Total hip arthroplasty for fractures of the proximal femur in older patientsRutz E, Leumann A, Rutz D, Schäfer D, Valderrabano V.
Displaced fractures of the proximal femur are common in older patients. The optimal treatment is still under debate. We retrospectively reviewed the results of 53 consecutive total hip arthroplasties (THA) performed in 12 men and 41 women for treatment of an acute fracture of the proximal femur. Men had an average age of 75.1 years (range, 61 to 90) and women 78.2 years (range, 61 to 91). At time of fracture, 42 patients (79.3 %) had radiological signs of hip osteoarthritis. At time of surgery, 8 patients (15.1%) needed trochanteric reconstruction in addition to the implanted THA.
Clinical and radiological follow-up was available for 39 patients (73.6 %). The average follow-up time was 55.5 months. The mean Harris Hip Score was 86.3 points (range, 68–97.7). The 4 month mortality rate was 1.9 % (1 patient). Four patients (7.5%) had had early postoperative complications, including dislocation in 3 patients (5.6%) and one (1.9%) minor reoperation (wound haematoma). One patient (1.9%) had revision surgery because of aseptic stem loosening 67 months after primary implantation. In elderly patients, THA is a safe long-term solution for treatment of displaced fractures of the proximal femur, allowing early weight bearing and assisting with rehabilitation.