Results of displaced subcapital fractures treated by primary total hip replacement
Introduction
Total hip replacement (THR) as primary treatment for displaced intracapsular neck of femur fractures in the elderly patients, remains controversial.9 Two recent long-term prospective randomised trials have shown that THR results in decreased pain and improved physical function, as compared to internal fixation and hemiarthroplasty.10., 11. They suggest primary THR for treatment of physiologically active elderly patients with displaced subcapital fracture who are presently treated either by internal fixation or hemiarthroplasty. However primary THR remains unacceptable to many because, besides being expensive and time consuming, it results in a very high dislocation rate in non-arthritic, previously mobile, fracture patients.1., 4., 6., 10., 11., 12., 13., 14. Our challenge to this concern stems from our view that a low dislocation rate along with good function can be achieved by using modern operative techniques in physiologically active elderly patients with displaced subcapital fracture.
We therefore reviewed our patients with displaced subcapital fracture, treated by THR, to assess morbidity, mortality and functional outcome.
Section snippets
Patients and methods
We identified 51 consecutive patients with displaced neck of femur fractures, treated by THR, during a period of 3 years from April 1997 to March 2000. In our hospital, patients above physiological age of 65 years were treated by arthroplasty for displaced subcapital fractures (Garden 3 and 4). THR was given preference over hemiarthroplasty to treat socially independent, mobile and alert patients. In this retrospective clinical study, the first author reviewed the patient hospital records to
Morbidity
Eleven out of 51 patients suffered early in-patient post-operative morbidity, including one dislocation (Table 2). Two patients had late complications resulting in revision surgery. The patient with early dislocation went on to have recurrent dislocations and underwent revision surgery. One patient developed a deep infection and underwent surgical debridement twice, before final revision to a Girdlestone excision arthroplasty.
Mortality
At the time of review 5/51 patients were dead. Of these two died
Discussion
This study shows that in carefully selected patients with displaced intracapsular hip fractures, primary THR resulted in minimal late morbidity (2% dislocation rate and 4% revision rate) in contrast to other series in the literature.4., 6., 10., 11., 12., 13., 14. A high early in-patient morbidity (22%) recorded in this study is comparable with other reports.
Several clinical trials have compared THR to hemiarthroplasty and internal fixation for treating displaced hip fracture.10., 11., 12., 13.
Conclusion
Our study confirms the place of primary THR in treatment of socially independent, mobile, alert patients with displaced hip fracture. We found OHS valuable in functional assessment of THR following hip fracture.
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Cited by (23)
Survival Rate and Application Number of Total Hip Arthroplasty in Patients With Femoral Neck Fracture: An Analysis of Clinical Studies and National Arthroplasty Registers
2020, Journal of ArthroplastyCitation Excerpt :One hundred twenty-seven full-text articles were assessed for eligibility. A total of 22 studies [3,11,12,17–35] published from 1999 to 2018 met all predetermined inclusion criteria and were assessed in this review. The systematic literature search and the reference search revealed 19 studies with 24 study cohorts [36–54], which were published from 2003 to 2019.
Clinical outcomes of total hip arthroplasty for fractured neck of femur in patients over 75 years
2015, Journal of ArthroplastyCitation Excerpt :However, if one excluded the patient with the lowest OHS, who was severely limited by contralateral hip and bilateral knee osteoarthritis, then the mean score in this study would be 42 and therefore equivalent to elective results. The mean score was still comparable to other THA for hip fracture papers looking at a younger population [36] and preferable to those obtained in populations undergoing hemiarthroplasty for NOF fracture with studies quoting a mean score from 35 to 38 [37–39]. We know that hip function peaks approximately 12 months following a TH, therefore if a THA provides a better functioning joint at 12 months then this is a significant advantage over hemiarthoplasty [12,40,41].
The results of total hip arthroplasty for fractured neck of femur in octogenarians
2014, Journal of ArthroplastyCitation Excerpt :The benefits of THA over Hemiarthroplasty are balanced by an increased risk of dislocation, greater operative time and higher implant cost [14]. The dislocation rate after THA ranges from 2% to 20% [1,13,15–21] following fracture although this may be reducing as the use of larger head sizes becomes commonplace [22]. There were no dislocations in the group of patients we studied.
Proximal femoral fractures in the elderly: How are we measuring outcome?
2011, InjuryCitation Excerpt :The OHS has been demonstrated to be consistent, reproducible and sensitive for patients undergoing primary and revision hip arthroplasty, and has been validated against SF-36, Eq5D and the arthritis impact measurement scale.144 Three studies used the OHS as timing points from one month to five years post injury, both as a single measure,99,157 and as a comparative measure over time.9 In one study, the OHS correlated well with estimated pre-injury mobility and SF-12, but showed differences not seen with simultaneous use of SF-36.9
Preoperative planning of prosthetic replacement in hip fractures in the elderly
2010, Revista Espanola de Cirugia Ortopedica y Traumatologia