LIMITED RECOMMENDATION This recommendation was downgraded from Moderate to Limited strength.
Strong evidence from one prospective clinical trial comparing 3 groups of patients randomized to non-operative care, internal fixation and hemiarthroplasty. Strong evidence is in favor of hemiarthroplasty group for composite QoL/Function outcome measures-Harris Hip Score (1m,3m and 6m) and EQ-5D (1m and 3m) but not at other time points, or other outcome measures including adverse events, length of stay or mortality.
There is strong evidence of equipoise between the non-operative care, internal fixation and hemiarthroplasty groups in the Wei (2020) study on all outcomes. However, there were significant differences in a few individual outcomes. For example, patients in the hemiarthroplasty group had better functional outcomes compared to the non-surgical group, whereas the outcomes between non-surgical and internal fixation groups were similar. Therefore, the overall strength of evidence was downgraded using EtDF to Limited.
Wei (2020) showed statistically significant and clinically meaningful short-term and intermediate-term pain, function and QoL outcome differences favoring the hemiarthroplasty group over the non-surgical group. However, these outcomes were similar in the long-term. All other outcome measures including pain, function, QoL as well as adverse events, complications, hospital stay, and mortality were similar between the 3 groups at all other time points. Therefore, hemiarthroplasty may be considered for short term improvement of function, QOL and mortality. Individual patient factors should be considered when determining appropriate intervention.
Benefits/Harms of Implementation
No differences in adverse events in two groups (hemiarthroplasty vs. non-operative), but better outcomes in hemiarthroplasty group at least in short and intermediate terms.
Outcome Importance
Composite QoL and Function outcomes are important and relevant (patient reported) to patient.
Acceptability
Patients may have variable acceptability of operative vs. non-operative recommendations.
Feasibility
Hemiarthroplasty may not be available in all centers.