Selection of the prostheses for the elderly patients with severe displaced fracture of the femoral neck / 中华创伤骨科杂志

ABSTRACT

Objective To explore the selection of prostheses for the elderly patients with severe displaced fracture of the femoral neck through retrospective comparison of the long term clinical results between bipolar hemiarthroplasty and total hip replacement. Methods From January 1986 to December 2002, 101 cases of Garden Ⅲand Ⅳtypes of the femoral neck fracture were treated with either bipolar hemiarthroplasty (Group A 55 cases) or total hip replacement (Group B 46 cases). The age of the patients at the time of operation ranged from 55 to 94 years old (mean 70.4 years old) in Group A, and from 57 to 75 years old (mean 69.5 years old) in Group B. The average period of follow up was 4.9 years (1 to 10 years) in Group A and 3.5 years (1.5 to 5 years) in Group B. The clinical results were evaluated according to Harris and Merle d'Aubigue criteria. The perioperative complications were compared. Results The excellent and good clinical results were 78.12 %in Groups A and 95.65 %in Group B respectively. The rate of groin and thigh pains was higher in Group A (36.36 %) than in Group B (6.52 %). The flexion of the hip in Group A was more limited (mean 85 degrees) than in Group B (mean 110 degrees). There were more cases of sunken femoral stem in Group A. The perioperative complications were similar in both groups. Conclusions The total hip arthroplasty is the first choice for the elderly patients with severe displaced femoral neck fracture if the conditions of the patient and the skills of the surgeon permit. The bipolar hemiarthroplasty is suitable for patients of more than 75 years old, or for those with severe diseases.