Abstract

The goal of this article is to evaluate our practice. We assessed and compared the outcome for 2 groups (internal fixation vs. hemiarthroplasty (AM) and total hip replacement THR) with particular interest in the re-operation rate. We conducted a retrospective study with 87 cases in total. 47 had cannulated screws and 40 had AM We concluded that there is no significant difference between the two groups in regard to mobility, pain status and mortality rate. We found a higher re-operation rate in screws group, although similar to many other studies.

Introduction

• 3 choices of treatment are available for displaced intracapsular fracture , namely internal fixation, hemiarthroplasty (AM) and THR

• Standard recommendations are:

• • Age more than 70 yrs hemiarthroplasty

  • Age less than 70 yrs internal fixation

  • Moderate/sever OA THR

  • Immobile patient consider no treatment

Aim of the study

1. To evaluate our practice.

2. Assess and compare the outcome for both groups. Particular interest in the re-operation rate.

Previous studies

• A study by k. Ravikumar and G. Marsh shows no difference in the mortality rate between the three groups . One year revision rate of internal fixation group is 25%. Recommend THR in physiologically active patients.

• A study by Annti Alho and David Rietti in Norway (1980), the total cost of prosthetic replacement was found to be 1.6 times more expensive than the internal fixation.

Type of the Study

• Retrospective study.

• 87 case in total, 47 had cannulated screws and 40 had AM (May 98 - June 2000 )

• Part of the information obtained from original data which have been collected regularly for The Scottish Hip Audit.

• 4 months F/U done by questionnaire filled by the mail or on the phone.

• Only displaced fractures of femoral neck were included.

• Both groups compared with regard to:

• • discharge destination.

  • Mortality .

  • Mobility.

  • Pain status.

  • Place of residence prior to fracture and at 4 months F/U.

  • Re-operation rate at 4 months and one year F/U.

General health in both groups, ASA grade %

Age & Sex difference between the two groups

Place of residence prior to fracture %

Discharge destination in both group %

Place of residence in both groups at 4 months F/U %

Walking status prior to fracture in both groups %

Walking status before the fracture and at 4/12 F/U in the screws group %

Walking status before the fracture and at 4/12 F/U in The AM group %

Mortality rate at 30 days

Mortality rate at 4 month F/U

Pain status at 4 months F/U in both groups %

Re-operation rate at 4 months F/U in both groups %

Re-Operation Rate At 4 Months

• The screws group shows higher figure (12.76%) compared to just (0%) for the AM group.

• In the screws group

• • 6 patients underwent major surgery ( removal of screws & THR) ,one of them dislocated once.

Re-operation rate at one year in both groups %

Re-operation rate at 1 year in both groups

• Screws group:

• • further two pts underwent removal of screws and THR.

  • In addition, two pts underwent removal of screws ( rate risen to 21.27%).

• AM group:

• • two pts underwent removal of prosthesis and THR.

  • one patient sustained fracture shaft of femur around the prosthesis (ORIF)

Reasons of re-operation

• Screws group:

• 1. Early mechanical failure. 4 cases [THR]

  2. Pain

  3. • avascular necrosis . One case

     • screws protrusion

     • • laterally 5 cases

       • to joint 1 case

• AM group

• 1. pain 2 cases

  2. fracture 1 case

Conclusion

• There is no significant difference between the two groups in regard to mobility, pain status and mortality rate.

• Selecting criteria close to SIGN .

• Higher re-operation rate in screws group,although similar to many other studies.

• It is interesting to see the re-operation rate in this group with further F/U .