Hemiarthroplasty for Displaced Intracapsular Femoral Neck Fractures

Abstract

Hemiarthroplasty still plays an irreplaceable role in the therapeutic algorithm of the treatment of displaced intracapsular femoral neck fractures. In elderly patients (over 80 years old), in a poorer general condition (ASA III and more), with low life activity, we prefer a cemented monoblock. In cases of biologically younger patients where the general or local condition does not allow performance of a total arthroplasty, a modular hemiarthroplasty with a replaceable head is indicated as it facilitates an easy conversion to total prosthesis in cases of erosion of the acetabulum. Of vital importance in all cases is the correct surgical technique, observing the relation between the head centre and the apex of the greater trochanter, i. e., the head centre has to be 1 to 2 mm below the apex of the greater trochanter. Of no less importance is the correct anteversion and suture of the capsule as a means of prevention of postoperative dislocation.

intracapsular femoral neck fractures - hemiarthroplasty - proximal femur fractures

References

• 1 Bartoníček J, Bartoš M. Operační přístupy při aloplastice kyčelního kloubu (Anatomické poznámky). [Surgical approaches in total hip arthroplasty - anatomical notes].  Acta Chir Orthop Traum Čech. 1986;  53 405-415
• 2 Bhandari M, Devereaux P J, Swiontkowski M F, Tornetta P, Obremskey W, Koval J K, Nork S, Sprague S, Schemitsch E H, Guyatt G H. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis.  J Bone Joint Surg [Am]. 2003;  85 1673-1681
• 3 Cornell C N, Levine D, O'Dohert J, Lyden J. Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly.  Clin Orthop. 1998;  348 67-71
• 4 Degreif J, Müller L P, Runkel M, Blum J, Willmann G. Long-term results after operative treatment of femoral neck fractures with ceramic head prosthesis.  Orthopaedics. 2001;  24 129-133
• 5 Devas M, Hinves B. Prevention of acetabular erosion after hemiarthroplasty for fractured neck of femur.  J Bone Joint Surg [Br]. 1983;  65 548-551
• 6 Džupa V, Bartoníček J, Skála-Rosenbaum J. Rozbor pacientů léčených v roce 1997 pro zlomeninu proximálního femuru - základní analýza souboru. [Analysis of patients treated in 1997 for proximal femur fractures - basic analysis of the group].  Acta Chir Orthop Traum Čech. 1999;  66 235-239
• 7 Džupa V, Bartoníček J, Skála-Rosenbaum J, Príkazský V. Úmrtí pacientů se zlomeninou proximálního femuru v průběhu prvního roku po úrazu. [Mortality of patients with proximal femur fractures during the first year after the injury].  Acta Chir Orthop Traum Čech. 2002;  69 39-44
• 8 Beghard J S, Amstutz H C, Zinar D M, Dorey F J. A Comparison of total hip arthroplasty for treatment of acute fracture of the femoral neck.  Clin Orthop. 1992;  282 123-131
• 9 Gilbert M S, Capozzi J. Unipolar or bipolar prosthesis for the displaced intracapsular hip fractures.  Clin Orthop. 1998;  353 81-85
• 10 Huggler A H. Die Alloarthroplastik des Hüftgelenkes mit Femurschaft- und Totalendoprothesen. Thieme, Stuttgart 1968; 102
• 11 Khan R JK, MacDowell A, Crossman P, Datta A, Jallali N, Arch B N, Keene G S. Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures.  Int Orthop (SICOT). 2002;  26 229-232
• 12 Kofoed H, Kofoed J. Moore prosthesis in the treatment of fresh femoral neck fractures.  Injury. 1983;  14 531-540
• 13 Kusaba A, Kuroki Y. Wear of bipolar prosthesis.  J Arthroplasty. 1998;  13 668-673
• 14 Ledinger W, Hoffmann G, Meierhofer J N, Wölfel R. Verminderung von schweren kardialen Komplikationen während der Implantation von zementierten Hüfttotalendoprothesen bei Oberschenkelhalsfrakturen.  Unfallchirurg. 2002;  105 675-679
• 15 Lu-Yao G L, Keller R B, Littenberg B, Wennberg J E. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports.  J Bone Joint Surg [Am]. 1994;  76 15-25
• 16 Martínez A A, Herrera A, Cuenca J, Panisello J J, Tabuenca A. Comparison of two different posterior approachs for hemiarthroplasty of the hip.  Arch Orthop Trauma Surg. 2002;  122 51-52
• 17 Müller M E, Allgöwer M, Willenegger H. Technique of internal fixation of fractures. Springer, Berlin 1965; 272
• 18 Müller L P, Degreif J, Basten K, Zöphel O, Rommens P M. Is there still an indication for operative treatment of femoral neck fractures with a ceramic hemiprosthesis?.  Arch Orthop Trauma Surg. 2000;  120 299-303
• 19 Müller L P, Degreif J, Hely H, Mehler D, Otto M, Rommens P M. Friction in hip hemiendoprosthesis. Review of literature and own model using cadaveric acetabula.  Hip Inter. 2002;  12 126-134
• 20 Ong B C, Maurer S G, Aharonoff G B, Zuckerman J D, Koval K J. Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up.  J Orthop Trauma. 2002;  16 317-322
• 21 Pajarinen J, Savolainen V, Tulikoura I, Lindahl J, Hirvensalo E. Factors predisposing to dislocation of the Thompson hemiarthroplasty.  Acta Orthop Scand. 2003;  74 45-48
• 22 Parker M J. The management of intracapsular fractures of the proximal femur.  J Bone Joint Surg [Br]. 2000;  82 937-941
• 23 Paton R W, Hirst P. Hemiarthroplasty of the hip and dislocation.  Injury. 1989;  20 167-169
• 24 Phillips T W. Thompson hemiarthroplasty and acetabular erosion.  J Bone Joint Surg [Am]. 1989;  71 913-917
• 25 Rogmark C, Carlsson A, Johnell O, Sernbo I. Costs of internal fixation and arthroplasty for displaced femoral neck fracture.  Acta Orthop Scand. 2003;  74 293-298
• 26 Soreide O, Lillestol J, Alho A, Hvidsten K. Acetabular protrusion following endoprosthetic hip surgery: a multifactorial study.  Acta Orthop Scand. 1980;  51 943-948
• 27 Sosna A, Čech O. Zadní operační přístup při aplikaci cervikokapitální endoprotézy. [Posterior surgical approach in the application of hemiarthroplasty].  Acta Chir Orthop Traum Čech. 1973;  40 537-543