Total hip replacement in acute intracapsular proximal femoral fracture: the role of large diameter heads & their effect on dislocation

Introduction

Current literature supports the use of total hip replacement (THR) for the treatment of displaced intra-capsular proximal femoral fractures (DIPFF). Case series of patients receiving this treatment show dislocation rates higher than that of patients who have THR to treat osteoarthritis. Large diameter THR have mechanical advantages in terms of dislocation and their role in PFF has yet to be assessed.

Objectives

To assess the role of large-diameter total hip replacements on the rate of dislocation when used to treat displaced intra-capsular proximal femoral fractures.

Design: Single surgeon, case series

Setting: Level I trauma centre

Inclusion criteria:

1. Displaced intra-capsular proximal femoral fracture (Garden III & IV).

2. Independently mobile pre-operatively for distances greater than a mile, with no more than 1 stick as a mobility aid.

3. Abbreviated mental test score of 9/10 or greater

Exclusion criteria:

1. Patient under 60

2. Pathological fractures

3. Additional fractures of the femur

Outcomes

1. Mortality

2. Morbidity (Including dislocation)

3. Oxford Hip Score

4. SF12

Patients/Participants: Retrospective study to assess patients who presented between May 2006 and December 2008 and met the requirements had a CPTÒ (Zimmer) cemented femoral stem, using 3^rd generation cementation techniques, and large diameter Duronò (Zimmer) head and cup (uncemented) inserted as a primary procedure via a modified Hardinge technique. Follow up was via routine clinic appointments, letter to GP and phone conversation with patient.

Results

67 patients were selected (49 female) average age was 74.6 (67–87). Follow-up was for an average of 14 months (3–39 months). No dislocations or deaths were recorded for this period of time.

Conclusions

This study suggests that the high rates of dislocation associated with THR for PPF can be limited by the use of large diameter components. This study should be followed up by a multi-centre multi-surgeon study.