title: Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients.
abstract: This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty. The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases.
  
  
  CONCLUSIONS
  There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group.
authors.affiliation: Lund University, Skåne University Hospital, Malmö, Sweden and, Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Rogmark
authors.affiliation: Blekinge Hospital, SE-371 85 Karlskrona, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Leonardsson
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002484:Cementation; D019317:Evidence-Based Medicine / Q000379:methods; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D062785:Hemiarthroplasty / Q000379:methods; D006801:Humans
keywords: fractures of the femoral neck; hip fractures; hemiarthroplasty; total hip arthroplasty; bone cement; approach