The management of displaced femoral neck fractures in independent, healthy patients remains controversial. Acetabular erosion is a time dependant phenomenon and our aim was to assess the long-term outcome of the Universal Head bipolar with an Exeter stem. 49 consecutive cemented bipolar hemiarthroplasties were performed in 49 patients between 1992 and 2000. Mean age was 71.6 (range 54–91). There were 13 male and 36 female. 23 patients were alive at final follow up. 17 patients were assessed in outpatients with clinical and radiographic assessment. 2 patients had a telephone questionnaire and 4 patients were lost to follow up or were unable to attend clinic. Kaplan-Meier Survivorship analysis was performed. Median follow up was 7.1 years (range 5–13.3 years). 26 patients had died by the time of final follow up. 5/14 patients (36%) with an ASA score of 3 died within 30 days. There was one dislocation and one periprosthetic fracture. There were no deep infections. There were no revisions for aseptic loosening or acetabular erosion. 75.6% of surviving patients returned to their pre-injury mobility level at 1 year. 5 year cumulative survival was 60% (95% confidence interval 46–74%). There was a statistically significant reduction in cumulative survival for ASA grades 3 and 4 compared to 1 and 2 (p=0.004). Cemented bipolar hemiarthroplasty for femoral neck fractures is a good alternative to Total Hip Arthroplasty for independent, healthy patients. There is no evidence of acetabular erosion. Careful patient selection is necessary as patients with high ASA scores have greater mortality rates regardless of surgical prosthesis.
Callus formation and the rate of union of nailed fractures of the femur has been determined in 22 patients with associated head injuries and compared with that in a group of patients with similarly treated fractures but without head injuries. The comparison confirms the widely held view that, in patients with head injuries, fractures frequently heal with excessive callus and at a faster rate than normal.
