Mid-Term Results of Total Hip Arthroplasty for Femoral Neck Nonunions in Long-Term Hemodialysis Patients

Abstract

Background. Performing primary arthroplasty in patient with renal osteodystrophy is associated with a number of difficulties due to low bone mineral density, which complicates the fixation of the endoprosthesis components, the presence of bone defects, and functional insufficiency of the gluteal muscles. The aim of the study evaluation of the mid-term results of primary total hip arthroplasty using cemented femoral and acetabular implants in hemodialysis patients with nonunions of the femoral neck. Materials and Methods. The authors conducted a study of 26 hemodialysis patients with pseudarthrosis of the femoral neck. The patients were divided into 3 groups: group I (12 patients) classification type A of the femoral neck nonunion, group II (10 patients) classification type B, group III (4 patients) of type C who underwent total hip arthroplasty. Results. The longest surgery duration was observed in patients of the III study group 121.2519.26 minutes. There were no statistically significant differences between the patients of the II and III study groups. The smallest rate of intraoperative blood loss was noted among patients of the 1st study group 440.83133.65 ml, the statistical significance of the differences was obtained both between the 1st and II, and between the I and III study groups, respectively. The smallest total number of complications after surgery was obtained in the 1st group 4 (8.33%). Revisions were performed in 8 (30.7%) patients among all three groups. There was a significant improvement on the Oxford hip score after 12 months (mean 29.8) and 24 months (mean 33.1) in all groups compared with preoperative results (mean 12.5). Twelve 12 months after surgery, the average value of the pain severity was reduced by 72.6% and amounted to 2.01. The risk of getting any orthopedic complication in cemented total hip arthroplasty of the classification type A of the pseudarthrosis is 2.5, with type B 3.4, with type C 5.7. Conclusion. The classification of femoral neck nonunions in hemodialysis patients allows to determine the tactics of surgical treatment. Cemented dual mobility cups are effective in patients with any type of femoral neck nonunions.