Management of hip fractures by total hip arthroplasty

One hundred and twelve patients ranging in age from 40 to 89 with acute intracapsular fractures of the hip were treated between the years 1970 to 1978 by total hip arthroplasty; 63% were subcapital, 27.6% were midcervical, and 8.9% were basilar; 53.5% were classified as Garden's Stage IV, 34.8% as Stage III and 11.6% as Stage II. A significant number of patients had associated medical conditions that made them poor risks for a possible second-stage operation. Moreover, 16 patients were considered for total hip arthroplasty because of associated hip disease. Of 85 patients evaluated after one year, 81.2% had no pain. Most patients maintained their previous levels of activity, but 13 were more active than before injury; 33 were worse. The decrease in activity was generally due to deterioration in associated medical conditions. Our experience indicates that total hip arthroplasty is best reserved for the previously active elderly patient with a displaced subcapital fracture who meets the criteria for prosthetic replacement.