title: The Cemented Unipolar Prosthesis for the Management of Displaced Femoral Neck Fractures in the Dependent Osteopenic Elderly.
abstract: Significant variability exists across orthopedic surgeons in the management of the displaced femoral neck fracture in the elderly patient (>75 years old). These patients tend to be less healthy, have inferior bone quality, and gait instability leading to increased risk of periprosthetic fracture, compromised implant fixation, dislocation, and need for revision. The surgeon's goals should be to restore mobility while eliminating pain and need for reoperation.
  
  
  
  In this review article, we examine the best available evidence in the literature to determine which strategy achieves optimal outcomes. We examine outcome studies comparing use of hemiarthroplasty and total hip arthroplasty, unipolar and bipolar hemiarthroplasty, and cemented vs cementless fixation of femoral stems.
  
  
  
  For the active, healthy, and lucid patient, or one who has preexisting groin pain, who sustains a displaced femoral neck fracture, the literature supports a total hip arthroplasty. Patients sustaining a displaced femoral neck fracture and who are less active, have decreased bone mass, and are at increased risk of falls would benefit most from a device that optimally balances the need for revision surgery, restores ambulation, and eliminates pain. Thus, the current evidence favors cemented, unipolar hemiarthroplasty for the dependent osteopenic elderly patient with a displaced femoral neck fracture.
authors.affiliation: Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Grosso
authors.affiliation: Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Danoff
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Padgett
authors.affiliation: New York University Hospital for Joint Diseases, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.affiliation: Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York.
authors.forename: William B
authors.initials: WB
authors.lastname: Macaulay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D062785:Hemiarthroplasty; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000601:surgery*; D011474:Prosthesis Design; D016896:Treatment Outcome
keywords: cemented femoral stem; femoral neck fracture; hemiarthroplasty; total hip arthroplasty; unipolar