O1355 PRIMARY PROSTHETIC REPLACEMENT IN UNSTABLE FRACTURES OF THE FEMORAL NECK. THIRTEEN YEARS OF EXPERIENCE. ANALYSIS OF COMPLICATIONS

Abstract

Objectives: Critical analysis of the results of 1124 patients over 70 years of age treated with an endoprothesis between 1987 and 2000. Patients: Patients over 70 years of age presenting a non-pathological unstable fracture of the femoral neck. Intervention: Depending on age and functional status preinjury, 715 times a hemi-arthroplasty; 409 times a total hip prosthesis. Main outcome and measurements: Evaluation of the functional status of the patients preinjury based on walking capacity and ability to perform some activities of daily life. Prospective follow-up of all surviving patients during the first postoperative year. Special attention to the local complications needing reintervention. The final functional evaluation in 708 surviving patients preoperatively classified as “independent”. Estimation of the revision arthroplasty rate and functional status of patients operated before 1995. Results: The overall mortality rate after 1 year: 20%. Complications after prosthetic replacement are not harmless: dislocation (2%) needing an early revision arthroplasty in about 50% of the cases; deep infection (< 1%) leading to a Girdlestone situation and sometimes even death. In 32% of the surviving patients preoperatively classified as “independent” the femoral neck fracture had caused an important additional impairment. Failure rate of prosthetic replacement for fractures much higher than after replacement for arthritis: at least 14% within five years. Conclusion: In patients younger than 70 years of age with a good life expectancy, prosthetic replacement has to be avoided whenever possible.