What is the preferred management option between Hemiarthroplasty (HAP) and Total Hip Arthroplasty (THA) for a 54-year-old patient in good physiological and physical condition?

Management of Displaced Femoral Neck Fracture in a 54-Year-Old Healthy Patient

For a 54-year-old patient in good physiological and physical condition with a displaced femoral neck fracture, total hip arthroplasty (THA) is the definitive treatment of choice. 1, 2

Rationale for THA Over Hemiarthroplasty

THA provides superior functional outcomes, better quality of life, and lower reoperation rates compared to hemiarthroplasty in properly selected patients, despite a slightly increased risk of complications. 1, 3

Key Decision Factors Supporting THA:

• Age and activity level: At 54 years old with good physical condition, this patient has a life expectancy well beyond 4 years, making THA the recommended intervention over hemiarthroplasty 3

• Functional superiority: THA demonstrates significantly better Harris Hip Scores and quality of life measures compared to hemiarthroplasty in active, independent patients without cognitive dysfunction 1, 3

• Reoperation risk: Hemiarthroplasty carries a risk of acetabular wear requiring eventual conversion to THA, whereas THA has lower long-term revision rates 4, 3

• Patient profile: The American Academy of Orthopaedic Surgeons specifically recommends THA for "healthy, active, independent older individuals without cognitive dysfunction" - this 54-year-old patient clearly fits this profile 1, 2

Critical Technical Specifications

Femoral Stem Fixation:

• Use cemented femoral stems - this is a strong recommendation to improve hip function, reduce residual pain, and decrease periprosthetic fracture risk 1, 2, 4

Implant Selection:

• Dual-mobility THA is preferred over conventional THA to minimize dislocation risk, which is the leading complication of conventional THA 4

Surgical Approach:

• The posterior approach is reliable when performed by an experienced surgeon using a dual-mobility cup 4
• Multiple approaches (posterior, direct anterior, minimally invasive) show similar safety profiles, with choice based on surgeon experience 5, 6

Important Caveats

Dislocation Risk:

• THA has higher dislocation rates than hemiarthroplasty in the first 4 years postoperatively, but this risk equalizes after 4 years 3
• This risk is substantially mitigated by using dual-mobility implants 4

When Hemiarthroplasty Would Be Appropriate:

• Hemiarthroplasty is reserved for frail patients with limited self-sufficiency, multiple comorbidities, or cognitive dysfunction - none of which apply to this 54-year-old healthy patient 1, 7
• The shorter operative time and lower dislocation risk of hemiarthroplasty only become relevant advantages in patients who cannot tolerate the slightly longer THA procedure 1

Perioperative Management

Timing:

• Surgery should be performed within 24-48 hours of admission for optimal outcomes 1, 2

Anesthesia:

• Either spinal or general anesthesia is appropriate 1, 2

Pain Management:

• Multimodal analgesia incorporating preoperative nerve block is strongly recommended 1, 2

Blood Loss Prevention:

• Tranexamic acid should be administered to reduce blood loss and transfusion requirements 2, 7

Thromboprophylaxis:

• Venous thromboembolism prophylaxis is mandatory 2, 7

Evidence Quality Note

The recommendation for THA over hemiarthroplasty in this patient population carries moderate strength despite strong evidence for functional benefit, because the American Academy of Orthopaedic Surgeons acknowledges the increased complication risk 1, 2. However, in a 54-year-old healthy patient, the functional benefits clearly outweigh the risks, making THA the unequivocal choice for optimizing long-term quality of life and minimizing future revision surgery 3.