title: Total hip replacement for hip fracture: Surgical techniques and concepts.
abstract: When treating a hip fracture with a total hip replacement (THR) the surgical technique may differ in a number of aspects in comparison to elective arthroplasty. The hip fracture patient is more likely to have poor bone stock secondary to osteoporosis, be older, have a greater number of co-morbidities, and have had limited peri-operative work-up. These factors lead to a higher risk of complications, morbidity and perioperative mortality. Consideration should be made to performing the THR in a laminar flow theatre, by a surgeon experienced in total hip arthroplasty, using an anterolateral approach, cementing the implant in place, using a large head size and with repair of the joint capsule. Combined Ortho-geriatric care is recommended with similar post-operative rehabilitation to elective THR patients but with less expectation of short length of stay and consideration for fracture prevention measures.
authors.affiliation: Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU P.O. Box 211, Core C, Bretton Gate, Peterborough PE3 9GZ, UK. Electronic address: rosscoomber@hotmail.com.
authors.forename: Ross
authors.initials: R
authors.lastname: Coomber
authors.affiliation: West Suffolk Hospital, Bury St. Edmonds, Suffolk IP33 2QZ, UK. Electronic address: matthew.porteous@wsh.nhs.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Porteous
authors.affiliation: Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK. Electronic address: matthew.hubble@nhs.net.
authors.forename: Matthew J W
authors.initials: MJW
authors.lastname: Hubble
authors.affiliation: Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU P.O. Box 211, Core C, Bretton Gate, Peterborough PE3 9GZ, UK. Electronic address: Martyn.Parker@pbh-tr.nhs.uk.
authors.forename: Martyn J
authors.initials: MJ
authors.lastname: Parker
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D015897:Comorbidity; D017558:Elective Surgical Procedures; D006617:Hip Dislocation / Q000453:epidemiology / Q000517:prevention & control*; D006620:Hip Fractures / Q000453:epidemiology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D020127:Recovery of Function; D018570:Risk Assessment; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Hip fracture; Instructional review; Total hip replacement