The value of modular hemiarthroplasty for unstable femoral neck fractures in elderly patients with coxarthrosis

BMC Musculoskeletal Disorders

Research Article

Clément M. L. Werner¹  Thorsten Jentzsch¹  Robert Döring¹  Max J. Scheyerer¹  William Pfäffli¹ 

[1] Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland;

关键词: Femoral neck fracture;    Bipolar hemiarthroplasty;    Osteoarthritis and coxarthrosis;    Double fond osteophyte (DFO);    Posterior wall sign (PWS);   

DOI  :  10.1186/s12891-016-1068-x

 received in 2015-10-15, accepted in 2016-05-11,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundDisplaced femoral neck fractures are common in the elderly patient. The surgical treatment options consist of a hemiarthroplasty (HA) or total hip arthroplasty (THA). However, the best surgical choice is still under debate. Bipolar HAs do not address preexisting arthritic changes of the acetabulum, which may lead to an unfavorable clinical outcome. The purpose of the present study was to conduct a long term follow-up analysis of the bipolar hemiarthroplasty with particular focus on the influence of preoperative acetabular osteoarthritis on the functional outcome.MethodsIn a retrospective observational study, the medical charts of consecutive patients treated with a bipolar hemiarthroplasty at a level one trauma center between 2004 and 2008 were reviewed before a final radiographic and clinical follow-up was performed. The outcome variables consisted of arthritic findings on the pre- and postoperative x-rays with particular focus on double fond osteophyte (DFO) and posterior wall sign (PWS) as well as the revision rate and functional scores.ResultsThis study included 102 patients with a mean age of 77.2 years. Most patients (75 %) had a Kellgren-Lawrence grading scale (KLGS) of 2 or 3. While only 30 % of patients had a DFO, most patients (73 %) had a PWS. The DFO correlated significantly with the KLGS, but no correlation was seen with the clinical outcome. Most patients showed a decreased offset by a mean of −7.8 mm. The mean modified Harris Hip Score (HHS) of 90.3 and the mean Merle d'Aubigné score of 10.8 correlated significantly. Despite a significant correlation of the HSS subcategory of pain and the preoperative KLGS, there was no statistical relationship between the arthritic x-ray measurements and the clinical outcome.ConclusionsIn the presented study population, the presence of radiographic acetabular osteoarthritis did not influence the clinical outcome after bipolar hemiarthroplasty for displaced femoral neck fractures.

【 授权许可】

CC BY   
© Döring et al. 2016