Chonnam Med J.  2013 Aug;49(2):81-86. 10.4068/cmj.2013.49.2.81.

Comparison of Minimally Invasive Total Hip Arthroplasty versus Conventional Hemiarthroplasty for Displaced Femoral Neck Fractures in Active Elderly Patients

Affiliations
  • 1Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea. tryoon@chonnam.ac.kr

Abstract

Fractures of the femoral neck in elderly patients can be treated by internal fixation, hemiarthroplasty, or total hip arthroplasty (THA), and the treatment modality used should be determined on the basis of considerations of the degree of fracture displacement, age, functional demands, and the risk factors for surgery and anesthesia. We studied 85 active elderly patients who underwent minimally invasive two-incision THA or conventional bipolar hemiarthroplasty (BHA) within 2 weeks of injury for the treatment of acute displaced femoral neck fractures. Patients were followed up for a minimum of 24 months. The average operation times were 70 minutes in the THA group and 46 minutes in the BHA group (p=0.002), and average blood losses during the perioperative period were 921 cc and 892 cc, respectively (p=0.562). In the THA group, the average postoperative Harris hip score was 88.3 and the average Western Ontario and McMaster University score was 28.8, whereas in the BHA group the corresponding scores were 80.4 (p=0.006) and 32.5 (p=0.012), respectively. There were 2 cases of hip dislocation in the THA group, and 2 cases in the BHA group underwent conversion to THA. Our short-term follow-up results were better for minimally invasive two-incision THA than for conventional BHA for the treatment of acute displaced femoral neck fractures in active elderly patients.

Keyword

Femoral neck fractures; Arthroplasty; Hemiarthroplasty

MeSH Terms

Aged
Anesthesia
Arthroplasty
Butylated Hydroxyanisole
Displacement (Psychology)
Femoral Neck Fractures
Femur Neck
Follow-Up Studies
Hemiarthroplasty
Hip
Hip Dislocation
Humans
Ontario
Perioperative Period
Risk Factors
Tacrine
Butylated Hydroxyanisole
Tacrine

Cited by  1 articles

Clinical Outcomes of Bipolar Hemiarthroplasty versus Total Hip Arthroplasty: Assessing the Potential Impact of Cement Use and Pre-Injury Activity Levels in Elderly Patients with Femoral Neck Fractures
Jun-Il Yoo, Yong-Han Cha, Jung-Taek Kim, Chan-Ho Park
Hip Pelvis. 2019;31(2):63-74.    doi: 10.5371/hp.2019.31.2.63.


Reference

1. Papandrea RF, Froimson MI. Total hip arthroplasty after acute displaced femoral neck fractures. Am J Orthop (Belle Mead NJ). 1996; 25:85–88.
2. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994; 76:15–25.
Article
3. Cabanela ME. Bipolar versus total hip arthroplasty for avascular necrosis of the femoral head. A comparison. Clin Orthop Relat Res. 1990; (261):59–62.
Article
4. Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Am. 2006; 88:2583–2589.
Article
5. Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist A, Ponzer S, Tidermark J. A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br. 2007; 89:160–165.
Article
6. Cameron HU. Mini-incisions: visualization is key. Orthopedics. 2002; 25:473.
Article
7. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978; 49:239–243.
8. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983; 31:721–727.
Article
9. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br. 1971; 53:183–197.
Article
10. Yoon TR, Bae BH, Choi MS. A modified two-incision minimally invasive total hip arthroplasty: technique and short-term results. Hip Int. 2006; 16:Suppl 4. 28–34.
Article
11. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51:737–755.
Article
12. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15:1833–1840.
13. Widmer KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty. 2004; 19:387–390.
Article
14. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976; (121):20–32.
Article
15. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002; 17:463–466.
Article
16. Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; (141):17–27.
17. Moore AT, Bohlman HR. Metal hip joint: A case report. J Bone Joint Surg Am. 1943; (25):682–692.
18. Moore AT. Metal hip joint; a new self-locking vitallium prosthesis. South Med J. 1952; 45:1015–1019.
Article
19. Thompson FR. Two and a half years' experience with a vitallium intramedullary hip prosthesis. J Bone Joint Surg Am. 1954; 36-A:489–502.
Article
20. Bateman JE. Single-assembly total hip prosthesis. Preliminary report. Orthop Dig. 1974; 2:15–22.
21. Giliberty RP. A new concept of a bipolar endoprosthesis. Orthop Rev. 1974; 3:40–45.
22. Long JW, Knight W. Bateman UPF prosthesis in fractures of the femoral neck. Clin Orthop Relat Res. 1980; (152):198–201.
Article
23. Langan P. The Giliberty bipolar prosthesis: a clinical and radiographical review. Clin Orthop Relat Res. 1979; (141):169–175.
24. Coleman SH, Bansal M, Cornell CN, Sculco TP. Failure of bipolar hemiarthroplasty: a retrospective review of 31 consecutive bipolar prostheses converted to total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2001; 30:313–319.
25. Beckenbaugh RD, Tressler HA, Johnson EW Jr. Results after hemiarthroplasty of the hip using a cemented femoral prosthesis. A review of 109 cases with an average follow-up of 36 months. Mayo Clin Proc. 1977; 52:349–353.
26. Lee BP, Berry DJ, Harmsen WS, Sim FH. Total hip arthroplasty for the treatment of an acute fracture of the femoral neck: long-term results. J Bone Joint Surg Am. 1998; 80:70–75.
Article
27. Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, Saleh KJ. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop Relat Res. 2001; (383):229–242.
28. Berger RA. Mini-incisions: two for the price of one! Orthopedics. 2002; 25:472. 498.
Article
29. Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res. 2003; (417):232–241.
30. Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ, Hartzband MA, et al. Minimally invasive total hip arthroplasty. Development, early results, and a critical analysis. Presented at the Annual Meeting of the American Orthopaedic Association, Charleston, South Carolina, USA, June 14, 2003. J Bone Joint Surg Am. 2003; 85-A:2235–2246.
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