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BACKGROUND: The optimal use of primary hemiarthroplasty (HA) or total hip arthroplasty (THA) for treating displaced femoral neck fractures (FNFs) remains controversial. This study aims to compare the outcomes of HA and THA in ambulatory patients 80 years or older, at 4- and 10-year postsurgery.

METHODS: In a prospective, randomized, single-blind trial, patients with acute displaced FNFs with a mean age of 85 (range 80-94) years were randomly allocated to receive either HA or THA. The primary end points were hip function (Harris Hip Score, HHS) and health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]). Secondary end points included hip-related complications, reoperations, mortality, pain in the affected hip, activities of daily living, a radiographic evaluation of acetabular erosion, and general complications.

RESULTS: At the 4-year follow-up, 39 patients in the HA and 39 in the THA group were available. At 10 years, 10 HA patients and 16 THA patients were available for follow-up. No differences were observed in the HHS at 4 and 10 years. The EQ-5D Index was statistically significant in favor of THA at 4 years, but no difference was observed at 10 years. No differences were found between the groups regarding hip-related complications, reoperations, mortality, activities of daily living, and pain in the operated hip. Hip function, activities of daily living, and pain in the operated hip deteriorated over time.

CONCLUSION: Up to 10 years after surgery, both HA and THA demonstrated comparable outcomes in hip function and health-related quality of life in ambulatory octogenarians and nonagenarians with displaced FNFs. This suggests that both interventions are suitable for this group of older patients.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.