[Hemi-prosthesis in femoral neck Fracture in the Elderly--OP video and our results].

BACKGROUND: In geriatric patients with Pauwels II and III type femoral neck fractures, endoprosthesis is the therapy of choice. We want to demonstrate the operation technique of implantation of a hemiprosthesis (dual head prosthesis) by video in an 87-year-old female patient. In addition, we analyse the long-term results after surgery more than one year after endoprosthesis in patients with femoral neck fractures.

METHOD: From 2007 to 2010, 219 public health insurance (AOK) patients with displaced femoral neck fractures were treated surgically at our hospital. This number of included patients puts us in the 97th percentile of all hospitals in Germany. Because the patients were publicly insured, all health information was available including completely retrospective post-hospital discharge as well as inpatient course and one-year mortality.

RESULTS: There were 77 % female and 23 % male patients in the study with an average age of 83.5 years. In addition to the femoral neck injury, 19 % of the patients had an accompanying PCCL of 3, and 44 % had a PCCL of 4. 16 % suffered from heart failure, 23 % from diabetes, and 19 % from renal insufficiency. Time to surgery averaged one day post-injury. A dual head prosthesis (hemiprosthesis) was implanted in 81.4 % of cases, and a total joint prosthesis in 18.6 %. Average operative time skin to skin was 53 minutes. Average inpatient stay was 13 days. 71 % of patients could ambulate independently on discharge. Of the remaining patients, two-thirds were already not ambulating independently prior to the fracture. Hospital mortality averaged 6 % (national average 8.1 %), and 30-day and 90-day mortality rates were 6 % and 16.3 %. Within one year, 22.2 % of patients had died (national average 26.8 %), with a natural mortality probability of 7.1 % for an age of 83.5 years. 11 patients were re-admitted, for contralateral prosthetic implantation (n = 6) or revision after periprosthetic fracture (n = 4). 54.6 % of patients were admitted to hospital during the year for other diseases (national average 53.8 %).

CONCLUSION: Endoprosthesis placement for displaced femoral neck fractures is a common, safe procedure. However, patients are old and have comorbidities. Despite recent decreases in hospital mortality, the risk of death remains more than twice as high within one year than that for uninjured patients of the same age.