Complications following 250 cemented modular hip hemiarthroplasties

Abstract

Background and Aims: Hemiarthroplasty is a common method of treating displaced femoral neck fractures, especially among elderly non-active patients with frailty syndrome. Complications arising from the use of a modern, modular hemiendoprosthesis via a posterior approach have been poorly reported in this population. The aim of this study was to evaluate complications and mortality associated with the use of Lubinus sp II cemented, unipolar hemiarthroplasty prosthesis and posterior approach during a 9-year follow-up. Material and Methods: All patients (244) who received hemiarthroplasty due to an acute fracture of the femoral neck in Central Finland Hospital, Jyvaskyla, Finland, during 2007 and 2008 were included. Patient records were retrospectively reviewed for intraoperative and postoperative complications. Results and Conclusion: Women composed 70% (n = 171) of the study population. Mean age was 83 years for women and 80 years for men. A total of 31 (12%) complications were found in 30 patients. These were 12 dislocations (5% of all patients), 5 (2%) periprosthetic fractures, 2 (0.8%) superficial and 5 (2%) deep infections, 1 (0.4%) protrusion of the prosthesis, 2 (0.8%) intraoperative fractures, and 2 (0.8%) partial sciatic nerve palsies. Conversion to total hip replacement was performed in 9 cases (4%) and a reoperation was required in 15 (6%) cases. Mortality rate at 9 years was 78% (95% confidence interval = 72%–83%). The overall rate of complications was acceptable although mortality was high in this comorbid patient population. The need for conversion to total hip arthroplasty and reoperation is low.

Hip hemiarthroplasty with modular neck: is it useful in residents’ learning curve? A prospective clinical trial

“…However, Group B patients showed significantly higher postoperative transfusion rates ( p = 0.0033) and overall early complication rates ( p = 0.002), compared to Group A patients. The complications observed in our study are consistent with findings reported by Ekman et al, 14 in a prospective case series including 250 patients with acute intracapsular displaced FNFs managed with cemented hip hemiarthroplasty. On the other hand, in a recent retrospective study comparing residents and senior surgeon-performed minimally invasive THA, Weber et al 29 reported no significantly different complication rates between groups.…”

“…Displaced intracapsular FNFs are commonly managed with hip hemiarthroplasty, especially in elderly patients with frailty syndrome. [14][15][16] To optimise postoperative hip biomechanics, the hip centre of rotation should be reproduced as accurately as possible. 17,18 Therefore, accurate preoperative planning performed on anteroposterior pelvis x-rays is mandatory.…”

“…22 In this context, a modular hip hemiarthroplasty could correctly restore femoral offset and properly balance soft tissue, thus reducing postoperative abductor muscular imbalances, and pain and wear rates. 14,21,23 This prospective observational study aims to: (1) assess the clinical outcome of hip hemiarthroplasty with a modular neck performed by orthopaedic residents, compared with senior surgeons; and (2) to evaluate whether this type of hip hemiarthroplasty can be safely used by surgeons in training.…”

“…In this context, a modular hip hemiarthroplasty could correctly restore femoral offset and properly balance soft tissue, thus reducing postoperative abductor muscular imbalances, and pain and wear rates. 14,21,23…”

Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: a comparison with an age-matched femoral neck fracture cohort and general population

“…We assumed a constantly decreasing proportion of patients across the annual data points. The complications and survival of patients operated on with cemented hemiendoprosthesis due to femoral neck fracture in our hospital between 2007 and 2008 have been reported by Ekman et al [14]. This cohort was used as reference.…”