Background:Cemented hip arthroplasty is an established treatment for femoral neck fracture in the mobile elderly. Cement pressurization raises intramedullary pressure and may lead to fat embolization, resulting in fatal bone cement implantation syndrome, particularly in patients with multiple comorbidities. The cementless stem technique may reduce this mortality risk but it is technically demanding and needs precise planning and execution. We report the perioperative mortality and morbidity of cementless bipolar hemiarthroplasty in a series of mobile elderly patients (age >70 years) with femoral neck fractures.Materials and Methods:Twenty-nine elderly patients with mean age of 83 years (range:71-102 years) with femoral neck fractures (23 neck of femur and 6 intertrochanteric) were operated over a 2-year period (Nov 2005–Oct 2007). All were treated with cementless bipolar hemiarthroplasty. Clinical and radiological follow-up was done at 3 months, 6 months, 12 months, and then yearly.Results:The average follow-up was 36 months (range 26-49 months). The average duration of surgery and blood loss was 28 min from skin to skin (range, 20–50 min) and 260 ml (range, 95–535 ml), respectively. Average blood transfusion was 1.4 units (range, 0 to 4 units) Mean duration of hospital stay was 11.9 days (7–26 days). We had no perioperative mortality or serious morbidity.We lost two patients to follow-up after 12 months, while three others died due to medical conditions (10–16 months post surgery). Twenty-four patients were followed to final follow-up (average 36 months; range: 26–49 months). All were ambulatory and had painless hips; the mean Harris hip score was 85 (range: 69–96).Conclusion:Cementless bipolar hemiarthroplasty for femoral neck fractures in the very elderly permits early return to premorbid life and is not associated with any untoward cardiac event in the perioperative period. It can be considered a treatment option in this select group.
Intracapsular femoral neck fracture is a common injury in elderly person. The primary goal of treatment is to return the patient to him or her pre-fracture functional status. The surgical treatment is the treatment of choice, lip replacement arthroplasty (hemi or total) is a viable treatment option. Thirty elderly patients (age 50-80 years) with a displaced intracapsular femoral neck fracture were under treatment over a five year period (January 2010 to December 2015). All of them underwent hemiarthroplasty either unipolar or bipolar, after appropriate medical and anesthetic fitness. The patients were reevaluated at six weeks, at six months postoperative interval and assessed using Harris hip score (HHS) and visual analogue scale (vas) for evaluation of outcome. The mean age of patients was 64.5 years and male female ratio was 43.3% - 56.7%. The mean HHS score was 85.3 by the end of the 6 months. The mean score on VAS scale was 60mm (moderate) at 2 weeks, 40mm (mild) at six weeks and 4mm (mu) at 6 months follow up visit. No significant complications were observed except hip pain. No patients needed revision surgery. Herniarthroplasty is the treatment of choice in elderly population with displaced femoral neck fracture (Garden type III or IV); provides early ambulation, good functional outcome, pain free joint with minimal complications without the need for revision surgery. CBMJ 2015 July: Vol. 04 No. 02 P: 8-12
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