Should we abandon primary prosthetic replacement for fresh displaced fractures of the neck of the femur?

The complications and results of 100 patients with a displaced femoral neck fracture, treated by primary prosthetic arthroplasty between 1972 and 1977, demonstrate a high morbidity from the surgical procedure. The six-month mortality was 20%. Good results were obtained in only 28% of the patients. In view of the reported incidence of deep-wound infection, dislocation and high mortality at six months, arguments are presented for and against the routine use of cemented hemiarthroplasty. Further consideration should now be given to alternative procedures, such as the muscle-pedicle graft. Total hip replacement may be indicated in some patients in whom accurate reduction of a displaced femoral neck fracture is impossible.