Hip Fracture in the Elderly: Repair or Replace?

Many older adults are faced with the problem of hip fracture. Which is better? To repair or replace the hip? Elderly patients in good physical and mental health who could still walk before the fracture are advised to choose the total hip replacement (THR).

Long-term studies in Sweden report fewer problems after THR compared to patients with a screw (internal fixation) holding the hip together. Patients with THR had less pain and could walk farther. Hips with internal fixation had 42 percent complications compared to four percent for the THR group.

There were also fewer reoperations after THR (four percent) compared to hip repair (47 percent). Most of the fractures repaired with screws had to be converted to a THR later.

Quality of life (QOL) was also measured in both groups. There was a decline in QOL for all patients. But the decline was minor in the THR group. Complications and reoperations for the internal fixation group resulted in major decreases in reported QOL.