OTA 2006 Posters
Scientific Poster #110 Geriatrics
Total Hip Arthroplasty for Acute Displaced Femoral Neck Fracture: Can
We Minimize Hip Dislocation with Optimal Patient Selection and Modern Surgical
Technique?
Stéphane Leduc, MD (*); Joseph Borrelli, MD (*);
William M. Ricci, MD (a,e-Smith & Nephew);
Washington University School of Medicine, St. Louis, Missouri, USA
Purpose: Recent randomized trials have demonstrated that primary
total hip arthroplasty (THA) is superior to internal fixation for displaced
femoral neck fracture in the active and lucid elderly patient. However,
compared to hemiarthroplasty, THA has historically been associated with
an unacceptably high dislocation rate (10-20%), diminishing enthusiasm for
THA in this patient population. We hypothesized that proper patient selection
combined with modern surgical technique and implants would reduce the short-term
dislocation rate for patients treated for acute displaced femoral neck fracture
with THA.
Methods: Between June 1999 and June 2005, 25 patients (15 females
and 10 males) with a mean age of 73 years were treated by two surgeons at
one institution with a THA for an acute displaced femoral neck fracture
(OTA31B). Patients were only considered for THA if they were independent
ambulators, lucid, and without Parkinson's disease. Postoperatively all
patients were allowed immediate weight bearing as tolerated and were instructed
to follow posterior hip dislocation precautions for 12 weeks. This cohort
was retrospectively identified and reviewed from a prospective database.
All patients were contacted in January 2006 to confirm dislocation status.
Average follow-up was 26 months with 21 of the 25 hips having more than
1 year of follow-up.
Results: THA was via a posterior approach in all cases. A large femoral
head was used whenever possible as dictated by the size of the acetabular
component: 36 mm (n = 3), 32 mm (n = 13), 28 mm (n = 9). All patients had
a cemented femoral component and an uncemented acetabular component with
a 20° elevated acetabular liner. Surgical technique included measures
to provide posterior stability with the hip internally rotated to at least
70° with hip flexion of 90° and neutral abduction. This included
removal of anterior trochanteric and acetabular osteophytes when present
and/or partial anterior capsulectomy. There were no hip dislocations (0%).
One diabetic patient had a superficial wound dehiscence treated with local
wound care. One patient had a nondisplaced greater trochanteric fracture
that healed without complication.
Conclusions: The data suggest that primary THA via a posterior approach
with modern implants and attention to posterior hip stability provides an
acceptably low short-term dislocation rate, much lower than previously reported
for this patient population and approaching that seen with primary THA for
osteoarthritis.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.