Ambulatory Ability and Personal Independence After Hemiarthroplasty and Total Arthroplasty for Intracapsular Hip Fracture: A Prospective Comparative Study

Background: Total hip arthroplasty (THA) has not only been associated with best functional outcomes but also with higher dislocation risk when compared with bipolar hemiarthroplasty (HA). The functionality and activities of daily living (ADL) of patients treated with THA or HA for intracapsular hip fracture (IHF) have been scarcely investigated in comparison with the preoperative status. Methods: Two comparable groups of 60 patients with an IHF who had undergone either THA or bipolar HA were created matching several preoperative characteristics. Matched variables included age, gender, body mass index, surgical delay, American Society of Anesthesiologists class, comorbidity, cognitive status, educational status, prefracture functional status, and radiographic fracture classification. Patients were prospectively followed up for 1 year using telephone interviews. Results: The ambulatory ability (5-item scale) and ADL Index significantly decreased in both the groups in comparison with the prefracture status at the 4-month and 1-year follow-up. The need for walking aids (5-item scale) at 4 months was significantly higher among patients who had undergone HA. Lower scores on the ADL Index were recorded among patients with HA in comparison with those with THA at 4 months and 1 year. No significant differences in ambulatory ability, complication rate, and mortality were detected between the 2 groups although HA and THA were associated with a tendency to a higher prevalence of general and local complications, respectively. Conclusion: THA provides better short-term results in terms of ADLs and allows early discontinuation in the use of walking aids as compared with bipolar HA in elderly cognitively intact patients with IHF.