total hip replacement in subcapital fracture neck of femur in elderly patients assistant professor...
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Total hip replacement in subcapital fracture neck of femur in elderly patients
Assistant Professor Dr Kapil Mani KCOrthopedic and Joint Replacement SurgeonCivil Service Hospital, Kathmandu, Nepal
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Nepal
Kathmandu
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Mount Everest
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Introduction
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• Management of subcapital fracture neck of femur
•Matter of Controversy and Challenging
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Different Surgical Options
Internal Fixation
Hemiarthroplasty
Bipolar Arthroplasty
Total Hip Arthroplasty
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•Total Hip Replacement
Definitive advantage
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Materials and Methods
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•Prospective analytical study
•From 2010 to 2014
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•Twenty Patients
•Managed by both uncemented and cemented arthroplasty
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•Minimum one year follow up
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Results
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Sex
MaleFemale
12 (60%)
8 (40%)
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Side
RightLeft
13 (65%)
7 (35%)
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Prosthesis
CementedUncemented11 (55%) 9 (45%)
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Three Month One Year0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Mortality
0
1 (5%)
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UTI Chest Infection CVA0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
Morbidity
Morbidity
2 (10%) 2 (10%)
1 (5%)
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Superficial Deep0
0.20.40.60.8
11.21.41.61.8
2
Infection
Infection
2 (10%)
0
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Harris Hip Score
ExcellentGoodFairPoor
8 (40%)
9 (45%)
3 (15%) 0%
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Discussion
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• Incidence of hip fracture: increasing
• In the past standard treatment assumed to be internal fixation
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• Most studies based on complications and reoperation rates ignoring the functions of hip
• Comparision of THR, hemiarthroplasty and Internal Fixation. ( 13 year follow up )
( Skinner et al )
• Harris Hip Score: Total 85% of cases excellent and good results (In our study)
• Recent Study regarding Internal Fixation.
( Tidermark J et al )
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Absolute indications: • Pre-existing arthritis of hip• paget’s disease• Renal osteodystrophy• Severe osteoporosis• Life expectancy more than 5 years• Those with high activity expectations • After failed interal fixation
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• The current overall mortality in elderly patients one year after hip fracture ranges from 14% to 36%.
(Koval KJ et al, Scott J et al)
• One year mortality in our study is 5%
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• High incidence of post-operative dislocation in the past.
(Gregory RJ et al)• Dislocation rate in our study is nil.
• Revision Rate is below 5% in 10 years.
(Gebhard JS et al)• Revision rate is nil in our study
• Cost benefit analysis (George M et al)
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Sub-capital fracture neck of femur in 73 years old male patient.
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Three month after surgery One year after surgery
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Patient walking with the help of crutches one week after surgery
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Take Home Message• Total hip replacement is one of the best
management options for sub-capital fracture neck of femur in independently mobile elderly patients.
• It has better rehabilitational potential, better function of hip and low revision rate.
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Thank you !