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Early Results Of Austin Moore Prosthesis In Elderly Patients With Fracture Neck Femur

*Dinesh Dhar

*Department of Orthopaedics, Rustaq Hospital, South Batinah Region, Sultanate of Oman

Address for Correspondence

Dr. Dinesh Dhar
Burj Al Raddha, P.O.Box 349, Al-Rustaq 329
Sultanate of Oman
Tel: +968 92357505      
Fax: +968 26878237
E-mail :


The prospective study was carried out in Referral Rustaq Hospital Oman to determine the functional results and complications in elderly patients (above 65 yrs) with fracture neck femur treated by hemiarthroplasty – Austin Moore Prosthesis from March 1999 to February 2003.  The patients were followed for 18 months.  The study design was descriptive and analytical.  Statistical analysis was done with chi-square test.
Results :  The total number of patients were 52 with average age of 71 years and above.  Male to female ratio was 1:3.  There were 57.6% patients with associated one or more co-morbidity.  The median duration of hospital stay was 7 days and surgery time 45 min.  Overall mortality at 15 months was 23%.  Wound infection was present in 5.7% cases.  The dislocation of prosthesis was seen in 3.8% patients.  Periprosthetic fracture was seen in 3.8% cases.  The morbidity and mortality was high in patients with systemic co-morbidity and those above 70 years of age but statistically was not significant ( p value > 0.05).  In surviving patients at 18 months functional assessment was graded excellent / good  in 82.7% patients.
Conclusion :  We recommend primary hemiarthroplasty for all elderly patients above 65 years with fracture neck femur as overall functional results are unsatisfactory in patients less than 65 years.
Keywords    Austin Moore Prosthesis (AMP), Hemiarthroplasty, Fracture neck femur

J.Orthopaedics 2007;4(1)e3


The best treatment for fracture of femoral neck is still to be determined (Masson et al 2004 1.  Studies by (Johansson et al 20002, Rogmark et al 2002 a, b3,4 Roden et al 20035) have shown a 30 – 40 % rate of reoperation after internal fixation and superior function after primary hemi – or total arthroplasty.

Internal fixation was associated with non union and avascular necrosis and need for frequent revision.  With introduction of Austin Moore Prosthesis in 1992, the problem of non union and avascular necrosis was improved as the femoral head was replaced by metallic implant.  The common complications and mortality in elderly patients with femoral neck fractures are mostly related to their age and other systemic co-morbidities.  The surgical procedure further adds to their depleting health status 8,9.

The Austin Moores Prostheis is commonly performed in our hospital in elderly patients with fracture neck femur.  The factors considered in selecting treatment modalities are age of the patient, general medical condition, type of fracture, availability of facilities and socio economic conditions of the patient 5,9 .

No results of early hemiarthroplasty for hip fractures have been reported in literature from any Gulf Medical Centres, although the procedure is commonly performed all over hospitals in Gulf region.

Material and Methods :
This prospective analytical study was conducted in Orthopaedic Department of Rustaq Referral Hospital, Oman from March 1999 to February 2003.
52 patients with fracture neck femur treated by hemiarthroplasty (Austin Moore Prosthesis) were followed on average for 15 months to assess the functional results and complications.  Inclusion criteria were age 65 years and above, Bedridden patients and those with rheumatoid arthritis, pathological fractures or any form of infection or a life threatening medical conditions were excluded from the study.
All patients history and clinical examination findings were recorded on a performa.  Patients variables such as demographic data mechanism of injury, duration of fracture, side of fracture and any associated systemic illness was noted. (Table I)  Appropriate Radiographs of the affected hip were taken to classify the type of fracture.  Relevant laboratory investigations, chest radiographs and ECG were done in all cases.
Patients who were fit underwent surgery under general anesthesia, only in five cases spinal anesthesia was used.  Patients were operated through Moore’s porterior approach in lateral position.  In all cases appropriate size Austin Moore’s Prosthesis was used.  Patients were routinely started as prophylactic injection 1st/2nd  generation cephalosparins which was continued post-operatively for 5 days as per the department protocol.
Patients were started on physiotherapy while in hospital and mobilized early.  After discharge from hospital the patient was followed at interval of 02 weeks, 08 weeks, 06 months, 12 months and 15 months to record any complications and at last follow up all the surviving patients were functionally assessed to grade the results.
The data was analyzed for frequencies of various variables.  Statistical analysis was done with chi-square test.
Results :

The total number of patients was 52 with female to male ratio of 3:1.  The average age of patients was 72 years.  47 patients were operated under general anesthesia and only 5 patients underwent surgery under spinal anesthesia.  57% (30) of patients had one or more systemic co-morbidity such as hypertension, Ischaemic heart disease, Diabetes Mellitus, Chronic Obstructive airway disease, Parkinsonism, chronic renal dysfunction.  The median duration of surgery was 45 min. (30-105) and hospital stay 7 (5-37) days.  Blood transfusion was given to 46 patients and 16 needed 2 or more units.

In 15 months follow up only.  3 patients had wound infection (5.7%).  Two patients (3.8%) had dislocation of the prosthesis and in both of them it was defected during first week.  Seven of surviving (13.4%) patients had complaints of persistent thigh or groin pain sometimes radiating to the knee causing significant discomfort to the patients.

Two patients (3.8%) had peri prosthetic fracture which was managed conservatively.  No neurovascular complication was noted.

In patients with co-morbidities the mortality at 15 months was 25% (8/30) and 40% patients had complications while 30% (9/30) were mobile independently at 15 months period.  Compared to 18% (4/22) deaths and 27.2% (6/22) complications in patients without prexisting co-morbidities.  The results were however not significant statistically  (p value < 0.05).

The overall mortality at 15 months was 23%.  Most of these patients were having one or more co-morbidities and their age was above 70 years.  The cause of mortality was mostly medical.
Functional assessments of the 46 patients who were alive at 15 months was done according to the grading system adopted in Table (II) adopted as comparable to that of Arcy and Devas(10) .  The result scoring showed that 20 patients (43.5%) were graded excellent with no pain and full mobility while 18 patients (39.2%) were graded good, the remaining 8 patients (17.3%) had poor results with restricted mobility and pain.

Discussion :

Fracture neck femur in elderly patients is a challenging problems.  The treatment depends on many factors including the type of fracture, functional demands and presence of any preexisting medical problems.

Over past few years a broader consensus has been reached as regards treatment of fracture femoral neck in active, independent, elderly patients, they benefit from a primary arthroplasty. (Dorr et al 198611, Skinner et al 1989 12, Ravi Kumar and Marsh 2000 13).  Austin Moore Prosthesis is most commonly performed procedure in developing countries.  This is especially indicated in patients with relatively shorter life expectancy.  Although Austin Moores prosthesis eliminates the chances of non union and avascular necrosis, other complications still occur.  The complications include deep vein thrombosis, chest infection, renal failure and bed sores.  The more specific complications associated with hemiarthroplasty are infection, dislocation of implant, peri prosthetic fractures, protrusion, thigh pain and neurovascular injury 7,9

The results of our study have shown overall mortality of 23% at 15 months which is comparable with other studies.  There is slight difference in patient characteristics, surgical approach, implant design but these factors are not related to mortality. 7,14 .

Arcy and Devas10 has also reported mortality of 23% in patients undergoing hemiarthroplasty at one year follow up.

Nather et al 19857,  have reported mortality of 15% in elderly patients undergoing Austin Moore prosthesis.  Lee et al have reported 6% mortality in patients with fracture neck of femur treated by total hip replacement (THA).  But they had slected relatively fit patients for THR14 .

Dislocation of prosthesis is a common mechanical complications in patient undergoing Arthroplasty.  There were two dislocations (3.8%) in present study.

Lu et al in their meta-analysis of literature on femoral neck fractures found dislocation rate of 2.1% in hemiarthroplasty group6 .  Tellizi and Wahab in their series reported dislocation rate of 3.4% 15 .

In the present study the infection rate was 5.7% which is comparable with other studies.  The rate of infection was kept low by routine are of antibiotics.  The infection rate has been reported to be high when posterior approach is used for arthroplasty due to proximity of incision to the perineum.

None of our patients had post operative deep vein thrombosis (DVT).   Routine use of low molecular weight Heparin prophylaxis is routine in our hospital.  DVT is less common in Asians and in Middle East population compared to western population.  Early  mobilization and use of prophylactic anti thrombotic agents could explain the low incidence of DVT in these patients.

In the present study the rate of complications and mortality was high in patients above 70 years and with preexisting underlying medical problems.  But this was not statistically significant.  Contrary to this other authors have found significant difference in mortality and morbidity in two groups (6,16,17) .  This could be due to small sample size.

13.4 percent of patients in our series had persistent thigh pain of various severity.  This is in concurrence with reported thigh pain in literature ranging from 15% to 50%.  Various factors may be responsible for thigh pain, implant size/design, loosening, infection.  Use of cement as in Thompson Prosthesis has been associated with less frequency of pain.

Functional assessment of 46 patients at 15 months follow up have shown excellent to good results in 82.7% of our cases which is comparable to the study of Arcy and Devas(10)  who reported 82% excellent  good results.

The present series has  certain limitations as the study was based on small sample size and vague hip scoring system for functional assessment of surviving patients.  Moreover the exact cause of mortality could not be ascertained in absence of post mortem.

However this study was conducted for commonly performed orthopaedic procedure to ascertain the results and complications in most commonly occurring fracture in elderly patients and approach to treatment of this condition where systemic and medical co-morbidities compound the inherent risks.


Hemiarthroplasty – Austin Moore Prosthesis for acute fracture neck femur in elderly patients is associated with certain complication inherent to the procedure and mortality and morbidity which is due to associated systemic medical condition most of the rime rather than due to the fracture itself.  Functional grading excellent to good was seen in 82.7% of our cases at 15 months follow up.  However large sample size and longer follow up is advisable.

Table  I
Demographic Data of Patients
Total Patients :  52









Age Groups

65 – 70

71 – 75

75 – 80

> 80









Side of Fracture







Duration of Fracture

0 – 7 days

7 – 14 days





Patients with Systemic co-morbidities




Table II
Variables For Grading Results





(of normal)

Walking Distance







Without discomfort




FFD < 10°



Mild discomfort




FFD > 20°

Moderate to


< 50%

Moderate to Severe discomfort



Reference :

  1. Masson M, Parker MJ, Fleischer S.  Cochrene   Database of systemic Reviews 2004.

  2. Johansson T, Jacobsson S A, Ivarsson I et al.   Internal fixation versus total hip arthroplasty in treatment of displaced femoral neck fractures, a prospective randomized study of 100 hips.  Acta Orthop Scand 2000 ; 71 : 597-602.

  3. Rogmark C, Carlsson A, Johnell O, Sanbo I.  A prospective randomized trial of internal fixation versus arthroplasty for displaced fractures of neck of femur.  Functional outcome for 450 patients at two years.  J Bone Joint Surg (Br) 2002a ; 84 : 183-8.

  4. Rogmark C, Carlsson A, Johnell O, Sanbo I.  Primary hemiarthroplasty in old patients with displaced femoral neck fracture.  A 1 year follow up of 103 patients aged 80 years or more.  Acta Orthop Scand 2002 b ; 73 : 605-10.

  5. Roden M, Schon M, Freden H.  Treatment of displaced femoral neck fractures : a randomized minimum 5 year follow up study of screws and bipolar hemiprosthesis in 100 patients.  Acta Orthop Scand 2003 ; 74 : 42 – 4.

  6. Lu-Yao G L, Keller R B, Littenberg B, Wennberg JE.  Outcome after displaced fractures of femoral neck.  A meta analysis of one hundred and six published reports.  J Bone Joint Surg Am 1994 ; 76 : 15-25.

  7. Nather A, Seow C S, Lau P, Chan A.  Mortality and morbidity for elderly patients with fracture neck of femur treated by hemiarthroplasty injury 1995 ; 26 : 187-90.

  8. Laursen Jo.  Treatment of intracapsular fracture of the femoral neck in Denmark : Trends in indications over past decade.  Acta Orthop Belg 1999 ; 65 : 478-84.

  9. Glyn A P .  Fracture of hip surgery 2000 ; 49 : 105-9.

  10. D’ Arcy J, Devas M.  Treatment of fractures of femoral neck by replacement with  Thompson Prosthesis.  J Bone Joint Surg Br 1976 ; 58 : 279 – 86.

  11. Dorr LD, Glousman R, Hoy AL, Vanus R, Chandler R.  Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty.  J Arthroplasty 1986 ; 1(1) : 21-8.

  12. Skinner P, Riley D, Ellery J, Beaumant A, Coumine R, Shafighian B.  Displaced sub capital fractures of femur : a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement injury 1989 ; 20(5) : 291-3.

  13. Ravikumar K J, Marsh G.  Internal fixation versus hemiarthroplasty versus total hip arthoplasty for displaced subcapital fractures of femur – 13 year results of a prospective randomized study.  Injury 2000 ; 31 (10) : 793 – 7.

  14. Lee BP, Beery D J, Harsman W S, Sim F H – Total hip arthroplasty for the treatment of acute fracture of femoral neck.  Long term results.  J Bone Joint Surg Am 1998 ; 80 : 70-5.

  15. Tellizi N, Wahab K H.  Reoperations following Austin Moore hemiarthroplasty ; a district hospital experience. Injury 2001 ; 32 : 465 – 7 .

  16. Martyn JP.  The management of intracapsular fractures of the proximal femur.  J Bone Joint Surg Br 2000 ; 82 : 937-41.

  17. Clayer M, Bruckner J.  The outcome of Austin Moore hemiarthroplasty for fracture of femoral neck.  An J Arthop 1997 ; 26 : 681-4.


This is a peer reviewed paper 

Please cite as : Dinesh Dhar:Early Results Of Austin Moore Prosthesis In Elderly Patients With Fracture Neck Femur

J.Orthopaedics 2007;4(1)e3





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