Abstract
We have to deal with an increasing number of patients who are suffering from a femoral neck fracture. In Ger-many in 1996 135.000 patients with this kind of fracture were treated. These fractures are usually found in old people and have a high complication rate:
Osteonecrosis of the femoral head: 12–43% (Kyle 1994)
Pseudarthrosis: 16–28% (Rogmark 2002)
The indications for a total hip replacement are:
– age > 65years
– presence of osteoporosis (also under 65)
– daily activity possible (otherwise hemialloarthroplasty)
– comorbidity such as osteoarthritis
We have to consider several aspects:
The mortality rate is lower if we use a hip replacement (THR ~6%, osteosynthesis ~10%) The complication rate is lower if we use hip replacement (THR ~2%, osteosynthesis ~5%) In 30% of cases we have to change from osteosynthesis to a total hip replacement due to secondary complications of osteosynthesis in mobile patients If we look at this data, we must conclude that total hip replacement is the goldstandard in the treatment of femoral neck fractures (with Garden III and IV) in the population older than 65 years. Hemialloarthroplasty is only indicated for patients who are more or less immobilized.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
