PROSPECTIVE STUDY OF FRACTURE NECK OF FEMUR ABOVE 65 YRS TREATED WITH HEMI ARTHROPLASTY AND CEMENTED BIPOLAR AMP
Abstract
1.To evaluate clinical outcome of patients treated with cemented bipolar
hemiarthroplasty .
2.To evaluate the complications .
MATERIALS AND METHODS:
Source of data :
This is a one and a half year from December 1st 2017 to May 30th 2019 study of patients with fracture neck of femur admitted in Lalitha
hospital , guntur
RESULTS:
In our study, the final Harris Hip Score as evaluated at 2weeks after discharge all patients had poor functional outcome results. After 3 months
follow up patients functional outcome improved with 60 % fair results , 17 % good results and poor results decreased dramatically from 100% at
2 weeks to 23 %at 3 months . At six months after sugery final follow up done and assessed for clinical and radiological outcomes . Hence , among
30 patients averaged 92 with the maximum score being 97 and the minimum score being 87 .Out off 30 patients, 23 patients (77%) achieved
Excellent result, 7 patients (23 %) achieved Good result.
CONCLUSION
Ÿ Female predominance is common in fractures around the hip .Most of the fracture neck of femur were sustained due to trivial injuries like slip
and fall. Femoral canal diameter is wider and in female than males . Proximal femoral trabeculations deteriorate as age progresses .
Garden type 3 fractures were the most common pattern of neck of femur fracture observed which accounted to 60%. Hypotension seen
commonly seen in patients with systemic co-morbidities . Lengthening not more than 2 cm is common complication . The final functional
outcome was excellent in 77 % of the patients. Limitation of the study included a small sample size of 30 patients and a short follow up period
of 6 months.
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Maini PS, Talwar N, Nijhawan VK, Dhawan M. Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck – 10 year study.Indian J Orthop 2006;40:154-6.
SKS Marya, RThukral, Singh C. Prosthetic replacement in femoral neck fracture in the elderly : Results and review of literature . Indian J Orthop. 2008 Jan-Mar;42(1):61-7.
Schneppendahl J, Grassmann JP, Petrov V, Bottner F, Korbl B, Hakimi M et al. Decreasing mortality after femoral neck fracture treated with bipolar hemiarthroplasty during the last twenty years. IntOrthop. 2012 October; 36(10): 2021–6.
Langslet E, Frihagen F, Opland V, Madsen JE, NordslettenL.Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial.ClinOrthopRelat Res. 2013;4:122-6
Labelle LW, Colwill IE Swanson AB: Bateman bipolar hip arthroplasty for femoral neck fractures. A five to ten year follow up study. Clin.Orthop.1990, 251:20-25.
Frihagen F, Nordsletten L, Madsen JE . Hemiarthoplasty or internal fixation for intracapsular displaced femoral neck fractures : randomized controlled trial. BMJ 2007;335:1251.
Zofka P. Bipolar hip hemiarthroplasty. ActaChirOrthopTraumatolCech 2007;74(2):99-104.
Malhotra R, Arya R, Bhan S. Bipolar hemiarthroplasty in femoral neck fractures. Archives of Orthopaedic and Trauma Surgery 1995;114(2):79-82.
KR Anil , Agarwal R , Sing S and Ratan R .The BHU bicentric bipolar prosthesis in fracture neck femur in active elderly. Journal of Trauma Management & Outcomes 2008, 2:7 .
Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–1519. doi: 10.1016/S0140-6736(07)60457-7. Van Vugt AB, Oosterwijk WM, Goris RJ. Osteosynthesis versus endoprostheses in the treatment of unstable intracapsular hip fractures in the elderly.A randomized clinical trial. Arch Orthop.Trauma Surg.1993,113:39-45.
Sikorski JM, Barrington R. Internal fixation versus hemiarthroplasty for the displaced subcapital fracture of the femur. A prospective randomized study.
BartonicekJ . Proximal femoral fractures : the pioneer era of 1818 to 1925.clin orthoprelat Res 2004 Feb;(419):306-10.
Parker MJ, Gurusamy K. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;3:CD001706
Berry DJ. Epidemiology: hip and knee. OrthopClin North Am. 1999;30:183–190. doi: 10.1016/S0030-5898(05)70073-0.
Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–1519. doi: 10.1016/S0140-6736(07)60457-7.
DystarSH ,Collaghan JJ , Savory CG . PRELIMINARY RESULTS OF UNCEMENTED P.C.A. TOTAL HIP REPLACEMENT. The Iowa Orthopaedic Journal .VOL 11-9 .
Emery RJH, Broughton NS, Desai K, Bulstrode CJK, Thomas TL. Bipolar HemiarthroplastyForSubcapital Fracture Of the Femoral Neck. A Prospective Randomised Trial of Cemented Thompson and Uncemented Moore Stems.J Bone Joint Surg Br. 1991; 73: 322-4.
Barnes R, Brown JT, Garden RS, Nicoll EA. Subcapital fractures of femur: A prospective review. J Bone Joint Surg. 1976, 58:2-24
Parker MJ. The management of intracapsular fractures of the proximal femur.J Bone Joint Surg. 2000, 82: 937-941.
Van Vugt AB, Oosterwijk WM, Goris RJ. Osteosynthesis versus endoprostheses in the treatment of unstable intracapsular hip fractures in the elderly.A randomized clinical trial. Arch Orthop.Trauma Surg.1993,113:39-45
Frank J, Chapman C.B. et Al. Unipolar or Bipolar hemiarthroplasty for femoral neck fractures in the elderly. Clin Orthop2003; 414: 259 –65.
Robert Victor. Unipolar V/s Bipolarartroplasty. Techniques in Orthop.2004; 19B : 138- 142
Khan RJ, MacDowell A, Crossman P, Data A, Jallali N, Arch BN, et al. Cemented or uncementedhemiarthroplasty for displaced intracapsular femoral neck fractures. IntOrthop 2002;26:229-32.
Standring S: Gray's Anatomy: The Anatomical Basis of Clinical Practice, 40thedn. Edinburgh, Churchill Livingstone 2008.
.Crock HV.An atlas of the arterial supply of the head and neck of the femur in man.ClinOrthop 1980;152:17-27.
WeitbrechtJ.SyndesmologiasiveHistoriaLigamentorumCorporisHumaniguainSeeundum.ObservationesAnatomicasConcinnavitetFigurisadObjectaReentiaAdumbratisIllustravit. PetropoliTypogrAcadSci 1742;139-141.
Claffey TJ. Avascular necrosis of the femoral head: an anatomical study. J Bone Joint Surg Br 1960;42:802-809.
Sevitt S, Thompson RG. The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg Br 1965;47:560-573.
Senn N. The classic: the treatment of fractures of the neck of the femur by immediate reduction and permanent fixation-1889. ClinOrthop 1987;218: 11-17.
Harty M. The calcarfemorale and the femoral neck. J Bone Joint Surg Am 1957;39:625-630.
.Greenwald AS, Haynes DW. Weight-bearing areas in the human hip joint J Bone Joint Surg 1972;54:157-167.
Bayliss AP, Davison JK. Traumatic osteonecrosis of the femoral head following intracapsular fracture: Incidence and earliest radiological features. ClinRadiol 1977;28:407-414.
Garden RS. Reduction and fixation of subcapital fractures of the femur.OrthopClin North Am 1974;5:683-712.
.Banks HH.Nonunion in fractures of the femoral neck.OrthopClin North Am 1974;5:865-885.
Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br 1971;53:183-196.
Eliasson-Eiskjaer S, Ostgard SE. Survivorship analysis of hemiarthroplasties. ClinOrthop 1993;286:206-211.
Kreder HJ. Arthroplasty led to fewer failures and more complications than did internal fixation for displaced fractures of the femoral neck. J Bone Joint Surg Am 2002;84:2108-2117.
Muller ME: The comprehensive classification of fractures of long bones. In: Manual of Internal Fixation. Ed: Muller ME, Allgower M, Schneider R, Willenegger H. 3rdedn. Berlin, Springer-Verlag; 136-138
LaVelle DG: Fractures and dislocations of the Hip. In: Campbell’s Operative Orthopaedics. Ed: Canale ST, Beaty JH. 11th edn. Pennsylvania: Mosby 2008; 3237-3308.
Bateman JE, Berenji AR, Bayne O, Greyson ND. Long term results of bipolar hemiarthroplasty in osteoarthritis of the hip .ClinOrthop 1990;251:54 -66.
Parker MJ, Pryor GA. Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: A randomized controlled trial of 208 patients. ActaOrthop. Scand. 2000,71:440-446.
American Society for Testing and Materials. ASTM F451-08: Standard Specification for Acrylic Bone Cement. West Conshohocken, PA: ASTM; 2008.
Ascherl R. Science of bone cement. Ortho Supersite. Available at: http://www.orthosupersite.com/view.asp?rID=3971. Accessed August 4, 2011.
Eveleigh R. Principles of bone cement mixing. British Journal of Perioperative Nursing. 2001;11(1):18-20.
Madrala A, Nuño N. Effect of stem preheating and precooling on residual stress formation at stem/cement interface for cemented hip implants. Journal of Biomedical Materials Research, Part B, Applied Biomaterials. 2010; 93(1):258-265.
Lo WH, Chen WM, Huang CK, Chen TH, Chiu FY, Chen CM. Bateman bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures: Uncemented versus cemented. ClinOrthopRelat Res. 1994;302:75–82.
Hoppenfeld S, DeBoer P: Surgical Exposures in Orthopaedics – The Anatomical Approach. 3rdedn. Philadelphia, Lippincott Williams and Wilkins 2002; 365-454.
Harkess JW, CrockarellJR,Jr. Arthroplasty of the Hip, 11th edition, Campbell Operative Orthopaedics, 312- 481
NilsdotterAand Bremander A . Measures of Hip Function and Symptoms .Arthritis Care & Research Vol. 63, No.S11, November 2011, pp S200 –S207.
MaryaSKS ,Thural R and Singh C : Prosthetic replacement in femoral neck fracture in the elderly: Results and review of the literature .Indian J Orthop. 2008 Jan-Mar; 42(1): 61–67.
Krishnan H., Yoon TR., Park KS. Bipolar Hemiarthroplasty in patients presenting with displaced intracapsular femoral neck fractures- A comparision of cemented and uncemented prosthesis placement.Malaysian Orthopaedic Journal 2010, Vol. 4 No.1.
Koval KJ, Zuckerman JD. Current Concepts Review: Functional Recovery after Fracture of the Hip. J Bone Joint Surg Am 1994;76:751-766.
Bath, R. Problems in the treatment of femoral neck fractures. Proceedings of the Royal Society of Medicine 1975; 63:1120-1128.
Hoppenfeld S, DeBoer P: Surgical Exposures in Orthopaedics – The Anatomical Approach. 3rdedn. Philadelphia, Lippincott Williams and Wilkins 2002; 365-454.
Haidukewych GJ, Israel TA, Berry DJ.Long term survivorship of cemented bipolar hemiarthroplasty for fracture of the femoral neck.ClinOrthop 2002;403:118-126.
Parvizi J, Holiday AD, Ereth MH, Lewallen DG: The Frank Stinchfield Award. Sudden death during primary hip arthroplasty.ClinOrthopRelat Res. 1999 Dec; (369):39-48.
Hinchey and Day. Primary prosthetic replacement in fresh femoral neck Fractures. JBJS1960; 42B: 633-640.
Lance Ford E.M. Use of Moore self lockingVitallium prosthesis in acute fractures of the femoral neck. JBJS1965; 47A: 832-841 .
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