Hemiarthroplasty in the Treatment Fractures of the Femoral Neck

Abstract

Objective: To epidemiologically and clinically evaluate patients with displaced femoral neck fractures that were surgically treatment with cemented hip hemiarthroplasty. Methods: All patients with displaced femoral neck fractures (Garden III and IV) who underwent cemented hip hemiarthroplasty using a unipolar prosthesis (Thompson), by means of a posterolateral access between June 2005 and September 2008 were retrospectively evaluated. Results: Seventy patients were initially evaluated. Their mean age was 83.1 years. The patients were predominantly female (84.3%). Thirty-six patients were monitored as outpatients for periods ranging from 10 to 48 months (mean of 26.5 months). Fifteen patients were lost to follow-up. Nineteen patients died, and the mortality rate within the first year was 25.4%. Patients classified as ASA III had a mortality rate of 25.7% and ASA II patients, a rate of 12.1%. Two patients had symptomatic deep vein thrombosis; one patient had an operative wound infection; and none of the patients presented hip dislocation. Most of the patients did not experience pain. Twelve patients (33%) showed deterioration of their walking ability. Conclusion: There were no cases of hip dislocation. Patients classified as ASA III had a higher mortality rate than did patients with ASA I or II. There was a worsening of walking ability in 33% of the patients. No revision due to loosening or pain was needed for any patient. Thirty patients did not present any pain (83.3%), four presented moderate pain (11.1%) and two presented intense pain (5.5%).

Evaluation of the quality of life of patients undergoing hemiarthroplasty of the hip

“…These data are in agreement with several other studies in which there was predominance of female patients ranging from two to eight women per man. 1 , 10 , 12 , 20 These proportions of 1.4:1 were also found in a study carried out by Rocha et al 21 The difference found between the sexes is partly explained by the lower bone mineral density among females after the menopause. 22 …”

“…In a study conducted in the city of São Paulo, Ono et al 10 observed that the mean age of patients with fractures of the femoral neck who underwent partial hip arthroplasty was 83.1 years (range: 58–99). Like in the present study, Chikude et al 12 reported a mean age of 83 years in an analysis on patients with fractures of the femoral neck.…”

“…According to the scale of Sikorski and Barrington, 17 one patient (8.3%) presented intense pain and needed analgesics, while 91.6% either did not present pain or presented only moderate pain and did not need analgesics, which was confirmed through the SF-36 analysis (median of 74) and was also observed in other studies. 10 , 12 , 24 Low presence of pain is an important factor for good postoperative quality of life.…”

“…Physiologically elderly patients with unstable femoral neck fractures, who place low demand on these structures, are treated by means of hip hemiarthroplasty. 10 …”

Incidence and associated factors of elderly mortality following hip fracture in Brazil: a systematic review and meta-analysis

“…Additionally, one study had a longer follow-up period, with mortality at 24 and 48 months of 26% and 40% in patients without delirium and of 36% and 60% in patients with delirium during hospitalization after a fracture [31]. the predictors identified in this systematic review were grouped into 1) demographic factors: older age [14,17,[20][21][22][23]33,34] and male sex [14,17,33]; 2) clinical factors: comorbidities [15,16,18,20,23,31], high scoring in surgical risk assessment scores [13,17,21,24,33,34,38], functional status before fracture [17,31,33,36], and cognitive/neurological disorders [15,23,31,39]; and 3) intra-hospital factors: infections [15,21,23,26,30] and the time between hospitalization and surgery [20,21,34,35]. Only one study addressed prolonged hospitalization as a factor associated with mortality [16] (S1Table).…”