The late outcome of femoral neck fractures

The late outcome of 562 consecutive femoral neck fractures is presented; 396 were treated with a Thompson hemiarthroplasty, 121 by internal fixation, 4 by primary total hip replacement, and 41 were treated conservatively. Mortality during the first 30 days was 5%. The incidence of primary and secondary local complications after osteosynthesis was 25%. Further operations were carried out in 10% of the hemiarthroplasties. Seventy-eight patients were evaluated clinically and radiologically 10 years after this operation; 24 had been converted to total hip replacements, and in 23 of the remaining 54 the prosthesis appeared loose on radiographs. There was severe protrusion of the metal head in 25 cases. The clinical result was excellent or good in only 17 of 78 cases. We conclude that osteosynthesis or total hip replacement, rather than a Thompson hemiarthroplasty, should be considered for the treatment of femoral neck fractures if the patient is active and appears to have a life expectancy of several years.