Commentary

Little debate surrounds the treatment of displaced fractures of the femoral neck in very young, high-demand patients (generally treated with fixation) and very old, low-demand patients (generally treated with arthroplasty). However, defining the boundaries for these extremes and the treatment for patients in the middle is controversial. The study by Rogmark et al. used an age of ≥70 years as a surrogate for bone quality and demand, with no upper age limit. In order to recruit a sufficient number of patients, a multicenter study was required; however, no attempt was made to standardize surgical technique or choice of implant. Moreover, after random allocation to “arthroplasty,” this group was further subdivided to receive either total hip replacement or hemiarthroplasty on the rather arbitrary basis of patient age, mental status, and life situation. Surgeons from 12 hospitals implanted 2 types of pins and more than 10 different types of arthroplasty components (using the operative approach of their choice). Details regarding quality of reduction, type of anesthetic, and prophylaxis against deep-vein thrombosis were not provided.