Abstract
Introduction
Dislocation is one of the most common orthopaedic complications after primary total hip replacement (THR). The reported dislocation rate in elective THR is 5–8%. This number increases up to 22% for THR done for neck of femur fractures. Due to the reported increase in dislocation for trauma, some surgeons prefer to do a hemi-arthroplasty or open reduction and internal fixation (ORIF). Hemi-arthroplasty is known to have poorer functional outcomes. Failure of ORIF is as high as 43%, and revision of failed ORIF to THR has reported dislocation rates of up to 42%.
Materials and methods
A retrospective review of all THR done for neck of femur fractures during 2006–2011 was undertaken. The patients in our institution who are considered for a THR must have an active life-style. Records were reviewed for delay to surgery, surgical approaches, articulations, bearing surfaces, follow up periods and cemented versus uncemented implants. We excluded all pathological fractures, extra-capsular fractures, failed ORIF, patients with incomplete data and patients with a follow-up period less than 3 months.
Hip dislocation was the end-point of the review and we did not study other causes of revision e.g. loosening of components or infection.
Results
A total of 115 cases were identified as suitable for analysis. Average age at surgery was 73.2 years (range 30–81). Delay to surgery was 5.3 days (range 1–63). Average follow up period was 18.3 months (range 3 months-4,3years). Four patients (3.4%) had a confirmed dislocation. Three of these patients had successful closed reduction and one patient required revision surgery and change of component orientation.
Conclusion
Our early dislocation rate of 3.4% is within the published results and shows that primary THR is an acceptable and safe option for displaced intracapsular NOF in active patients. Most recent studies have shown superior functional outcomes of THR compared to hemi-arthroplasty or poorly performed ORIF.
NO DISCLOSURES
