Treatment of displaced femoral neck fractures in the elderly with arthroplasties has become
standard practice during the last decade and results in good and predictable outcomes regarding
hip function and health-related quality of life (HRQoL). There is, however, a lack of evidence
concerning certain types of arthroplasties and different subgroups of patients. Patients with
severe cognitive dysfunction have a very limited life expectancy after a hip fracture and low
functional demands, as well a low HRQoL before the injury. Many surgeons have concerns
regarding arthroplasties in these patients. The bipolar hemiarthroplasty (HA) is designed to
reduce stress and erosion on the patient`s natural acetabulum and should, in theory, render a
better functional outcome and HRQoL than the unipolar HA. Patients with arthroplasties after
displaced femoral neck fractures are at higher risk of sustaining a late periprosthetic fracture
(PPF) compared to patients treated due to degenerative joint disease. In addition, some
prosthetic designs have been pointed out as being a risk factor for PFF. Uncemented
arthroplasties are widely used for various indications and show excellent clinical results. In
addition, there are concerns about cementing in older frail patients with multiple comorbidities.
All patients in Studies I to IV have been treated with arthroplasties because of a displaced
femoral neck fracture.
Study I is a randomised controlled trial (RCT) comparing treatment with internal fixation (IF)
and treatment with HA in patients with severe cognitive dysfunction. Compared to treatment
with IF, HAs appear to result in a better HRQoL and fewer reoperations.
Study II is an RCT with a 48-month follow-up comparing bipolar and unipolar HAs. Treatment
with a bipolar HA resulted in a better HRQoL after four years.
In Study III a cohort of 2757 patients with primary or secondary arthroplasties after femoral
neck fractures were investigated. A single cemented femoral implant was used. The incidence
of PPFs was high (2.3%) in the cohort, but the surgical outcome after reoperation for a PFF was
better compared to previous reports.
Study IV is an RCT with a 12-month follow-up comparing uncemented arthroplasties with
cemented arthroplasties. The uncemented arthroplasties showed inferior results regarding
functional outcome and HRQoL.
The main conclusions of this thesis are: Treatment of displaced femoral neck fractures with
arthroplasties is safe, even for patients with severe cognitive dysfunction; the use of
uncemented arthroplasties should be avoided and there are still controversies regarding the use
of bipolar Has
