Don't throw away the Austin Moore.

For the last 20 years, the authors' institution has treated displaced femoral neck fractures in the elderly with femoral head prosthetic replacement. The procedure has been accomplished utilizing a posterolateral approach, sectioning of the short external rotators, suction fitting of the acetabulum, and capsular repair. The post-operative management has been progressive ambulation and full weight bearing. The authors review the operative procedure, perioperative complications, and functional long-term follow-up in 173 elderly patients who had prosthetic replacement for femoral neck fractures. These were all done as primary procedures. One hundred pressfit Austin Moore procedures were performed in 97 patients from 1977 to 1981. Eighty bipolar proximal femoral replacements were performed in 76 patients from 1985 to 1987. These were each consecutive groups of patients and excluded were patients with pathologic fractures. There were four patients with spasticity in the Austin Moore group and four patients with spasticity in the bipolar group. Medical complications were similar in both groups. There were no deep infections in either group. Two of the three dislocations in the Austin Moore group were in patients with spasticity. Seven patients (7%) died within 3 months in the Austin Moore group and nine patients (11%) died within 3 months in the bipolar group. At 2-year follow-up, 24 patients (24%) died within 2 years in the Austin Moore group and 16 patients (20%) died in the bipolar group. At follow-up (mean, 26 months), there did not appear to be any statistically significant difference in the patients' Harris hip scores. The average hip score ranged from 55 to 92, with a mean of 76 in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)