J Korean Hip Soc.  2010 Sep;22(3):203-208. 10.5371/jkhs.2010.22.3.203.

Two-Incision Bipolar Hemiarthroplasty for Treating Femoral Neck Fracture: Analysis of 15 Cases

• Kim BH
• Chung YY
• Jun SH
• Choi DH

• KMID: 1461171
• DOI: http://doi.org/10.5371/jkhs.2010.22.3.203

Abstract

INTRODUCTION
We wanted to evaluate the efficacy of bipolar hemiarthroplasty using Berger's two-incision surgical technique for patients with muscular weakness around the hip joint and/or a high risk of dislocation.
MATERIALS AND METHODS
We performed bipolar hemiarthroplasty for 15 femoral neck fractures using Berger's two-incision technique between December 2005 and July 2007. The mean age of the patients was 75.2 years old. Four of them had difficulty in walking due to the sequalae after stroke and five have been treated for psychoneurologic disorders. We investigated the operation time, the length of the anterior and posterior incisions, the amount of bleeding, the time untill walking after the operation, the total hospital stay, the recovery to activities of daily living and the complications such as dislocation.
RESULTS
The mean operating time was 93 minutes. The average anterior and posterior skin incision length was 6.4 cm and 7.2 cm, respectively. The mean amount of bleeding was 420 cc at the time of surgery and 230 cc postoperatively through a drain. The patients started walking at a mean of 3.3 (1 to 5) days after the operation and the mean hospitalization was 24.3 days. Fourteen patients went back to their pre-injured activities of daily living, except one case with an intraoperative periprosthetic fracture. As for complications, two cases (13.3%) of femoral fracture were intraoperatively observed and one case of skin necrosis on the anterior incision site occurred. There were not any cases of dislocation or infection.
CONCLUSION
Two-incision bipolar hemiarthroplasty had advantages for rehabilitation in elderly patients who have a high risk of dislocation, as well as in the patients with muscle weakness. But the operation took a long time and it had a high complication rate.

Keyword

Femoral neck fracture; Bipolar hemiarthroplasty; Minimal invasive surgery; Two-incision technique

MeSH Terms

Activities of Daily Living
Aged
Dislocations
Femoral Fractures
Femoral Neck Fractures
Femur Neck
Hemiarthroplasty
Hemorrhage
Hip Joint
Hospitalization
Humans
Length of Stay
Muscle Weakness
Necrosis
Periprosthetic Fractures
Skin
Stroke
Walking

Figure

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  Fig. 1 Anterior skin incision is placed directly over the femoral neck and posterior skin incision is started from greater trochanter.

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  Fig. 2 After retraction of the tensor facia lata laterally and sartorius and rectus femoris medillay, anterior joint capsule is visible.

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  Fig. 3 (A) First, bipolar cup is inserted into acetabulum through anterior skin incision. (B) Then femoral stem is inserted into femoral canal through posterior skin incision under direction visualization. (C) Femoral head is mounted on the taper of the femoral stem and reduced into bipolar cup.

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