The Application Of Hemi Hip Arthroplasty For Elderly Femoral Neck Fracture And Related Research

Objective: The incidence of femoral neck fracture is increasing year by year. With the medical progress, the application of artificial joint replacement for the treatment of elderly patients with femoral neck fracture has received the affirmation of more and more doctors. At present, the application of uncemented bipolar hemi hip arthroplasty for elderly patients with femoral neck fracture has become a clinical routine. However, elderly patients usually got a lot of comorbidities due to many factors like the degeneration of physical function. Trauma often takes a long time to recover for poor patient tolerance. So the effect of the surgery often seems to be unsatisfactory. In this study, we reviewed the clinical data of the aged patients with femoral neck fracture who underwent uncemented bipolar hemi hip arthroplasty for treatment. The data included the patients’ general condition like age, gender, Body Mass Index and so on. The data of the clinical results after surgery like the complications in the follow up was also collected in our study. In addition, we investigated the patients with preoperative disease. Our aim is to study the results of the application of uncemented bipolar hemi hip arthroplasty for elderly femoral neck fracture. Also we tried to find out the relationship of the comorbidities and surgical outcomes.Methods: In our study, we reviewed 258 elderly patients who took uncemented bipolar hemi hip arthroplasty as the treatment for femoral neck fracture in Shanghai Ninth People’s Hospital. The preoperative data included ASA score to anesthesia, anesthesia, preoperative waiting time, operation time and intraoperative bleeding. The postoperative data included hip dislocation, periprosthesis fractures, prosthesis loosening, secondary surgery, postoperative deep vein thrombosis, joint infections, wound healing problems, 30-day and 1-year mortality. The functional outcome was evaluated by Harris hip score. We divided the patients into excellent group, good group and fair group according to the actual patients’ postoperative Harris hip score. We also analyzed the relationship of the comorbidities and surgical outcomes by using the Ordinal Logistic Regression.Results: The average age of the patients was 85.140 ± 4.37 including 71 males(27.5%) and 187 females(72.5%). According to Garden classification, we got type Ⅰ 6 cases(2.3%), type Ⅱ 8 cases(3.1%), type Ⅲ 84 cases(32.6%), type Ⅳ 160 cases(62.0%). The most common type of preoperative complications in the order: 98 cases of hypertension(40.0%), 85 cases(32.9%), diabetes COPD39 cases(15.1%), 36 cases of coronary heart disease(14.0%). Among them, there are 68 patients(26.4%) without comorbidities, 95 people with 1 disease(36.8%), 54 people(20.9%) with 2 diseases and 41(15.6%) patients got at least 1 disease. According to ASA score, there were 47 cases(18.2%) for Ⅰ, 145 cases(56.2%) for grade Ⅱ, 59 cases(22.9%) for grade Ⅲ and 7 cases(2.7%) for grade Ⅳ. Most patients(239, 92.6%) underwent surgery under general anesthesia, the other(19, 7.4%) were completed under the spinal canal anesthesia. Patients’ average preoperative waiting time was 50.678 ± 7.215 hours. Average operation time(from the incision to suture) was 48.236 ± 12.448 minutes. Average intraoperative hemorrhage amount was 105.937 ±37.219 ml. 3 patients got hip dislocation after surgery. Another 3 got periprosthesis fractures. Only 1 case of symptomatic DVT was reported. 24 patients died within one year after operation. The average Harris hip score was 88.71 ± 8.62. There is no direct relationship between the postoperative joint function the way of anesthesia. The older the patient is, the lower postoperative Harris score he(she) got(P=0.007,OR=1.12). BMI also got the similar result(P=0.005,OR=1.22). ASA score showed that the high score group got a poor prognosis after analysis(P<0.001,OR=3.23). There was no was no significant difference the patients with only one kind of disease patients without disease(P=0.309>0.05). As the number of complications increased, joint function in patients with will become worse(OR =3.76, 8.81). In hypertension, coronary heart disease, COPD and diabetes, only people with diabetes have an impact on the results(P<0.001,OR=1.19).Conclusions:(1) In our study, we found no postoperative infection. Dislocation rate was 1.16%. 1.16% patients got a periprosthesis fracture. Postoperative mortality rate of 9.3% a year. The average Harris hip score was almost 89. Postoperative outcomes were good. The results of the application of uncemented bipolar hemi hip arthroplasty for elderly femoral neck fracture are satisfactory.(2) The functional outcomes of patients were connected to the patients’ age, BMI, ASA score and numbers of comorbidities. In hypertension, coronary heart disease, COPD and diabetes, only diabetes had an impact on the results. So, in the face of the old, fat, ASA score higher and patients with diabetes, more attention is need for a better outcome.