Indications for bipolar prosthesis in femoral neck fractures. A retrospective study of the prognosis in geriatric patients with bipolar prostheses with reference to the preoperative health status

In Germany the decision to implant a bipolar prosthesis in patients with femoral neck fracture depends mainly on the patient's age and general condition. Taking into account the clinical results to date, however, these criteria alone appear not to be adequate. In our hospital 182 patients were provided with a bipolar prosthesis between January 1986 and February 1989 after traumatic hip fracture. By June 1990, the end of this investigation, 56% had died. In a retrospective study of the 67 surviving patients 25 (6-48) months postoperatively, we found that the results obtained with this bipolar prosthesis were comparable to those seen with total hip endoprostheses according to the Harris hip function score and to radiological findings regarding the frequency of loose stems and protrusion. We also employed a standardized system to evaluate the clinical condition of each patient preoperatively as well as the intra- and postoperative complications. These clinical data were compared with the postoperative survival and the Harris hip score. We found: (1) Good to excellent results in 45% (greater than 80 points), satisfactory results in 52% (51-80 points) and poor results in 3% after a period of up to 48 months. Good to excellent functional results were frequently obtained in healthy older patients. (2) Life expectancy in our group of 182 patients was shorter than in the normal population of the same age. (3) The reduced life expectancy was not attributable to the fracture trauma or the operation but rather to preexisting unrelated causes. In fact the fracture trauma itself often appeared to be a result of the patient's preexisting bad health.(ABSTRACT TRUNCATED AT 250 WORDS)