@ Cen: You are right. Independence and QoL in case of surgically treated  femoral neck fractures are adversely affected in the postoperative period. In my opinion THR should be preferred in the elderly in comparison with osteosynthesis because the recovery is more rapid.

Dear Panayot, I totally agree with your opinion that THR in treatment of femoral neck fractures offer more rapid functional recovery.

Best regards,

Cen

Hi, do you recommend an age, after which you prefer THR? 65, 70,80?

I prefer THR more after 65, but it's depends, which type of fracture, level of  osteoporosis etc. An interdisciplinary care approach it is preferable. This ensures that:

The fractures are optimally stabilized and mobilization as early as possible, the co-morbidities have to adequately treated and also outpatients follow-up treatment.

Dear Wietse,

Thank you very much for your answer and very interesting information about this topic.

I agree with you for hemi arthroplasty that is sufficient in the cases without coxarthrosis and cheaper.

 Dear prof. Cen,

Based on rehabilitation outcomes, in generally, we can say that hip replacement (hemi or total) after hip fracture is the best solution to elderly individuals, especially those over the age of 70. In this way, functional disability time is shorter; opportunity of avoidance the complications of prolonged recumbency is higher; the return to a more qualitative life, with functional independence during daily life activities, is more swiftly.

Dear Teuta,

Thank you very much for your very useful and interesting comments in this topic, where you are very experienced.

This is a very interesting question but a very difficult one as well. I do agree with the ages proposed and I rather follow AAOS recommendations for this subject. Basically after 65 years BIPOLAR implants (monopolar implants should be prohibited regarding their high level of complications) are the best except for those that kept extended capabilities and activities (including sport practice); for them a standard THR is proposed (but they are rather a few). Before this age, each time a stable osteosynthesis with a low risk of non-union, mal-union, or AVN and with early possibility of efficient REHAB is possible we try to save hips. If not, a THR is performed.

For elderly patients, the quality of life looks very poor and statistics already showed a very high rate of morbidity and mortality with a very poor survival rate for a 5 years follow-up. May be should we consider that as some specific diseases such as cancer, hip fractures are one of the means used by death to select individuals.

Best regards

cemented bipolar hemiarthroplasty is better option for elder peopie above 70years of age.

I recommend total /he mire placement is the ideal treatment for elderly individual with femoral neck fracture for better quality of life

Dear Ali,

Thank you very much for comment, cemented bipolar hemiarthroplasty is one solution but it is depends also from the situation of the acetabulum. If there are degenerative changes, THR is better choice.