EARLY POST OPERATIVE MOBILITY AND MORTALITY IN OCTO AND NONAGENARIANS FOLLOWING HEMIARTHROPLASTY FOR INTRACAPSULAR NECK OF FEMUR FRACTURES.

Abstract

Background: Intracapsular neck of femur fracture (# ICNOF) is one of the most common fractures in the elderly. In octa and nonagenarians, with age associated and other co morbidities, achieving a pre injury status of mobility is the deemed result. The physiological age, rather than the chronological one is an important factor determining the type of joint used and results in these patients.

Aim: We present here, a study of 349 patients in the age group of 80 to 100, who underwent hemiarthroplasty as primary treatment for # ICNOF.

Patients and Methods: We studied the data from a prospective hip database of patients undergoing hemiarthroplasty for # ICNOF between Jan 2000 and Jan 2005. All patients admitted with # ICNOF in our centre are assessed by a Hip audit nurse. Pre and post operative data is collected in a specific format. Patients undergo hemi-arthroplasty usually within 24 hours of admission. The type of joint used in decided by the operating surgeon. Patients were reviewed at the 4 month mark after the surgery. They were assessed for pain, mobility and complications. Seven outcomes and eight possible confounding factors were considered and statistical comparison was done to find specific correlation between these factors.

Results: 613 patients underwent hemiarthroplasty during the said period. 349 of these were more than 80 years of age. The mortality and mobility in this group was studied and various factors determining the outcome were assessed and statistical correlation tested. The mortality was expectedly higher in elderly population. Post operative mobility was mainly related to the preoperative functional status. In addition, age, other co-morbidities, ASA grade and joint type also had bearing on the Results:

Discussion: We are a busy District General Hospital in Scotland and hemiarthroplasty for # ICNOF is one of the routinely performed surgeries with more than 100 patients undergoing this procedure in a year. We have a dedicated Hip audit nurse who is responsible for maintaining a database for all these patients.

With increasing age of the population, # ICNOF in over 80s has evolved into a commonly encountered problem. Early mobilisation and aiming for pre injury functional status is an achievable goal in most. ‘The better they walked before, the better they will walk after’ is the golden rule to predict outcome. We use uncemented Austin Moore prosthesis for all patients but prefer to use a bipolar uncemented HAP coated prosthesis (JRI Furlong prosthesis) for patients who are relatively active and independent, regardless their age. The early results in this second group of patients are predictably better, but it will require further detailed study to determine whether these hold true in long term as well.