Endoprosthesis in medial femoral neck fractures

Alloarthroplasty of the hip joint in the elderly has improved significantly the outcome of femoral neck fractures. The indication for a hip replacement is based on the biological age of the patient and the type of fracture. In our hospital in a 5-years period (1996-2000) we treated operatively 305 patients with femoral neck fractures (248 medial., 57 lateral). Of these, 239 patients received a endoprosthesis (190 total hip joint replacements, 49 hemialloarthroplasty). The other 66 patients (most of them younger patients) were treated by osteosynthesis. The complication rate of the endoprosthetic hip replacement was low; five hematoma/seroma and two deep infections had to be treated operatively. In 21 patients (8.79%) we saw hip luxation; 17 could be treated by closed and four by open reduction. Reluxation was found in nine of these 21 patients. Only two patients (both over 80 years old) died between the first 2 postoperative weeks. Eighty percent of the patients were able to walk, half of them alone or with help outside their homes. Fifteen percent of the patients could be mobilized in a wheel chair; only 5% were confined to bed. Conclusion: For the treatment of femoral neck fractures in older patients, the cemented hip endoprosthesis is the method of choice.