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Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial

BMJ 2007; 335 doi: (Published 13 December 2007) Cite this as: BMJ 2007;335:1251
  1. Frede Frihagen, clinical research fellow1,
  2. Lars Nordsletten, professor of orthopaedic surgery1,
  3. Jan Erik Madsen, professor of orthopaedic surgery1
  1. 1Orthopaedic Centre, Ulleval University Hospital, Oslo, Norway, and Faculty of Medicine, University of Oslo, Norway
  1. Correspondence to: F Frihagen j.f.frihagen{at}
  • Accepted 10 October 2007


Objective To compare the functional results after displaced fractures of the femoral neck treated with internal fixation or hemiarthroplasty.

Design Randomised trial with blinding of assessments of functional results.

Setting University hospital.

Participants 222 patients; 165 (74%) women, mean age 83 years. Inclusion criteria were age above 60, ability to walk before the fracture, and no major hip pathology, regardless of cognitive function.

Interventions Closed reduction and two parallel screws (112 patients) and bipolar cemented hemiarthroplasty (110 patients). Follow-up at 4, 12, and 24 months.

Main outcome measures Hip function (Harris hip score), health related quality of life (Eq-5d), activities of daily living (Barthel index). In all cases high scores indicate better function.

Results Mean Harris hip score in the hemiarthroplasty group was 8.2 points higher (95% confidence interval 2.8 to 13.5 points, P=0.003) at four months and 6.7 points (1.5 to 11.9 points, P=0.01) higher at 12 months. Mean Eq-5d index score at 24 months was 0.13 higher in the hemiarthroplasty group (0.01 to 0.25, P=0.03). The Eq-5d visual analogue scale was 8.7 points higher in the hemiarthroplasty group after 4 months (1.9 to 15.6, P=0.01). After 12 and 24 months the percentage scoring 95 or 100 on the Barthel index was higher in the hemiarthroplasty group (relative risk 0.67, 0.47 to 0.95, P=0.02. and 0.63, 0.42 to 0.94, P=0.02, respectively). Complications occurred in 56 (50%) patients in the internal fixation group and 16 (15%) in the hemiarthroplasty group (3.44, 2.11 to 5.60, P<0.001). In each group 39 patients (35%) died within 24 months (0.98, 0.69 to 1.40, P=0.92)

Conclusions Hemiarthroplasty is associated with better functional outcome than internal fixation in treatment of displaced fractures of the femoral neck in elderly patients.

Trial registration NCT00464230.


  • Kenneth Nilsen, Wender Figved, Evind Kaare Osnes, Bjørn Robstad, Marte T Magnusson, Willimijn Vervaat, Åsa Axelsson, Vibeke Lambert-Grave, and Helene Søberg participated in the collection of data.

  • Contributors: The protocol was written by all the authors. FF analysed the data and drafted the manuscript, which was revised by LN and JEM. All authors approved the final version. FF is guarantor.

  • Funding: Norwegian Foundation for Health and Rehabilitation through the Norwegian Osteoporosis Society and the Norwegian Research Council, Nycomed, Smith and Nephew, and OrtoMedic.

  • Competing interests: FF has received lecture fees from OrtoMedic, who market orthopaedic implants; LN has received consulting and lecture fees from DePuy, Biomet, OrtoMedic, and SCP, who all manufacture and market orthopaedic implants.

  • Ethical approval: Regional ethics committee.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 10 October 2007
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