Hip Pelvis.  2016 Jun;28(2):104-111. 10.5371/hp.2016.28.2.104.

Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture

• Kim Y
• Kim JK
• Joo IH
• Hwang KT
• Kim YH

• KMID: 2328346
• DOI: http://doi.org/10.5371/hp.2016.28.2.104

Abstract

PURPOSE
We investigated the incidence and time of dislocation and other factors associated with dislocation of bipolar hemiarthroplasty related to the treatment of femoral neck fracture in old age patients.
MATERIALS AND METHODS
Between January 2002 and April 2014, 498 femoral neck fractures (467 patients) were treated with bipolar hemiarthroplasty and included in this study. All surgeries were performed using the postero-lateral approach. The incidence of dislocation was investigated. A comparative analysis between a control group and dislocation group was performed with respect to patient factors including age, gender, body mass index, comorbidities, the ASA (American Society of Anesthesiologists) score, mental status and center-edge angle, and surgical factors including type of femoral stem, leg length discrepancy, femoral offset and method of short external rotator (SER) reconstruction.
RESULTS
The incidence of dislocation was 3.8%, and the dislocation occurred on average 2.2 months (range, 0.6-6.5 months) after operation. No difference in patient-related factors was observed between the two groups. However, a smaller center edge (CE) angle was observed in the dislocation group (42.1°±3.2° vs. 46.9°±5.4°, P<0.001), and significantly lower incidence of dislocation was observed in tendon to bone repair group (0.7% vs 7.8%, P<0.001).
CONCLUSION
SERs should be repaired using the tendon-to-bone repair method to reduce dislocation rate in elderly patients who undergo bipolar hemiarthroplasty using the postero-lateral approach due to femoral neck fracture. In addition, patients with smaller CE angle should be carefully monitored due to high incidence of dislocation.

Keyword

Elderly; Femoral neck fractures; Hemiarthroplasty; Dislocations; Risk factors

MeSH Terms

Aged*
Body Mass Index
Comorbidity
Dislocations*
Femoral Neck Fractures*
Femur Neck*
Hemiarthroplasty*
Humans
Incidence
Leg
Methods
Risk Factors*
Tendons

Figure

• 

  Fig. 1 Measurement of global femoral offset on plain radiograph was defined as the addition of the distance between the longitudinal axis of femur to center of femoral head plus the distance from the center of the femoral head to a perpendicular line passing through the medial edge of the ipsilateral teardrop point of the pelvis.

• 

  Fig. 2 Measurement of leg length discrepancy on plain radiograph was defined as the difference in perpendicular distance in millimeters between a line passing through the lower edge of the teardrop points to the corresponding tip of the lesser trochanter.

• 

  Fig. 3 Measurement of center-edge angle on plain radiograph was defined as the angle between the center of prosthetic head and the lateral edge of acetabulum.

• 

  Fig. 4 A 72 years old woman with femur neck fracture. (A) An immediate postoperative anteroposterior radiograph shows 40° of center-edge angle, measured as the angle between the center of prosthetic head and the lateral edge of acetabulum. (B) Radiograph obtained at postoperative 14th day showed dislocation of bipolar hemiarthroplasty. (C) The patient was treated with closed reduction and the radiograph was taken after closed reduction. There was no recurrence of dislocation thereafter.

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