Fractured neck of femur in the mobile independent elderly patient: should we treat with total hip replacement?

VS Pai
Dunedin Hospital, Dunedin, New Zealand

D Ardern
Tauranga Hospital, Tauranga, New Zealand

N Wilson
Star Ship Hospital, Auckland, New Zealand

PURPOSE. To report the outcome of displaced subcapital neck of femur fractures in the independent elderly (>70 years) managed with total hip arthroplasty through a modified Hardinge approach.

METHODS. Between 1998 and 2000, a surgeon performed a cemented hip replacement using a modified lateral approach in 35 consecutive patients in the Hawke's Bay Regional Hospital, Hastings. Medical charts and out-patient follow-up clinic records were reviewed with respect to outcomes, with particular reference to complications. Independent review of functional outcome was completed at one year postsurgery using a questionnaire.

RESULTS. At an average follow-up of 1.8 years (range, 1-3 years), no patient needed further surgery. One patient had died, giving a mortality rate at one year of 2.9%. All other medical complications were successfully treated. The overall prevalence of early medical complications was 43%. There were no dislocations, and 80% of patients had a good clinical outcome at their latest follow-up.

CONCLUSION. The modified lateral approach of Hardinge minimises the incidence of postoperative dislocation. However, there was a high incidence of medical complications and aggressive treatment of such complications was necessary, both preoperatively and postoperatively. The number of pre-existing medical conditions was a significant factor influencing patient morbidity.