title: Total hip arthroplasty for acute displaced femoral neck fractures via the posterior approach: a protocol to minimise hip dislocation risk.
abstract: Total hip arthroplasty (THA) is considered superior to hip hemiarthroplasty (HHA) in long term pain relief and functional outcome after femoral neck fracture; high early dislocation rates may however negate these advantages. This study elucidates whether a protocol of careful patient selection, surgical technique algorithm and use of modern implants could yield low dislocation rates in hip fracture patients treated with THA via the posterior approach. Over a seven year period all patients admitted to our institution that were cognitively lucid, independent ambulators and without Parkinson's disease underwent THA for acute displaced femoral neck fractures using a posterior approach, large femoral heads, elevated acetabular liners and a surgical technique algorithm. Twenty-nine THAs were performed in 26 patients (mean age of 71 years, range 50-87 years) and were followed for a mean of 32 months (range 13-48 months). There was one dislocation 7 weeks postoperatively in a non-compliant patient resulting in reoperation. There were no other reoperations or major complications. Our results indicate that low dislocation rates can be accomplished for displaced femoral neck fractures treated with THA via the posterior approach using a protocol that includes careful patient selection, surgical technique focused on intraoperative stability, and the use of modern implants.
authors.affiliation: Orthopaedic Trauma Service, Washington University School of Medicine / Barnes-Jewish Hospital, St Louis - USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: Jakub S
authors.initials: JS
authors.lastname: Langer
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leduc
authors.forename: Philipp N
authors.initials: PN
authors.lastname: Streubel
authors.forename: Joseph
authors.initials: J
authors.lastname: Borrelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002985:Clinical Protocols; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006622:Hip Prosthesis; D006801:Humans; D004204:Joint Dislocations / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies