Functional Results of Hip Arthroplasty with Acrylic Prosthesis
The prosthetic replacement of the femoral head in the active elderly patients with intracapsular femoral neck fractures eliminates the concern regarding the re-operation due to fixation failure, nonunion, and avascular necrosis of the femoral head. However, the best choice of the prosthesis for joint replacement in patients with femoral neck fractures is controversial. BA has the advantages of a lower probability of dislocation and being a simple surgical technique. However, the main concern is the possibility of occurrence of the protrusio acetabuli from the acetabular erosion, groin and thigh pain, less survival at the long-term follow-up than THA, and the higher probability of a second operation. Even though the total hip arthroplasty (THA) provides good functional results and long-term survival compared with BA, it can develop serious complications such as a dislocation in the early post-operative period. Patients with the intracapsular femoral neck fractures have a high risk of a post-operative dislocation. The size of the replaced head is a contributing factor to incidence of dislocation. Larger diameter femoral heads are believed to have less chance of dislocation and further more facilitates increased ROM. There is limitation in the widespread use of larger diameter femoral head against conventional polyethylene because of the risk of accelerated wear and resulting osteolysis. The development of new polyethylene with improved wear characteristics in the early laboratory and clinical studies could be reduce the this risk. In this series from the Merle d'Aubigne and Postel classification categorized to six levels according to the level of pain, mobility, and ability to walk, the THA group had better results. Despite there being no limitation of ROM in the early post-operative period, no dislocation was encountered in either group. However, there is some controversy regarding the use of highly cross-linked polyethylene. Even though a few edge fractures of the highly cross-linked polyethylene were attributed to the component mal-position, the possibility of fatigue failure due to the decrease in yield strength and ultimate tensile strength from high dose radiation emphasize the need for long-term studies in young active patients. However, the patients with intracapsular femoral neck fractures caused by osteoporosis often have coexisting medical problems with limited life expectancy, which means that the demands for daily livings are low. Early post-operative complications such as a dislocation are more important factors in their management. From this point of view, a THA with large diameter femoral head is recommended for the management in patients with intraarticular femoral neck fractures because THA produces a better result than BA. However, it should be noted that this study has limited statistical power because of the sample that was not prospectively randomized. Even though a highly cross-linked polyethylene shows good short and mid-term results and long-term study, a long-term study will be needed to justify its continued use. Given the relatively decrease in life expectancy of patients with intracapsular femoral neck fractures, it would be possible to study on the clinical and functional outcomes in the early post-operative period.
FUNCTIONAL RESULTS OF HIP ARTHROPLASTY WITH ACRYLIC PROSTHESIS
Functional results of hip arthroplasty with acrylic prosthesis
Intracapsular femoral neck fractures are common orthopedic injuries. However, there is some controversy regarding the optimal surgical treatment for these injuries. Prosthetic replacement of the femoral head is one of the options for treating a displaced intracapsular femoral neck fracture in elderly patients. The proponents of arthroplasty suggest that replacing the femoral head eliminates the risk of revision surgery due to serious complications such as head necrosis, nonunion of the fracture site, etc. However, there is some controversy regarding the choice of prosthesis for the joint replacement in patients with intracapsular femoral neck fractures. Bipolar hemiarthroplasty (BA) has a higher incidence of groin pain secondary to acetabular erosion, as well as increased probability of revision arthroplasty. Even though total hip arthroplasty (THA) provides good functional results and long-term survival compared with BA, it has several disadvantages such as component dislocation and decreased functional activity due to a limitation in extreme motion. Larger diameter femoral heads (≥36 mm) have a larger range of motion and believed to be a valuable tool for preventing a dislocation in THA. Based on this data, it was hypothesized THA with a 36 mm-femoral head will produce superior results without any serious complications compared with BH. We already reported on clinical data on the performance of THA using a large head in patients with a intracapsular femoral neck fracture. However, it has limited statistical power because of the small sample size. We extended the sample size and analysed the result. The aim of this study was to evaluate the short-term clinical outcomes of THA with large diameter of head and BA in physiologically active elderly patients with displaced intracapsular femoral neck fractures.
of hip arthroplasty with acrylic prosthesis.
Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency.