USE OF CEMENTLESS, RECTANGULAR, DUAL-TAPER, STRAIGHT FEMORAL STEM WITH BIPOLAR HEAD PROSTHESIS IN FEMUR NECK FRACTURES; A PRELIMINARY REPORT IN 50 PATIENTS

Abstract

We aimed to report our initial experience with the use of cementless, rectangular, dual-taper, straight femoral stem (SL-PLUS) with bipolar head prosthesis in femur neck fractures.

We operated 50 consecutive patients (28 women, 22 men; age ranged from 41 to 99 years; mean age 74) due to femur neck fractures and inserted the above-mentioned prosthesis. We used cemented femoral stem in severely osteoporotic patients. According to the Garden’s classification, there were 12 type II, 34 type III and 4 type IV fractures. We used direct lateral or posterolateral approach to insert the prosthesis. The entire operating time did not exceed 90 minutes and severe bleeding was not seen, in any patient. All patients were allowed to full weight bearing by a walker within the first postoperative 48 hours. We could evaluate the functional outcome of 25 patients who survived and had at least 6 months complete follow-up. We used Harris’ hip score for evaluation of the patients’ functional outcomes. Eight patients were lost to follow-up within the first postoperative 3 months, 15 patients died within the first postoperative 8 months and two patients could not walk due to an initial cerebrovascular disorder. The data of 15 patients, who passed away, showed that, mean age was 82 (70–99) years, 13 of 15 them were older than 75 years, 9 were man and 6 were woman, there were 2 type 2, 11 type 3 and 2 type 4 fractures.

Mean age of the included patients was 70 (41–88) years. There were 18 women and 7 men. There were eight type II, 15 type III and 2 type IV fractures. After a mean follow-up period of 17 (6–27) months, the mean hip score of 25 patients was 77 (51–96) points. There were two excellent (90–100 pts), 7 good (80–89 pts), 12 fair (70–79 pts) and 4 poor (< 70 pts) functional outcomes. Similar mean hip scores were observed between ≤70 (77.9 pts) and > 70 years (75.8 pts) age groups (P=0.849), between man (78.0 pts) and woman (76.1 pts) patients (P=0.297) and between Garden type II (70.9 pts) and Garden types III–IV (79.3 pts) fractures (P=0.075).

The rate of obtaining a satisfactory or fair functional outcome in the surviving elderly patients who were initially treated using a cementless, rectangular, dual-taper, straight femoral stem with bipolar head prosthesis due to femur neck fractures was 84% at the early postoperative period. Age, gender and type of the fracture do not influence the functional outcome. The risk of early postoperative mortality seems to increase in patients older than 75 years and with displaced fractures.

This kind of prosthesis can be preferred to lessen the operation time, intraoperative bleeding, to avoid the peroperative complications due to bone cement application and to allow early postoperative rehabilitation in femur neck fractures of the geriatric population.