Abstract
Introduction: The best method of management of displaced intracapsular femoral neck fractures in elderly patients remains undecided. Most are treated by hemiarthroplasty.
Aim: To clarify the issue of whether or not to use cement in hemiarthroplasty for displaced, intracapsular, femoral neck fractures in the elderly.
Methods: Consecutive patients with displaced, intracapsular, femoral neck fractures treated by hemiarthroplasty between January 1997 and May 1998, in two hospitals within one region were reviewed. The same monoblock prosthesis was used; in Hospital A they were uncemented (121 patients), and in Hospital B they were cemented (123 patients). All surviving patients (50 and 56 respectively) were interviewed for assessments of pre-fracture and current pain, walking ability, use of walking aids and activities of daily living (ADL), using validated scoring systems. The average follow-up was 36 months.
Results: The patients’ demographical data were similar (the mean age was 82 and 84 years respectively). There was no greater incidence of intra-operative fall in diastolic blood pressure or oxygen saturation in the cemented group. Cemented procedures took, on average, 15 minutes longer. Fewer of the cemented group had been revised or were awaiting revision (p=0.036). There was no difference in complication or mortality rates at any time between surgery and follow-up (p=0.86). Prospective assessment revealed highly significant differences in favour of cement, in terms of pain (p=0.003), walking ability (p=0.002), use of walking aids (p=0.004) and ADL (p=0.009).
Conclusion: Our findings support the use of cemented hemiarthroplasty for the displaced intracapsular femoral neck fracture in the elderly patient.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
