TOTAL HIP ARTHROPLASTY FOR THE TREATMENT OF DISPLACED FEMORAL NECK FRACTURES: 10 YEARS FOLLOW UP, ASSESSMENT OF STABILITY AND LOOSENING

Abstract

Aim: To evaluate the midterm results of primary cemented or cementless total hip arthroplasty for the treatment of displaced femoral neck fractures.

Material and Methods: Between 1990–2000, 121 patients with displaced fractures of the femoral neck underwent primary prosthetic replacement 2.1 days on average after their admission. The mean age of the patients was 65,7 years (ranged 33–88) and the mean follow up period 4,1 years (mean 2–10 years), 112 patients had type III–IV femoral neck fractures according to Garden classification while the rest 9 patients had Garden II fractures but with associated osteoarthritis of the hip joint, A cement-less total hip arthroplasty was applied in 75 patients (Group A, average age 61,4 years) while the rest 46 patients were treated with cemented T.H.A (Group B, average age 72.4 years). Last follow up evaluation with the modified Harris Hip Score (HHS) and radiological assessment with the Engh and Wixon et al scores was available in 92 patients. 10,8% of the patients died from reasons unrelated to the implant, In 30 elderly patients (< 75 years old, 22 available in the last follow up) a cementless T.H.A. was applied due to established impairment of their cardiopulmonary status (coronary disease, chronic heart failure, COPD, positive history of myocardial infarction) or systematic diabetes mellitus.

Results: The mean HHS was 82, 3 degrees (52–97). Radiological score for the cementless T.H.A. was +5, 8 for the cup and +6,4 for the stem according to Engh scale (satisfactory integration for the proximal porous prosthesis-Perlecta, Synergy), and a 74,8% liability of integration according to Wixon scale (Sportono type of prosthesis). Complications were recorded in 19 patients: Early T.H.A, dislocation 3, 26% (3 Pi), loosening 5,4% (5 Pt), heterotopic ossification 8,6% (8 Ft), periprosthetic fracture 1,08 % (1 Pt) and femoral nerve paresis 1,08 % (1 Pt). One patient (1, 08%) had superficial wound infection treated with i.v. antibiotics, continuous irrigation and debridement. No systematic postoperative complications (acute renal failure, heart failure, coma) were noted in the elderly patients with cardiopulmonary disorders, possible due to selection of a cementless prosthesis and therefore to the lesser intraoperative time and the avoidance of toxic reactions from the cement.

Conclusion: Total cemented or cementless prosthetic replacement for the treatment of femoral neck fractures in selected cases give very good midterm results. Cementless T.H.A, is probably the choice of treatment in elderly patients with cardiopulrconary disorders, as the integration of the prosthesis is not affected from the degree of osteoporosis and the toxicity of cement is avoided.