RESUMO
Controversy in the treatment of displaced femoral neck fractures in the elderly focuses on the use of fixation versus the use of a prosthesis. Beginning in 1980, at The New York Hospital-Cornell Medical Center, it became routine to treat elderly patients for displaced fractures with bipolar hemiarthroplasty. This retrospective study evaluates the morbidity, mortality, and clinical and social functioning of 246 consecutive patients treated with bipolar hemiarthroplasty for Garden III and Garden IV nonpathological fractures. Follow-up ranged from 1 to 6 years. Of the 246 patients with 247 femoral neck fractures, 201 were female and 45 were male; the average age was 78 years. Fourteen patients (5.7%) died during the postoperative hospitalization. Thirty-one patients (13.3%) died within the first year following surgery. Mortality was related to the number of preexisting medical conditions: patients with four or more preexisting conditions had a significantly higher mortality than others (p less than 0.001: chi 2). The overall wound infection rate was 3.2%. There were only two failures (0.9%), both for deep infection, requiring Girdlestone debridement. One patient was revised for infection with successful reimplantation. There were two postoperative dislocations (0.9%), both reduced closed. Only one bipolar (0.4%) required conversion to a total hip replacement for a fractured acetabulum, none for arthritic wear. No radiographic evidence of significant acetabular erosion or protrusion nor femoral component loosening was noted. Clinical results were evaluated using the Hospital for Special Surgery Hip Rating Scale.(ABSTRACT TRUNCATED AT 250 WORDS)