Evaluation of Replacement Hemiarthroplasty in Femoral Neck Fracture by Bipolar Prosthesis through lateral approach

Résumé

Introduction: Fractures of the neck of the femur, which is common in elderly people, remain in many ways an unsolved fracture to regain full anatomic and functional results. In our country many patients appear late at hospital and internal fixation in the elderly causes high incidence of non-union and avascular necrosis of the head of femur. To avoid these complications and to regain early ambulation, replacement hemiarthroplasty is preferred. We have studied the outcome of the hemiarthroplasty by bipolar prosthesis in lateral approach to hip. Methods: This prospective observational study was carried out in Dhaka Medical College Hospital (DMCH), National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) and Clinics in Dhaka during the period of January 2006 to December 2007. 20 patients of both sexes were included by purposive sampling. Patients were followed up and evaluated by modified Harris Hip rating system. Results: Age of the patients varied between 45-84 years (average 65 years). 75% of the patients attended to hospital within 3 weeks and 25% patients between 3-12 weeks of injury. Patients were followed up at 6 weeks, 18 weeks, 30 weeks & 48 weeks after operation. At final follow up, 6 patients (30%) had no pain, 8 patients (40%) had slight pain, 6 patients (30%) had moderate pain. Limping- 5 patients (25%) had no limping, 10 patients (50%) had slight limping & 5 patients (25%) had moderate limping. 9 patients (45%) could walk long distance, 7 patients (35%) up to 6 block, 3 patients (15%) up to 3 block, 1 patient (5%) indoors only. 18 patients (90%) had good range of motion (>90%). Overall results using bipolar prosthesis were excellent in 8 patients (40%), good in 7 patients (35%), fair in 2 patients (10%), poor in 3 patients (15%); excellent and good results were considered satisfactory (75%). Conclusion: Replacement hemiarthroplasty by bipolar prosthesis is an effective method of treatment for displaced femoral neck fractures; it mobilizes the patient faster, decreases the morbidity rate and thus maximally improves overall results.