Primary total hip replacement in patients with displaced femoral neck fractures

Current Opinion in Orthopaedics

Volumn 19, Issue 1, 2008, Pages 28-32

  Iorio, Richard ^a,b  

^a LAHEY HOSPITAL AND MEDICAL CENTER   (United States)

^b BOSTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Complications; Cost effectiveness; Displaced femoral neck fracture; Total hip arthroplasty

Indexed keywords

AGE SPECIFIC CARE; ANALGESIA; ARTHROPLASTY; CONVALESCENCE; COST EFFECTIVENESS ANALYSIS; ELDERLY CARE; FEMUR NECK FRACTURE; HEALTH CARE COST; HUMAN; INDEPENDENCE; MORBIDITY; OSTEOSYNTHESIS; OUTCOME ASSESSMENT; PHYSICAL ACTIVITY; POSTOPERATIVE COMPLICATION; PREDICTION; PRIORITY JOURNAL; REVIEW; TOTAL HIP PROSTHESIS; TREATMENT OUTCOME;

EID: 37349090023     PISSN: 10419918     EISSN: None     Source Type: Journal    
DOI: 10.1097/BCO.0b013e3282f276cc     Document Type: Review

References (24)

1. Macaulay W, Pagnotto MR, Iorio R, et al. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg 2006; 14:287-293. The public health implications of the epidemic of hip fractures in the elderly will be staggering, with annual expenditures expected to exceed $15 billion annually in the United States. The decision to perform internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty or total hip replacement must be based on a patient's mental status, living arrangements, level of independence and activity, and bone and joint quality.
2. Bhandari M, Devereaux PJ, Tornetta P, et al. Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg 2005; 88A:2122-2130.
3. Iorio R, Schwartz B, Macaulay W, et al. Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons. J Arthroplasty 2006; 21:1124-1133. A survey was distributed to the American Association of Hip and Knee Surgeons' membership to evaluate surgical treatment preferences for displaced femoral neck fractures. Prefracture hip pain/osteoarthritis, poor bone quality, and fracture comminution were the main reasons why arthroplasty was chosen over reduction with internal fixation. Ambulatory status and dislocation risk were the most important factors for choosing hemiarthroplasty. Total hip arthroplasty was used by 88% of responders. Dislocation risk and ambulatory status were influential factors against performing total hip arthroplasty. Arthroplasty was the preferred surgical option for this group of surgeons.
4. Iorio R, Healy WL, Appleby D, et al. Displaced femoral neck fractures in the elderly: disposition and outcome after 3-6 year follow-up evaluation. J Arthroplasty 2004; 19:175-179.
5. Koval KJ, Zuckerman JD. Hip fractures: 1: overview and evaluation and treatment of femoral neck fractures. J Am Acad Orthop Surg 1994; 2:141-147.
6. Totterman A, Walloe A, Nordsletten L. Interpreting preoperative radiographs in displaced femoral neck fractures: observer variability in evaluating signs of poor outcome. Arch Orthop Trauma Surg 2007; 127:185-189. The decision to treat an intracapsular femoral neck fracture with either prosthesis or internal fixation has to be based on variables other than the preoperative radiographic signs seen on routine films.
7. Heetveld MT, Raasmakers ELFB, Van Ech-Smit BL, et al. Internal fixation for displaced fractures of the femoral neck: does bone density affect clinical outcome? J Bone Joint Surgery [Br] 2005; 87-B:367-373.
8. Parker, MJ, Raghavan R, Gurusamy K. Incidence of Fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res 2007. [Epubahead of print] This study showed that there was an increased risk for intracapsular hip fractures developing nonunion with older age and in females.
9. Bhandari M, Devereaux PT, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck: a meta-analysis. J Bone Joint Surg 2003; 85-A:1673-1681.
10. Bjorgul K, Reikeras O. Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: a prospective study of 683 patients treated with hemiarthroplasty or internal fixation. Acta Orthop 2006; 77:368-374. Reduction with internal fixation is inferior to hemiarthroplasty even when fractures with the best healing characteristics are chosen for reduction with internal fixation and poor prognostic fractures are chosen for hemiarthroplasty. No difference was seen in mortality at 1, 3 and 12 months.
11. Raia FJ, Chapman CB, Horera MF, et al. Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly? Clin Orthop Relat Res 2003; 414:259-265.
12. Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2289 patients. Acta Orthop 2006; 77:359-367. Primary arthroplasty should be used in most patients with displaced femoral neck fractures. The healthy, lucid individual, 70-80 years old, should be given a total hip arthroplasty. The older, impaired or institutionalized patient would benefit from hemiarthroplasty.
13. Ragmark C, Carlsson A, Johnell O, Sernbo I. Costs of internal fixation and arthroplasty for displaced femoral neck fractures: a randomized study of 68 patients. Acta Orthop Scand 2003; 74:293-298.
14. Iorio R, Healy WL, Lemos DW, et al. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop 2001; 383:229-242.
15. Blumfeldt R, Tornkvist H, Ponzer S, et al. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures: randomized controlled trial performed at four years. J Bone Joint Surg 2005; 87A:1680-1688.
16. Tidermark J, Ponzer S, Svensson O, et al. Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly: a randomized controlled trial. J Bone Joint Surg 2003; 85B:380-388.
17. Johnansson T, Bachrach-Lindstrom M, Aspenberg P, et al. The total cost of displaced femoral neck fracture: comparison of internal fixation and total hip replacement: a randomized study of 146 hips. Int Orthop (SICOT) 2006; 30:1-6.
18. Schmidt AH, Asnis SE, Haidukewich GJ, et al. Femoral neck. Fractures AAOS Instructional Course Lectures 2005; 54:417-445.
19. Baker RP, Squires B, Gargan MF, Bannister GD. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a randomized controlled trial. J Bone Joint Surg 2006; 88A:2583-2589. Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in a prospectively, randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.
20. Parvizi J, Erth MH, Lewellen GG. Thirty day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am 2004; 86A:1983-1987.
21. Kline GR, Parvizi J, Vegari DN, Rothman RH, Purtill JJ. Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem. J Arthroplasty 2006; 21:1134-1140. This study demonstrated that the use of an uncemented, proximally coated, collarless, tapered femoral component is a viable option for patients with acute hip fracture requiring total hip replacement. Despite poor bone quality, there was no compromise in stability or osseous integration of the component. Well trained, adult reconstruction surgeons performed total hip replacement in displaced femoral neck fracture patients with minimal complications.
22. Abboud JA, Patel RV, Booth RE, Nazarian DG. Outcomes of total hip arthroplasty are similar for patients with displaced femoral neck fractures and osteoarthritis. Clin Orthop Relat Res 2004; 421:151-154.
23. Blomfeldt R, Tornkvist H, Ponzer S, et al. Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a two-year follow-up of 84 patients. Acta Orthop 2006; 77:638-643. Secondary total hip replacement after failed internal fixation results in inferior hip function compared with a primary total hip replacement for a displaced femoral neck fracture in the active and lucid elderly patient. Moreover, patients with failed internal fixation had to undergo at least one reoperation and experienced a significant reduction in health-related quality of life before the salvage total hip replacement.
24. Healy WL, Iorio R. Total hip arthroplasty: optimal treatment for displaced femoral neck fractures in elderly patients. Clin Orthop Relat Res 2004; 429:43-48.