Hip resection arthroplasty for acute femoral neck fractures in the non-ambulator

Abstract

Objectives: Hemiarthroplasty (HA) is the current standard of care for displaced femoral neck fractures (FNFs) in non-ambulators. Despite excellent outcomes, arthroplasty-specific risks remain, including dislocation, implant failure, periprosthetic fracture and infection, and fat embolization syndrome. To eliminate the possibility of these complications, should non-ambulatory patients with acute, native hip FNFs be treated with simple hip resection arthroplasty (HRA) instead of HA? Design: Retrospective case series. Setting: Large, urban level-1 trauma center. Patients/Participants: Five non-ambulatory patients (6 hips) with acute, native hip FNF underwent femoral head and neck resection. Also, the most recent 10 FNFs treated with HA were also identified for comparison purposes. Intervention: HRA was performed via a Smith-Peterson approach with an oscillating saw or osteotome to complete the fracture or perform a fresh neck cut. Main Outcome Measurements: Outcomes included postoperative vs preoperative VAS pain scores and narcotics usage, and return to baseline functional status (sit up in bed or a chair postoperatively). Procedure time for HRA was compared with the 10 most recent patients with FNF treated with HA. Results: HRA resulted in decreased postoperative vs preoperative VAS pain scores (7.7 vs 3.3, P = .002), and decreased operative times (59.2 minutes for HRA, 111.8 minutes for HA, P < .001). All HRA patients had immediate return of baseline function. Conclusion: HRA offers shorter operative times when compared with HA, decreased postoperative VAS pain scores, and immediate return to functional baseline status without possibility of arthroplasty-specific complications. HRA may be an acceptable treatment option for FNFs in the non-ambulator. Level of evidence: IV

Girdlestone resection arthroplasty for femoral neck fractures has poorer outcomes than hemiarthroplasty in frail patients with increased risk for arthroplasty-related complications: a retrospective case study of 21 patients

“…In a group of 14 patients treated with GRA after neglected FNF, none of the 14 patients were taking regular pain medication and all could walk short distances, some with and some without walking aids at FU [ 4 ]. In 6 non-ambulatory patients receiving GRA for FNF, reduced pain scores pre- vs. postoperatively as well as restored baseline function were found [ 5 ]. In 36 patients treated with GRA mostly as a secondary procedure for a hip fracture, the mobility status for all patients had deteriorated compared with that before the fracture and 63% were immobile and unable to walk even with aids and assistance [ 3 ].…”

“…GRA used as the primary treatment of patients with FNF is a rather rarely mentioned treatment option and is only described in a few small studies [3][4][5].…”