Hip hemiarthroplasty with modular neck: is it useful in residents’ learning curve? A prospective clinical trial

Abstract

Background: The number of femoral neck fractures (FNFs) worldwide will drastically increase in the next few decades, reaching 6.3 million by 2050. In the future, therefore, newly-qualified orthopaedic surgeons will treat this kind of injury more frequently than in past decades. This prospective observational study aims to assess whether hip hemiarthroplasty with modular neck, performed via the Hardinge approach, can be safely carried out by orthopaedic residents. Methods: Patients referred to our Level I trauma centre, between January 2016 and June 2017, with displaced intra-articular femoral fractures, were prospectively recruited. All patients underwent cemented modular bipolar hip hemiarthroplasty (Profemur Z, MicroPort Orthopedics Inc., Arlington, TN, USA) via the Hardinge approach, with the patient positioned in lateral decubitus. The surgical procedures were performed by the same surgical and anesthesiology team, under spinal anaesthesia. All patients underwent clinical and radiographic follow-up up to 24 months. Complications and re-operations were recorded. Clinical evaluation was performed using the Harris Hip Score (HHS), Osteoporosis Quality of Life Questionnaire QUALEFFO-41 and EuroQol-5D (EQ-5D) questionnaire. Anteroposterior pelvis x-rays were performed preoperatively, postoperatively and at 1, 3, 6, 12 and 24 months follow-up. Results: 118 patients met the inclusion criteria (male: 50; female: 68; mean age: 74.3 years; range 65–88 years) and were included in the current study. 67 patients out of 118 (56.8%) were managed by senior orthopaedic surgeons (Group A), whereas the remaining 51 patients out of 118 (43.2%) were treated by orthopaedic residents (Group B). Hip hemiarthroplasties performed by senior surgeons showed the prevalent use of straight (short or long) necks, whereas, in surgical procedures performed by residents, there was a significantly higher use of varus/valgus, anteverted or retroverted necks. The overall complication rate was significantly higher in Group-B patients, compared with Group-A patients ( p = 0.002). The length of hospital stay and the mean clinical scores at 24 months follow-up showed no significant differences. Conclusions: Hip hemiarthroplasty with modular neck can be safely employed during the learning curve of orthopaedic residents. Great efforts, however, should be made in future to improve residents’ training in the management of FNFs.

The health-related quality of life for hemiarthroplasty and total hip arthroplasty in the elderly: A meta-analysis

“…Solarino evaluated HRQoL in the elderly after 2 years, and the outcomes were not statistically significant, possibly owing to their telephone interview methods. The online telephone method perhaps neglected some important indicators, especially the patient's neurocognitive status motoring self-control and the ability to cooperate in physiotherapy treatment (1). The HRQoL scores of the observation group were dominant, and the results were statistically different.…”

“…to choose the optimal treatment and nursing measures. Modular surgical training residents can help them efficiently restore femoral offset and balance damaged soft tissue, reducing the incidence of postoperative abductor imbalance, hip pain, and acetabular wear (1). Its dislocation rate of THA is higher than hemiarthroplasty and internal fixation; however, there is still controversy about the dislocation rate of THA in elderly patients (25,26).…”

“…The evaluation of HRQoL in elderly patients with FNFs is associated with the outcome of THA and hemiarthroplasty operation. Younger orthopedic residents should gain more experience working with elderly patients with FNFs under supervision from senior orthopedic surgeons to acquire proficient skills for hip arthroplasty operations (1). Simultaneously, orthopedic nurses need continuing education about hip arthroplasty perioperative management.…”

“…The number of femoral neck fractures (FNFs) in the elderly population has been increasing drastically in the last few decades, and it will be 6.3 million by 2050 (1). The growing number of FNFs places a heavy burden on the health-related quality of life (HRQoL) of the global healthcare system (2).…”

“…As the number of elderly patients with FNFs increases with the global aging trend, this study aims to analyze the differences in HRQoL scores between posterior femoral neck surgery in elderly patients, aiming to provide a basis for selecting optimal surgically effective nursing interventions. In order to improve the mobility and satisfaction of patients with FNFs, we should make great efforts in perioperative training and management (1,3). In fact, the activity of daily living (ADL) and HRQoL, as well as mobility, pain, mortality, and neurocognitive function are more closely related to the surgical effect (4).…”