Total Hip Arthroplasty for Displaced Fracture of the Femoral Neck using Size 32 mm Femoral Head and Soft Tissue Repair after a Posterior Approach

The optimal operative treatment of displaced sub capital femoral fractures in the elderly is controversial. Recently, randomised controlled trials have suggested a better outcome with the use of total hip arthroplasty (THA) to treat displaced intra capsular fractures of the femur for elderly patients in good health. However, overall there is limited evidence to support the choice between different types of arthroplasty. Dislocation remains a concern with THA, especially when a posterior approach is used. We analysed the outcome of twenty primary cementless THA using a posterior approach with soft tissue repair and a size 32 mm head in active elderly patients presenting with displaced intra capsular femoral neck fractures. We also compared the results with the outcome in a cohort of matched patients who underwent primary THA for osteoarthritis. Satisfactory results were noted in terms of pain control, return to pre-morbid activity and radiological evidence of bone implant osseointegration. The functional outcome in the fracture group was similar to the osteoarthritis group. In conclusion, with optimal patient selection THA seems to provide a good functional outcome and pain control in the management of displaced intracapsular femoral neck fractures. Use of 32 mm head and posterior capsule repair may reduce the high risk of dislocation noted with the posterior approach.