The Monk hard-top endoprosthesis for intracapsular fractures of the femoral neck.

The Monk hard-top hip prosthesis has an acetabular cup of polyethylene, covered by a metal cap. The femoral stem is of two types, for insertion with or without acrylic cement. One hundred and sixteen patients of an average age of 78.5 years, who has sustained intracapsular fractures of the femoral neck of Garden type 3 of 4, were treated by Monk hard-top arthroplasty. After a mean follow-up time of 23.9 months (range 9-47 months), 73 survivors were re-examined clinically and radiologically. Using Love's classification it was found that in 34 cases (48 per cent) the result was excellent and in 21 cases (30 per cent) it was good. In 12 cases (17 per cent) the result was fair and in 4 cases (5 per cent) it was poor. The poor result in this latter-mentioned group was mainly due to medical diseases that interfered with walking. There was clinical and radiological evidence of an increased tendency of loosening of the uncemented prosthesis. Our numbers were, however, too small to draw definite conclusions about this. Our experience with the Monk hard-top endoprosthesis is satisfactory, but a longer time of observation will be required to establish whether this prosthesis is better than the conventional type for intracapsular fractures of the femoral neck.