scholarly journals Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants

Geriatrics ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 70
Author(s):  
Riccardo L. Alberio ◽  
Mattia Rusconi ◽  
Loris Martinetti ◽  
Diego Monzeglio ◽  
Federico A. Grassi
Keyword(s):  
Femoral Neck ◽  
Older Patients ◽  
Womac Score ◽  
Femoral Neck Fractures ◽  
Radiographic Evaluation ◽  
P Value ◽  
Short Term ◽  
Dual Mobility ◽  
Clinical Records ◽  
Clinical And Radiological Results

The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations.

Dual mobility total hip arthroplasty in the treatment of femoral neck fractures

2020 ◽  
Vol 102-B (11) ◽  
pp. 1457-1466 ◽  
Author(s):  
Yong-Han Cha ◽  
Jun-Il Yoo ◽  
Jung-Taek Kim ◽  
Chan-Ho Park ◽  
Young-Sun Ahn ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Cohort Studies ◽  
Surgical Site Infection ◽  
Comparative Studies ◽  
Femoral Neck Fractures ◽  
Dislocation Rate ◽  
Site Infection ◽  
Dual Mobility ◽  
One Year

Aims To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). Methods Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. Results A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z −4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z −3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z −4.2). Conclusion While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457–1466.

scholarly journals Dual Mobility Acetabular Cup Versus Hemiarthroplasty in Treatment of Displaced Femoral Neck Fractures in Elderly Patients: Comparative Study and Results at Minimum 3-Year Follow-up

2019 ◽  
Vol 10 ◽  
pp. 215145931984861 ◽  
Author(s):  
Skender Ukaj ◽  
Osman Zhuri ◽  
Fatime Ukaj ◽  
Vlora Podvorica ◽  
Kushtrim Grezda ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Dislocation Rate ◽  
Harris Hip Score ◽  
Elderly Persons ◽  
Dual Mobility ◽  
Displaced Femoral Neck Fractures ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Hip fractures are serious injuries associated with relatively high mortality rates and disabilities, commonly seen in elderly persons. There is an ongoing debate regarding the advantages of various hip arthroplasty devices. This study aimed to analyze the long-term advantages of 2 different surgical procedures and assess if the dislocation rate, Harris Hip Score (HHS), and functional independence measure (FIM) are more favorable in dual mobility (DM) than those in hemiarthroplasty (HA). Hypothesis: Dual mobility procedures provide better postoperative outcomes than HA in terms of HHS, FIM, and dislocation rate. Materials and Methods: The survey was a prospective, comparative interventional single-blinded study performed at the University Clinical Center of Kosovo, a tertiary health-care institution. A total of 94 patients underwent DM or conventional bipolar HA for repair of displaced femoral neck fractures within 2 weeks of injury. Primary outcomes were postoperative dislocation rate, FIM, and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, mortality rate, and postoperative infection rate. Results: There were no significant differences for most parameters between the groups. We found a significant difference in the dislocation rate between the 2 groups, wherein there were no dislocations in the DM group and 3 dislocations in the HHS group (0% vs 6.4%). In terms of postoperative HHS at 12 months and 3 years, DM provided better outcomes (<0.034 and <0.014, respectively). Discussion: Dual mobility compares favorably to HA in terms of dislocation rate and HHS, while no difference was found for FIM. In order to have a more complete overview, we recommend more intense long-term studies including several heterogeneous parameters to compare the clinical outcomes between DM and HA. Level of evidence (with study design): Level II.

scholarly journals Short-Term Clinical Efficacy of Femoral Neck System Versus Multiple Cannulated Compression Screws in the Treatment of Garden III and IV Femoral Neck Fractures

2022 ◽  
Author(s):  
Xuefeng Zhou ◽  
Sichao Gu ◽  
Li Li ◽  
Lei Xu ◽  
Xujin Wang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Clinical Efficacy ◽  
Weight Bearing ◽  
Operation Time ◽  
Femoral Neck Fractures ◽  
Teaching Hospitals ◽  
Harris Hip Score ◽  
Clinical Report ◽  
Short Term

Abstract Femoral neck system (FNS) , as a novel minimally invasive internal fixation device, has been gradually applied in the treatment of femoral neck fracture.However, there are few related clinical studies on FNS at present, especially there is no clinical report on FNS in treating GardenIII and IV femoral neck fractures. The aim of the present study was to compare the short-term clinical efficacy of FNS and multiple cannulated compression screws (MCCS) in the treatment of Garden III and IV femoral neck fractures. The data of 78 patients with femoral neck fracture who were admitted to three teaching hospitals affiliated to Anhui Medical University and received internal fixation with FNS and MCCS from June 2019 to December 2020 were collected for a retrospective study. There were 39 patients in both the FNS and MCCS groups. The basic data, perioperative data were recorded and compared between the two groups of patients. The results of the study are encouraging. The operation time was shorter in FNS group than that in MCCS group (p<0.001). The post-operative partial and complete weight-bearing time was earlier in FNS group than that in MCCS group (p<0.001). The Harris hip score in FNS group was higher than that in MCCS group (p<0.001). The incidence rate of lateral thigh irritation in FNS group and MCCS group was 0 (0/39) and 33.3% (13/39), respectively (χ2=15.600, p<0.001). The length of femoral neck shortening was significantly shorter in FNS group than that in MCCS group (t=-5.093, p<0.001). In conclusion, The application of FNS for Garden III and IV femoral neck fractures can shorten the operation time, reduce the frequency of intraoperative fluoroscopy, and facilitate the recovery of hip joint function, so it provides a novel choice for the treatment of Garden III and IV femoral neck fractures in young people.

scholarly journals INTRACAPSULAR FEMORAL NECK FRACTURES

2018 ◽  
Vol 25 (09) ◽  
pp. 1317-1322
Author(s):  
Muhammad Jawad Ahmed ◽  
Maryam Shahid ◽  
Muhammad Hammad Ahmed ◽  
Bilal Nazarq
Keyword(s):  
Femoral Neck ◽  
Functional Outcome ◽  
Femoral Neck Fractures ◽  
Outcome Variable ◽  
P Value ◽  
Bipolar Hemiarthroplasty ◽  
Chi Square ◽  
Neck Of Femur ◽  
Chi Square Test ◽  
Walking Aid

Objectives: To compare of functional outcomes in terms of post-operativemobility for unipolar versus bipolar un-cemented hemiarthroplasty in elderly patients withdisplaced intracapsular femoral neck fractures. Study Design: Randomized Control Trial.Setting: Department of Orthopedics Bahawal Victoria Hospital, Bahawalpur. Period: April 2015to October 2016. Methodology: Sample size is (calculated by taking n6 =138, confidenceinterval 95, power of study 80, P1= 33%, P2=13%) 69 in each group. Sampling technique usedwas non probability consecutive sampling. All patients who meet the inclusion criteria presentingto orthopedic unit of Nishtar Hospital Multan with fracture neck of femur were selected for study.Patients were divided into two groups randomly by lottery method and enrolled for unipolaror bipolar hemiarthroplasty. Chi-square test was used to compare outcome variable in bothgroups. A p-value < 0.05 was considered statistically significant. Effect modifiers like age andsex was controlled by stratification. Chi square test was applied to see significant difference.Results: Overall, there were 100% (n=138) patients in this study, both genders. The mean ageof the patients was 66.35±4.29 years. (Range: 60 to 80years)Mean age and SD of group A (nowalking aid) was 54.52 ± 3.10 and in group B (walking aid) 54.99 ± 3.19. Time up go score wasnoted as successful 33.3% (n=46) and 66.7% (n=92) as unsuccessful. Walking aid was notedin 65.2% (n=90) patients. Functional outcome was noted as good in 26.8% (n=37) patientsand noted as bad in 73.2% (n=101) patients. Out of 100% (n=38) patients, good outcomewas 26.3% (n=10) unipolar and 73.7% (n=28) bipolar. Out of 100% (n=100) Bad outcomewas 59% unipolar and bipolar 41%. Conclusion: Functional outcome in term of mobility isbetter in case of bipolar prosthesis as compared to unipolar. Thus in our conclusion bipolarprosthesis is preferred procedure as compared to unipolar hemiarthroplasty in treating patientswith displaced intracapsular femoral neck fracture.

scholarly journals Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Oscar Vazquez ◽  
Axel Gamulin ◽  
Didier Hannouche ◽  
Wilson Belaieff
Keyword(s):  
Blood Transfusion ◽  
Femoral Neck ◽  
Elderly Population ◽  
The Elderly ◽  
Femoral Neck Fractures ◽  
Medical Complications ◽  
Short Term ◽  
Duration Of Surgery ◽  
Discharge Location ◽  
Surgical Site Complications

Abstract Background Femoral neck fractures (FNF) are frequent in the elderly population, and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the dynamic hip screw system (DHS) are considered gold standards for osteosynthesis. The newly available femoral neck system (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate the short-term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS, and FNS. Methods All the patients of the author’s institution aged ≥ 75 years with a non-displaced (Garden I and II) FNF eligible for osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS, or FNS depending on the surgeon’s preference. Clinical data (age, gender, ASA score, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from the patients’ charts. The radiological analysis assessed the fracture classification, fracture impaction, and proximal femur shortening at 3 and 6 months using the institutional imaging software. Results Baseline characteristics in the TS (n = 32), DHS (n = 16), and FNS (n = 15) groups were similar with respect to age (mean 85 years), gender (female to male ratio 4:1), and ASA score. There were no significant differences across the groups for the need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location, and mortality within 3 months. The duration of surgery was significantly lower in the FNS group (43.3 vs 68.8 min; p < 0.001). The radiological assessment found similar impaction (5.2 mm ± 4.8) and shortening (8.6 mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with a shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multicenter randomized studies are however necessary to confirm these first results.

Comparison of functional outcome of cemented total hip replacement versus cemented dual-mobility cup total hip replacement for the management of displaced femoral neck fractures in the active elderly patients

2020 ◽  
pp. 112070002091041 ◽  
Author(s):  
Ramy A M Rashed ◽  
Hannah Sevenoaks ◽  
Qaisar A Choudry ◽  
Mohammed S Kasem ◽  
Tarek A Elkhadrawe ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Elderly Patients ◽  
Range Of Motion ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Neck Fractures ◽  
Dual Mobility ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Hip Replacements

Introduction: Current guidelines recommend treating displaced femoral neck fractures with a total hip replacement in fit and active elderly patients. Dislocation remains the main complication. Dual-mobility cup (DMC) hip replacements maybe a solution to decrease dislocation, with the benefit of increasing stability, achieving better range of motion and functional outcomes. Patients and methods: This is a prospective randomised controlled trial which included 62 patients with Garden III and IV femoral neck fractures. The mean age was 67.2 years. 30 males and 32 females were included, randomised and allocated to 2 treatment groups; a cemented DMC replacement group, or a cemented 32-mm head total hip replacement (THR). The posterior approach was used in all patients. Postoperative functional outcome was assessed using Harris Hip Score (HHS). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire. Results: The mean HHS for the DMC group at 4, 6 and 12 months were higher than mean HHS scores for the THR group ( p < 0.001). The range of motion at 1 year was statistically better in the DMC group compared to the THR group ( p < 0.001). The DMC showed a statistically better effect on the HRQoL measurements as compared to the THR group. There were no dislocations in both groups. Conclusions: DMC hip replacements provide better functional, patient reported outcomes, and range of motion than the conventional THR. Combined with its stability, DMC replacements are a useful solution in managing femoral neck fractures in active elderly patients. Trial serial number 020841 (IRB Number 00007555).

scholarly journals Dual mobility in primary total hip arthroplasty: current concepts

2019 ◽  
Vol 4 (11) ◽  
pp. 640-646 ◽  
Author(s):  
Rory Cuthbert ◽  
James Wong ◽  
Philip Mitchell ◽  
Parag Kumar Jaiswal
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
High Risk Patient ◽  
Femoral Neck Fractures ◽  
Risk Patient ◽  
Functional Improvement ◽  
Dual Mobility ◽  
Total Hip

Total hip arthroplasty (THA) is one of the most successful surgical procedures – reducing pain and providing functional improvement. However, THA instability is a disabling condition and remains the most common indication for revision THA. To combat the risk of instability, the concept of dual mobility (DM) was developed. This article provides a comprehensive review of DM in the literature. Widespread use of first-generation DM was limited due to concern regarding wear of the polyethylene head and the unique complication of intraprosthetic dislocation (IPD). Implant modifications using highly cross-linked, durable polyethylene and a smooth, cylindrical femoral neck have all but eliminated IPD in contemporary DM. In multiple studies, DM demonstrates statistically significant reductions in dislocation rates comparative to standard bearing primary THA. These results have been particular promising in high-risk patient populations and femoral neck fractures – where low dislocation rates and improved functional outcomes are a recurrent theme. From an economic perspective, DM is equally exciting – with lower accrued costs and higher accrued utility comparative to standard bearing THA. Longer-term clinical evidence and higher-quality prospective comparative studies are required to strengthen current research. Dual mobility may well represent the future gold standard for THA in high-risk patient populations and femoral neck fractures, but due diligence of long-term performance is needed before recommendations for widespread use can be justified. Cite this article: EFORT Open Rev 2019;4:640-646. DOI: 10.1302/2058-5241.4.180089

Is the position of dual-mobility cup in THA for femoral neck fractures optimal? A retrospective study

2019 ◽  
Vol 30 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Pierre-Alban Bouche ◽  
Simon Corsia ◽  
Baptiste Boukebous ◽  
Pierre Boutroux ◽  
Redoine Zahi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Femoral Neck ◽  
Femoral Neck Fractures ◽  
Dual Mobility Cup ◽  
Dual Mobility

scholarly journals The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Shuai Cui ◽  
Dehui Wang ◽  
Xuejie Wang ◽  
Zehui Li ◽  
Wenlai Guo
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Replacement ◽  
Operation Time ◽  
The Elderly ◽  
Reoperation Rate ◽  
Femoral Neck Fractures ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled

Abstract Background Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors. Materials and methods Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared. Results There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up. Conclusions In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.

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