Degenerative changes in normal femoral heads in the elderly

Unipolar hemiarthroplasty and bipolar hemiarthroplasty are frequently chosen for treating subcapital hip fracture; however, clinical outcome varies substantially. Although total hip arthroplasty is indicated for subcapital hip fracture in patients with degenerative hip disease, there is a lack of data on the incidence and extent of degenerative change in patients with subcapital hip fracture without obvious degenerative hip disease. This investigation evaluated articular cartilage in 25 consecutive femoral heads removed from elderly patients who sustained acute femoral neck fracture. All patients' femoral heads demonstrated grade 2 or 3 chondromalacia with an average involvement of 54% of the whole femoral head surface area. Review of the literature describes the cost-to-benefit ratio associated with painful hip arthroplasty. This study demonstrated a high incidence of femoral head degenerative change, which may account for the variable clinical results and proliferation of the term unsolved fracture. In the patient with a subcapital hip fracture, total hip arthroplasty may prove to be a better alternative.