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Resumen: Introducción: La hemiartroplastía bipolar (HA) es una alternativa para el tratamiento de las fracturas desplazadas de cuello femoral en pacientes de edad avanzada con baja demanda funcional y comorbilidades asociadas. El objetivo fue describir la funcionalidad en pacientes mayores de 65 años con fracturas intracapsulares de cadera tratados con HA. Material y métodos: Revisión retrospectiva de pacientes mayores de 65 años entre Enero de 2012 y Mayo de 2017. Se evaluó con la escala de Harris (HHS) y Oxford a los seis meses y al año posterior a la cirugía. Se documentaron las complicaciones y la mortalidad durante el primer año postquirúrgico. Resultados: 48 casos (12 hombres; 36 mujeres), edad promedio de 80.8 ± 7.7 años. Comorbilidades más frecuentes: hipertensión arterial (77.1%), osteoporosis (37.5%), diabetes (33.3%) e hipotiroidismo (29.2%). El porcentaje de complicaciones postoperatorias asociadas fue de 8.3% (cuatro casos). La mediana del HHS a los seis y 12 meses fue de: 90.5 (DE: 77.5-96.0) y 96 (DE: 92-98), respectivamente. La escala de Oxford fue de 45.5 (DE: 38.5-48.0) a los seis meses y de 47.0 (DE: 43.5-48) al año postoperatorio. El 4.2% (dos casos) fallecieron durante el primer año postquirúrgico y ninguno estuvo asociado al procedimiento. Discusión: La HA ofrece buenos resultados funcionales en pacientes mayores de 65 años, con una tasa baja de complicaciones. En nuestra serie y en el corto plazo no se observó mortalidad asociada al procedimiento quirúrgico.
Abstract: Introduction: Bipolar hemiarthroplasty is an alternative for the treatment of displaced femoral neck fractures in elderly patients with low functional demand and associated comorbidities. The goal was to describe functionality in patients over 65 years of age with intracapsular fractures of the hip. Material and methods: Retrospective review of patients over 65 years of age between January 2012 and May 2017. It was evaluated with the Harris Hip Score (HHS) and Oxford scale at six months and the year after surgery. Complications and mortality were documented during the first post-surgical year. Results: 48 cases (12 men; 36 women), average age of 80.8 ± 7.7 years. Most common diseases: high blood pressure (77.1%), osteoporosis (37.5%), diabetes (33.3%) hypothyroidism (29.2%). The percentage of associated postoperative complications was 8.3% (four cases). The median HHS at six and 12 months was: 90.5 (DE: 77.5-96.0) and 96 (DE: 92-98), respectively. The Oxford scale was 45.5 (DE: 38.5-48.0) at six months and 47.0 (DE: 43.5-48.0) per postoperative year. 4.2% (two cases) died during the first post-surgical year and none were associated with the procedure. Discussion: HA provides good functional outcomes in patients over 65 years of age, with a low rate of complications. No mortality associated with the surgical procedure was observed in our series and in the short term.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Fraturas do Colo Femoral , Hemiartroplastia/métodos , Fraturas do Quadril/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Background: The fracture neck of femur is one of the commonest fractures in elderly. With life expectancy increasing with each decade, our society is becoming increasingly an active geriatric society, with significant number of hospitalized and nursing home patients with femoral neck fractures and their sequelae. Selection of the type of prosthesis is very important in hemiarthroplasty as different types are available. Since the last two decades, bipolar replacements of the femoral head have gained popularity for treating femoral neck fractures. Aim & Objective – To assess and analyse the results of management of fracture neck of femur with bipolar hemiarthroplasty. Methods: After obtaining ethical committee approval and informed consent from patient, detailed history of patient was taken with particular emphasize on mode of injury and associated medical illness. On the day of surgery , under anesthesia and patient in lateral position, following strict aseptic precautions, either lateral (Hardinge) or Posterior (Southern-Moore) approach incision made, tissues dissected, joint capsule incised and femoral head extracted with the help of cork screw. Then the appropriate size of prosthesis with cement was seated. The wound was closed meticulously in layers. Knee flexion, isotonic quadriceps exercises were started from 1st or 2nd post op day and patients were mobilized with walker as tolerated. Patients are educated on different position of legs that should be avoided in the postoperative period. Follow up was done after 6 weeks and for further at 3 months, 6 months & 1 year .Result: In our series, at the end of final follow-up, there was no evidence of loosening, radiolucent zones, distal migration or subsidence of prosthesis. The patient with Periprosthetic fracture healed and is weight bearing fully with no pain. One patient who had moderate heterotopic ossification had still has some mild pain occasionally. Conclusion: we conclude that bipolar hemiarthroplasty produces good functional outcomes with minimal complications for displaced intracapsular femoral neck fractures and has several advantages; these results are comparable to the other studies.
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Introduction: With various options available like unipolar, bipolar hemiarthroplasty or total hip arthroplasty, it would be wise to choose hemiarthroplasty as it is a procedure with a short operating time with lesser morbidity for elderly patients with displaced intra-capsular neck femur fractures.This study is aimed primarily at comparing the functional results obtained after a hemiarthroplasty using Austin Moore’s prosthesis and cemented modular bipolar prosthesis and studying the associated complications in these cases. Materials and methods: A total of 68 elderly patients who had fulfilled the inclusion criteria were enrolled for this prospective, randomized, comparative study between 2 groups labeled as group A (Austin Moore’s prosthesis) and group B (bipolar prosthesis). Out of total 68 patients, 4 patients from group A were lost to follow up and 2 patients from group A died. Similar surgical approach, perioperative and follow up protocol were followed for both groups. Functional outcome measured using Harris hip score. Statistical comparison of functional outcome and clinic-radiological assessment were done for each patient at 3 months, 6 months and 1 year. Results: The average age of the patient was 73.0 years in Group A and 76.0 years in Group B. After the end of 12 months, mean score was 86.50 in Group A which was comparable to 89.56 in Group B subjects. After duration of 12 months 94.1% of the subjects in Group B had excellent to good Balan B, Shetty SK, Shetty A, Chandran R, Mathias LJ. Displaced intra-capsular neck femur fractures in elderly: Austin Moore’s prosthesis or Cemented Modular Bipolar Prosthesis. IAIM, 2016; 3(7): 287-296. Page 288 treatment which was more compared to 78.6% of the cases in Group A, but the difference was not significant. Incidence of superficial infection and dislocation of prosthesis was equal in both groups. Complications rate were also comparable between the two groups. Conclusion: Primary Hemiarthroplasty is an efficient way for treatment of displaced intra-capsular neck femur fractures in the elderly patients more than or equal to 60 years. Percentage of patients achieving excellent to good outcome at the end of 1 year are more in group B. Long term studies are needed to compare complications with hemiarthroplasty using 2 different prostheses.
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We report a rare case of a complete disassembly of the inner head from the bipolar cup without polyethylene wear and locking system failure. An 84-year-old man who had a femur neck fracture of the right hip underwent a replacement of the bipolar prosthesis 4 months ago. He fell down from a height of a chair and felt a sudden sharp pain in the right hip. Roentgenograms revealed that the inner head was dislocated from the outer cup; subsequently, a revision surgery was carried out. When the outer head was removed from the acetabulum, the bearing insert and locking ring were not deformed. Because there was no evidence of loosening of the femoral stem, identicallysized bipolar cup and metal head replacement was performed. At a 6 months follow-up, he had mild hip pain but had returned fully to daily living.