMF, and statistician SAL. All authors participated in the interpretation of the results and in preparation of the manuscript. JEG, SAL, and JMF performed the statistical analyses. JEG was mainly responsible for writing the manuscript.