Fractured neck of femur in the mobile independent elderly patient: should we treat with total hip replacement?
OBJECTIVE
To report the outcome of displaced sub-capital neck of femur fractures in the independent elderly (>70 years) managed with total hip arthroplasty through a modified Hardinge approach.


METHODS
Between 1998 and 2000, a surgeon performed a cemented hip replacement using a modified lateral approach in 36 consecutive patients in the Hawke's Bay Regional Hospital, Hastings. Medical charts and out-patient follow-up clinic records were reviewed with respect to outcomes, with particular reference to complications. Independent review of functional outcome was completed at one year postsurgery using a questionnaire.


RESULTS
At an average follow-up of 1.8 years (range, 1-3 years), no patient needed further surgery. One patient had died, giving a mortality rate at one year of 2.9%. All other medical complications were successfully treated. The overall prevalence of early medical complications was 43%. There were no dislocations, and 80% of patients had a good clinical outcome at their first follow-up.


CONCLUSIONS
The modified lateral approach of Hardinge minimises the incidence of postoperative dislocation. However, there was a high incidence of medical complications and aggressive treatment of such complications was necessary, both preoperatively and postoperatively. The number of pre-existing medical conditions was a significant factor influencing patient morbidity.
Pai
V S
VS
Dunedin Hospital, 207 Musselburgh Rise, Dunedin, New Zealand. vasu_chitra@slingshot.co.nz
Ardern
D
D
Arden
D
D
Wilson
N
N
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation*; D005260:Female; D005265:Femoral Neck Fractures / Q000534:rehabilitation* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology