Primary endoprosthetic replacement for acute femoral neck fractures. A review of 150 cases

A review of 150 consecutive endoprosthetic replacements for acute displaced femoral neck fractures was undertaken to investigate the following serious criticisms of the method. The first is excessive hospital mortality and morbidity, especially in comparison to internal fixation procedures retaining the femoral head. The second is pain, derived from the 'unphysiologic' nature of placing a metal prosthesis against otherwise normal acetabular cartilage. In the first instance the procedure is condemned as too major an operative procedure, poorly tolerated by elderly patients. In the second, it is a poor procedure if it requires revision in a patient incapable of withstanding more than one operation. A detailed follow-up shows that the in-hospital mortality in patients averaging 79.8 years of age, was 4%, lower than published mortality for either hemiarthroplasty or internal fixation. Close postoperative monitoring, antibiotic and antiembolic prophylaxis (2.0% infection, 6% embolic complications), and rapid mobilization contributed significantly to the increased survival. Painful endoprostheses, the most frequent complication, occurred in 16.7% of the 125 patients available for follow up at an average of 21 months. The causes of pain were considered technical problems judging prosthetic neck length, head size, sinking and loosening. Dissolution of the medial femoral neck was associated with a narrow stem prosthesis in five of six of these failures. The above statistics suggest that primary endoprosthetic replacement for displaced femoral neck fractures carries with it neither the excessive mortality and morbidity nor the pain induced potential for early reoperations that have been suggested by the recent literature.