PRIMARY TOTAL HIP REPLACEMENT FOR ACUTE DISPLACED SUBCAPITAL FEMORAL FRACTURES

Abstract

Introduction The aim of the study was to review the results of total hip arthroplasty (THA) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur.

Materials and methods 37 patients who underwent THA for displaced fractures of neck of femur between 1995 to 2001 were reviewed. Only those patients with 3 years or more follow-up were reviewed.

Results Average age was 67.7 years (37–80 years) with Male:Female ratio 5:32. Fracture involved left hip in 12 and right hip in 15 patients. Average Modified Barthel index before the fracture was 18.5 (13–20) and average Waterlow score was 12 (5–19). Majority were ASA grade II (22 patients). All patients were operated by the senior author. 31 hips were cemented, 1 uncemented and 5 hybrids. Canulated CF-30 (Sulzer, Switzerland) femoral stem was most commonly used (32 patients) and the acetabular component was Weber Metasul cup in most cases (33 patients).33 hips had metal-on-metal bearing surface and the rest had metal-on-polyethylene. Average hospital stay was 12.6 days; majority (33) of the patients were discharged home and the rest needed additional rehabilitation. Average post-operative drop in Hb was 2.63 and14 patients needed blood transfusion. Average transfusion was 0.86 units per patient. Average follow-up was 5.8 years (3–9.5 years). Complications included: wound leakage (5), minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), peri-prosthetic fracture (2), stem loosening (1). 3 hips (8%) were revised (loosening 1, peri-prosthetic fractures 2). Average harris hip score at follow-up was 92 (66–100).

Conclusion In relatively fit, young and mobile patients, we recommend total hip replacement as the primary treatment since it promises better function and pain relief and avoids the drawbacks of internal fixation and hemiarthroplasty.