Abstract

HEMIARTHROPLASTY (CEMENTED THOMPSON) VERSUS CEMENTED TOTAL HIP REPLACEMENT IN DISPLACED (GARDEN,) FEMORAL NECK FRACTURES THE ELDERLY PATIENTS

*Dr. Ali H. Kadhim, F.I.C.M.S.ortho, Wael M. Khamess, M.S.C and Ass. Prof. Dr. Ahmed, FICMS

ABSTRACT

Background: Fracture of the neck femur common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, typically result from low- energy falls, and may be associated with osteoporosis. Women are at greater risk. Fractures of the femoral neck in the young are a very different injury and are treated in very different ways. Femoral neck fractures in young patients typically are the result of a high- energy mechanism, and associated injures are common. Most fractures of the femoral neck are intra-capsular. Basi-cervical femoral neck fractures are extracapsular femoral neck fractures and often are considered with intertrochanteric femoral fractures. It is anticipated that the total number hip fracture will exceed in 1914 between age (65-99) years. Aim of the Study: Assessment and comparison of the effectiveness of treatment in both the cemented Total hip arthroplasty and cemented Hemiarthroplasty (Thompson) for intracapsular femoral neck fractures Garden type 3 and 4 fractures in elderly patients 60- 80 years, they assessed for range of motion, superficial infection, pain score, blood loss, and dislocation rate in both groups. Patients and Methods: Prospective comparative study randomly selected of two groups of patients from (October 2015- October 2017 including the follow up) to compare the results of 42 patients admitted to the orthopedic unit in AL-Imamien AL- Kadhemien medical city hospital and they were complaint of intra-capsular femoral neck fracture Garden type 3 and 4 for elderly patients, they were operated upon during approximately 2-4 days In group 1 cemented Hemiarthroplasty done for 16 patients In group 2 cemented Total Hip Arthroplasty done for 26 patients Inclusion criteria are (Garden type 3 and 4 intra-capsular femoral neck fractures, Elderly patients 60-80 years, and Ambulatory patients) Exclusion criteria are (non-ambulatory patients, patients with severe comorbid conditions, mental retardation, and contra-indication to anesthesia) They were followed for 52 weeks for range of motion, severity of pain, dislocation rate, and peri-prosthetic fractures, and infection. Results: Patients number in this study were 42, female patients 24(57.1%), male patients 18(42.8%), the results showed that operative time was 60-90 min. for cemented THA group, and 45-55 min. for cemented Hemiarthroplasty group, blood loss was 400 ml for THA, and 250 ml for Hemiarthroplasty group, superficial infection occur in one patient (4%) for group 2 with THA, and one patient (6%) for group 1 with Hemi- arthroplasty, hip dislocation occur in one patient (3%) in those with THA, peri- prosthetic fracture occur in one patient (6%) in Hemiarthroplasty group, Modified Harris Hip score for group 1 (64-84), and for group 2 (80-88), hospital stay in both groups was approximately 5-7 days, mortality was one patient ( 6%) for group 1 with Hemiarthroplasty, and one patient (3%) for group 2 with THA. Conclusion: Although the number of patient used in this study was small for such prospective comparative study for comparison of the results of cemented THA and cemented Hemiarthroplasty for intra-capsular femoral neck fracture garden type 3 and 4 fracture had resulted in better functional outcome and less postoperative morbidity from those with Hemiarthroplasty, if we take into consideration the THA for those with ambulatory lifestyle and active patients for those with intra-articular displaced femoral neck fracture it will be better for long term follow up and less morbidity regarding the doubts of the benefits and risks of the THA surgery.

Keywords: THA, Hemiarthroplasty, intra-capsular displace femoral neck fracture, elderly.