Reported rates of dislocation in hip hemiarthroplasty
(HA) for the treatment of intra-capsular fractures of the hip, range
between 1% and 10%. HA is frequently performed through a direct
lateral surgical approach. The aim of this study is to determine
the contribution of the anterior capsule to the stability of a cemented
HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature,
providing ten hip joints for investigation. A Thompson HA was cemented
in place via a direct lateral approach. The cadavers were then positioned
supine, both knee joints were disarticulated and a digital torque
wrench was attached to the femur using a circular frame with three
half pins. The wrench applied an external rotation force with the
hip in extension to allow the hip to dislocate anteriorly. Each
hip was dislocated twice; once with a capsular repair and once without
repairing the capsule. Stratified sampling ensured the order in
which this was performed was alternated for the paired hips on each
cadaver. Comparing peak torque force in hips with the capsule repaired
and peak torque force in hips without repair of the capsule, revealed
a significant difference between the ‘capsule repaired’ (mean 22.96
Nm, standard deviation ( Cite this article:
Patients who sustain hip fractures should be operated on within 24 hours of admission according to the Royal College Of Physician Guidelines. A delay to theatre of more than 4 days is associated with an increase in inpatient mortality. A high proportion of patients with hip fractures are elderly and take aspirin, clopidogrel or warfarin. A retrospective review of 100 patients admitted between December 2006 and July 2007 with a hip fracture was conducted. Our aims were to assess the proportion of patients taking antithrombotic medication, when the antithrombotic medication was stopped pre-operatively and see whether there was a delay to theatre. We also evaluated any association between patients taking antithrombotic medication and a return to theatre, post-operative morbidity and mortality and length of inpatient stay. 47 patients were taking aspirin, 1 was taking clopidogrel, 2 were on aspirin and clopidogrel and 3 patients were taking warfarin. The aspirin group had an increased delay to theatre compared to the no antithrombotic group, however, both groups had similar numbers operated on within 24 hours. 68% (32/47) patients had the aspirin stopped on the same day as the operation. 1 patient taking aspirin returned to theatre for evacuation of a haematoma. The main post-operative complication was pneumonia (n=9). 8 patients required a blood transfusion of which 5 were taking aspirin. The main causes of mortality were ischaemic heart disease (n=7) and pneumonia (n=5). The mean lengths of inpatient stay were 22.48 days in the aspirin group, 50 days in the aspirin and clopidogrel group, 66 days in the clopidogrel group, 24.33 in the warfarin group and 24.81 days in the no antithrombotic group. It is suggested from this small study that there is no advantage in stopping aspirin prior to hip fracture surgery. However, further studies need to be undertaken.
