The results of treatment of 73 transcervical and 49 extracapsular fractures of the femoral neck in patients with rheumatoid arthritis were compared with the results in 152 normal patients. In undisplaced transcervical fractures that were internally fixed and followed up for more than six months, there was no significant difference in results between the rheumatoid patients (5 acceptable results in 8 patients) and the control patients (8 acceptable results in 9 patients). In displaced fractures, when internally fixed, the rheumatoid group (8 acceptable results in 27 patients) did significantly less well than the control group (17 acceptable results in 30 patients). In hips affected by the disease, the results were worse (1 acceptable result in 9 patients). Hemiarthroplasty gave acceptable results in two-thirds of the rheumatoid patients with transcervical fractures, whether used as primary treatment of displaced fractures or as revision of failed pinnings. This was not affected significantly by the presence of disease in the joint. In extracapsular fractures, the presence of rheumatoid arthritis, whether or not it affected the hip, did not appear to affect the outcome. The presence of osteoporosis was associated with poor results.
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