J Korean Orthop Assoc.  2015 Aug;50(4):280-289. 10.4055/jkoa.2015.50.4.280.

The Result of Total Hip Arthroplasty after Failure of Multiple Screw Fixation for Femoral Neck Fracture

• Kim MC
• Park KS
• Yoon TR

• KMID: 2035864
• DOI: http://doi.org/10.4055/jkoa.2015.50.4.280

Abstract

PURPOSE
The purpose of this study is to analyze the result of secondary total hip arthroplasty (THA) after primary internal fixation failure in femoral neck fracture patients and compare the results with primary THA for femoral neck fracture.
MATERIALS AND METHODS
Among the femoral neck fracture patients, we analyzed clininal and radiologic results of those who underwent secondary THA after internal fixation failure and those who underwent THA as early treatment. Cases with patients over age 40 years and with at least two year of follow-up period were used for analysis. Periopertive conditions of patients were evaluated by using surgery time, bleeding amounts and period to start gait using walker or crutch after surgery. Clinical results were assessed by using Harris hip score and Western Ontario and McMaster Universities Osteoarthritis Index, and radiologic results were derived by observing follow-up simpe X-ray.
RESULTS
The group of secondary THA had longer surgery time, more bleeding amount and longer period to start gait. But between the two groups, there was no difference of clinical and radiologic result at final follwing up. Both of two group had excellent clinical and radiological results.
CONCLUSION
THA after internal fixation showed excellent clinical and radiologic results that was comparable to compare with primary THA.

Keyword

femoral neck fractures; post-traumatic avascular necrosis of the femoral head; fracture nonunion; total hip arthroplasty

MeSH Terms

Arthroplasty, Replacement, Hip*
Bleeding Time
Femoral Neck Fractures*
Femur Neck*
Follow-Up Studies
Gait
Hemorrhage
Hip
Humans
Ontario
Osteoarthritis
Walkers

Figure

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  Figure 1 A 73-year-old female patient with right femur neck fracture. (A) Preopertive radiograph. (B) Immediate postoperative radiograph after primary total hip arthroplasty. (C) Final follow-up at 2 years.

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  Figure 2 A 64-year-old male patient with right femur neck fracture. (A) Preopertive radiograph. (B) Postoperative radiograph after screw fixation at local hospital. (C) Radiograph after 4 month, screw fixation failure. (D) Postoperative radiograph after screw removal and secondary total hip arthroplasty. (E) Final follow-up at 2 years.

Reference

1. Choo SK, Oh HK, Kim JI, Lee HD, Jang GR. The result of osteosynthesis for femur neck fracture in old age patients. J Korean Hip Soc. 2011; 23:32–38.

2. Hwang SK, Ryu HY. Comparison of the results of internal fixation of femoral neck fracture according to the fixation methods. J Korean Hip Soc. 2008; 20:265–272.

3. Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures: no problems? A consecutive study of 224 patients treated with internal fixation. Injury. 2009; 40:274–276.

4. Hui AC, Anderson GH, Choudhry R, Boyle J, Gregg PJ. Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. J Bone Joint Surg Br. 1994; 76:891–894.

5. Leighton RK, Schmidt AH, Collier P, Trask K. Advances in the treatment of intracapsular hip fractures in the elderly. Injury. 2007; 38:Suppl 3. S24–S34.

6. Cho MR, Lee HS, Lee SW, Choi CH, Kim SK, Ko SB. Results after total hip arthroplasty with a large head and bipolar arthroplasty in patients with displaced femoral neck fractures. J Arthroplasty. 2011; 26:893–896.

7. D'Arrigo C, Perugia D, Carcangiu A, Monaco E, Speranza A, Ferretti A. Hip arthroplasty for failed treatment of proximal femoral fractures. Int Orthop. 2010; 34:939–942.

8. Yoon TR, Bae BH, Choi MS. A modified two-incision minimally invasive total hip arthroplasty: technique and shortterm results. Hip Int. 2006; 16:Suppl 4. 28–34.

9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51:737–755.

10. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15:1833–1840.

11. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983; 31:721–727.

12. Widmer KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty. 2004; 19:387–390.

13. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976; 121:20–32.

14. Khalily C, Lester DK. Results of a tapered cementless femoral stem implanted in varus. J Arthroplasty. 2002; 17:463–466.

15. Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; 141:17–27.

16. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978; 49:239–243.

17. Yoo MC, Lee SU, Kum SJ, Lee KL, Jeon CW. Treatment and complication of the femoral neck fracture. J Korean Hip Soc. 1989; 1:40–50.

18. Dickson JA. The unsolved fracture; a protest against defeatism. J Bone Joint Surg Am. 1953; 35:805–822.

19. Speed K. The unsolved fracture. Surg Gynecol Obstet. 1935; 60:341–351.

20. Arnold WD, Lyden JP, Minkoff J. Treatment of intracapsular fractures of the femoral neck. J Bone Joint Surg Am. 1974; 56:254–262.

21. Lee KH, Park CS, Kim MK, Kwon JH. A clinical study of the femoral neck fracture. J Korean Orthop Assoc. 1992; 27:1293–1301.

22. Sung YB, Shin YW, Park CK. Risk factors for avascular necrosis and nonunion after multiple pinning for an intracapsular femoral neck fracture. J Korean Hip Soc. 2009; 21:35–40.

23. Szita J, Cserháti P, Bosch U, Manninger J, Bodzay T, Fekete K. Intracapsular femoral neck fractures: the importance of early reduction and stable osteosynthesis. Injury. 2002; 33:Suppl 3. C41–C46.

24. Roberts WB, Charles MC, James DH, Paul T 3rd. Rockwood and Green's fractures in adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins;2010. p. 1583–1584.

25. Lee JO, Cho HC, Lee DH, Gang SB, Lee JH, Yoon KS. Reduction and fixation of femoral neck fracture in patients older than 65 years. J Korean Hip Soc. 2005; 17:34–39.

26. Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, Saleh KJ. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop Relat Res. 2001; 383:229–242.