Abstract
Introduction: During the last decade the treatment regime for dislocated femoral neck fractures has switched towards more arthroplasties. There has been apprehensions regarding long-term results for arthroplasties. The opinion has been put forward that preserving the femoral head is preferable to performing total hip arthroplasty.
Methods: 409 of the 450 patients in a randomized study 1995–97 had valid follow-up at 4 months, 1, 2, 5, and 10 years (or until deceased). Mentally intact, independently living and walking patients over 70 years were included and randomized to osteosynthesis (n=217) or arthroplasty (n=192).
Results: After 10 years 168 patients (77 percent) were deceased and there were 99 failures (46 percent) in the osteosynthesis group. In the arthroplasty group 145 patients (76 percent) were deceased and there were 17 failures (9 percent) after 10 years. Both groups had the same rate of failure between 2 and 10 years.
There was significantly better results regarding pain and function in the arthroplasty group at 4 months. At 10 years the results were still not superior for osteosynthesis.
A Cox regression analysis regarding sex, age, time to surgery, smoking, osteoporosis, trauma type, preoperative function and choice of skin incision comparing the patients without hip complications at 10 years with the patients with failures in each group revealed no risk factor for failure.
Discussion: Arthroplasty for hip fracture show a reliable long-term result while osteosynthesis leads to a high rate of complications and is not superior regarding pain and function even when successful. Both methods have the same mortality.
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