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Lateral Apporach to Cementless Total Hip Arthroplasty for Femoral Neck Fractures in Patients 70 Years of Age and Older

February 19, 2016

Contributors: Myung-Sik Park, MD; Sun Jung Yoon, MD, PhD; Seongyup Jeong; Seung Min Choi Jr, MD; Seung-Ho Kim

INTRODUCTION: The minimally invasive anterolateral approach for total hip arthropalasty (THA) is reasonably safe and reduction of dislocation rate to prevent revision surgery. The aim of this study was to evaluate the results of lateral approach of THA as treatment for femoral neck fractures in older patients. A retrospective study was conducted on elderly patients with femoral neck fractuers treated with THA through a lateral approach between March 2009 and April 2014. Eighty-two patients included our cohort. Clinical improvement was assessed using a visual analog scale (VAS), Harris Hip Score (HSS), and Clinincial Frailty Scale (CFS). Acetabular and femoral components were assessed on anteroposterior and lateral radiographic views. The mean VAS, HSS, and CFS improved after THA. There was one dislocation three months postoperatively treated with just closed reduction, two superficial infections, and one undisplaced intraoperative periprosthetic fracture. Motality rate was 1.2% (1/82) in early postoperative period. No cases of revision were reported. The lateral approach of cementless THA is a valuable treatment option for the active elderly femoral neck fracture population.

BACKGROUND: Femoral neck fractures in the elderly patients are frequent and life threatening. Therefore, appropriate treatment for femoral neck fractures is needed. To evaluate the outcomes of cementless total hip arthroplasty and anterolateral approach after acute femoral neck fracture in elderly patients, we reviewed short-term outcome of 82 patients.

PATIENTS AND METHODS: Over a five-year period, we retrospectively reviewed 82 patients who underwent cementless total hip arthroplasty with anterolateral approach. Patients aged over 70 years were admitted with a femoral neck fracture. The study group included47 women and 36 men with a mean age of 78 years. The mean follow up was 9.4 months (range, 3.0-55.2 months). The modified Harris hip score and American Society of Anesthesiologists classification used to assess patient's pre-injury functional and physical status respectively.

RESULTS: A 97-year-old male patient with pneumonia expired in the intensive care unit seven days postoperatively and other two patients aged 76 and 77 died due to lung cancer and renal failure with acute kidney injury respectively in two years after total hip arthroplasty. Therefore, three deaths occurred. One died during the same admission. One death had occurred by one year and one death by two years. Preoperative mean Clinical frailty scale and modified Harris hip score were 2.68 and 80.6 and postoperative mean clinical frailty scale and modified Harris hip score were 2.97 and 80.3 respectively. Postoperative periprostheic fracture was occurred in one patient and he has a revision surgery. Postoperative dislocation were not occurred.

CONCLUSION: This study demonstrates that cementless total hip arthroplasty with anterolateral approach for elderly patients can be performed safely without any dislocation and allows the majority of patients to return to independent living and has a low complication rate compared with other approaches without increasing mortality.

Results for "Surgical Exposure"

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