Is Taking an Antiplatelet Agent a Contraindication for Early Surgery in Displaced Femur Neck Fracture? / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate whether we have to stop the antiplatelet agents prior to hemiarthroplasty surgery in patients with displaced femur neck fractures to reduce postoperative complications. MATERIALS AND METHODS: We enrolled forty-three patients with displaced femur neck fractures who were treated by bipolar hemiarthroplasty and were taking antiplatelet agents. Group I included 21 patients who discontinued antiplatelet agents and had delayed operations at an average 5.7 days and group II included 22 patients who had had early operations within 24 hours without stopping the antiplatelet agents. We compared the pre- and postoperative levels of hemoglobin, the volume of postoperative transfusion requirement and complications. Student's t-test and chi-square test were used for statistical analysis. RESULTS: The average differences between preoperative and postoperative hemoglobin was 1.4+/-0.4 g/dL decrease in group I and 2.1+/-0.5 g/dL decrease in group II (P<0.001). Patients who received a blood transfusion were 11 in group I and 13 in group II (P=0.66). Total number of blood transfusion was 13 pints in group I and 18 pints in group II (P=0.23). Pneumonia occurred in one patient in each group. Four pressure sores and three diaper rashes were developed in group I. But there were no patients requiring massive transfusion, reoperation due to hematoma and infection in each group. CONCLUSION: Although continuous taking of antiplatelet agents in displaced femur neck fracture is associated with an increased risk of postoperative bleeding, taking an antiplatelet agent itself is not a contraindication of early surgery.

Hip Arthroplasty Using Cementless Modular Femoral Stem for Displaced Femoral Neck Fracture in Patients More than 70 Years Old

Purpose: To evaluate the clinical and radiological results of hip arthroplasty using a cementless modular femoral stem in patients older than 70 years with a femoral neck fracture. Materials and Methods: From January 2002 to May 2005, 67 hip arthroplasty procedures (66 patients) using a cementless modular femoral stem for displaced femoral neck fractures in patients older than 70 years of age were evaluated. All the patients were followed up for more than 2 years. The mean age at surgery was 77 (70~92) years. There were 22 men and 44 women. The mean follow up period was 31 months (24~41). The clinical evaluation was performed by examining the perioperative Activities of Daily Living (ADL) and postoperative complications. The radiological evaluation for femoral stem loosening and osteolysis was performed using the serial postoperative radiographs. The radiological evaluation for leg length discrepancies was performed using the immediate postoperative radiograph. Results: In preoperative ADL, 31 cases (46%) were in grade 1, 21 (31.5%) in grade 2, 14 (21%) in grade 3, 1 (1.5%) in grade 4 and none in grade 5. A review of the postoperative ADL revealed 25 cases (37.5%) in grade 1, 18 (27%) in grade 2, 21 (31%) in grade 3, 3(4.5%) in grade 4 and none in grade 5. Postoperative restoration of the ADL was observed in 48 cases (71.5%). There were no significant complications. Radiographically, all cases showed stable bony fixation of the femoral stem with the exception of 1 case, who showed subsidence and a pedestal reaction. Postoperative leg length discrepancy was observed in 5 cases (7.5%) but was <1 cm in all cases. Conclusion: In elderly patients older than 70 years of age with a displaced femoral neck fracture, cementless hip arthroplasty using a modular femoral stem provides good initial stability and subsequent secure bony fixation with minimal complications.