Abstract
National Institute of Clinical Excellence (NICE) recommended total hip replacement (THR) surgery for fit patients with fracture neck of femur (NOF) in 2011. Our hospital implemented hip fracture program to follow these recommendations the same year. However, the increased incidence of further procedures compared with those undergoing the THR for osteoarthritis alone has led to concern regarding dislocation and other complications when using THR treatment for fracture NOF particularly with the posterior approach.
We introduced dual mobility implant for THR for hip fracture program patients to minimize risk of hip instability but allowing the use of the posterior approach which is recognised as giving a faster recovery than the Hardinge type approaches in this patient group. The Arthroplasty database for hip fracture program was reviewed from September 2011 to September 2015 for appropriateness of this treatment. During this period, 120 Dual Mobility THRs were carried out in 119 patients (36 males, 84 females) with mean age at 78 years (42–94) and average follow-up of 24 months (2–56 months). All patients were either operated by a fellowship trained arthoplasty surgeons or the senior surgeons using posterior approach. All patients undergoing THR for NOF were found to meet the NICE guidelines criteria for THR. No post-operative dislocation, infection, hetotropic ossification or lysis was recorded. Mean Harris Hip Score (HHS) at 19 months was 82 (54–98). In this cohort 112 patients (94.3%) were able to ambulate in non-trendlenburg gait pattern. One patient developed deep vein thrombosis in early post-operative period.
This study emphasises beneficial use the dual mobility implant combined with the posterior approach in THR for fracture NOF patients and highlights the areas of improvements in hip fracture management.
