Functional outcome of modified Pauwels' intertrochanteric osteotomy and total hip arthroplasty in femoral neck fractures in elderly patients

Abstract

Background:A high union rate (75%-100%) with a lower incidence of avascular necrosis (8%-9.3%) has been reported with intertrochanteric osteotomy in femoral neck fractures in elderly whereas arthroplasty eliminates the incidence of nonunion and avascular necrosis We present a series of femoral neck fracture in elderly treated with modified Pauwels’ intertrochanteric osteotomy and total hip arthroplasty for their functional outcome.Materials and Methods:29 elderly patients of 60 years and above sustaining fresh subcapital femoral neck fracture underwent total hip arthroplasty (group I, n=14) and modified Pauwels’ intertrochanteric osteotomy (group II, n=15). Functions were evaluated using modified Harris hip score, d'Aubigne and postel criteria and SF-36 score at 6, 12, 52 and 100 weeks.Results:The fracture union in group II was achieved in 14 (93.3%) patients at the fracture site at an average of 15 weeks and osteotomy united in all patients. Avascular necrosis of the femoral head was observed in one patient (6.7%). Average operative time was 88.9 and 65.6 minutes in group I and II, respectively (P value = 0.00001). An average of 0.8 and 0.2 unit blood was transfused in patients in group I and II, respectively (P value = 0.001). Average time of full weight bearing was 6.1 weeks and 11.6 weeks in group I and group II, respectively. At 100 weeks 71.4% (n = 10) patients in group I and 80% (n = 12) patients in group II showed good to excellent results on the basis of modified Harris hip score. 71.4% (n = 10) patients in group I and 66.6% (n = 10) patients in group II showed good to excellent results on the basis of d'Aubigne criteria. Average SF-36 score was 17.2% in group I and 17.6% in group II. Revision osteotomy was performed in one patient in group II because of implant cut through. Another patient in group II underwent THR because of painful hip. One patient in group I presented with dislocation after 3 weeks of surgery.Conclusion:Functional results of total hip arthroplasty and intertrochanteric osteotomy are comparable and the valgus intertrochanteric osteotomy with osteosynthesis in subcapital femoral neck fractures in elderly patients of sixty years and above may be considered as an option.

Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate

“…Total hip arthroplasty (THA) is a “substituting” procedure and reserved for the elderly patient. Even in the elderly with femoral neck fracture Magu et al 10 . have suggested osteotomy provides comparable results with THA.…”

“…Even in the elderly with femoral neck fracture Magu et al. 10 have suggested osteotomy provides comparable results with THA.…”

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

“…Sinno 2010 [86] ✓ (A) Bansal 2019a [50] ✓ (A) Jin 2021 [67] ✓ (A) Soreide 1979 [87] − Magu 2008 [75] ✓ (A) Mansukhani 2017 [102] ✕ Table 3. Counts of reported surgical-related barriers and facilitators with a positive association (), negative association (), or absence of an association (-), with weight bearing after hip fracture surgery.…”

“…For comparison of internal fixation and arthroplasty, most studies reported arthroplasty (hemiarthroplasty) [50,51,53,55,59-61, 64, 67, 86, 99, 100], femoral head replacement [98], and total hip replacement [75]) as a facilitator of weight bearing compared with internal fixation. In contrast, one study reported PFN as a facilitator of weight bearing when compared with hemiarthroplasty [74].…”