Hemiarthroplasty vs total hip after a hip fracture

When an older adult has a displaced femoral neck fracture, the surgeon can replace just the ball (hemiarthroplasty) or the ball and the socket (total hip replacement). The socket is usually healthy in these patients, which is why replacing only the ball is often enough.

What the biggest trial found

The HEALTH trial randomized 1,495 people aged 50 and over who could walk on their own before the fracture, across 80 hospitals in 10 countries.²⁴

• Second operations: about the same, 7.9% after a total hip and 8.3% after a hemiarthroplasty, over two years.
• Dislocation: more common after a total hip (4.7% vs 2.4%).
• Function and quality of life: slightly better after a total hip, but the difference was too small to matter clinically.
• Mortality: similar (14.3% vs 13.1%).

A Cochrane review pooling 17 trials agreed: any benefit of a total hip over a hemiarthroplasty is likely small, and dislocation is roughly twice as likely with a total hip.²⁶

Who might be offered a total hip?

The AAOS guideline says a total hip may benefit properly selected patients, such as people who were very active and independent before the fracture or who already had arthritis in the hip.⁴⁹ For frailer patients, or those with memory problems, a hemiarthroplasty is usually preferred. This is a decision to make with the surgical team, often quickly.