EARLY HIP REPLACEMENT IN PATIENTS WITH FEMORAL NECK FRACTURES

Abstract

The aim of the study was to improve the surgical treatment outcomes for hip fracture by optimizing the methods of preoperative preparation for endoprosthesis, choosing the method of endoprosthesis and postoperative management of elderly and senile patients.
 The study was based on the analysis of the treatment outcomes of 339 patients with femoral neck fractures, aged 50-85 years for 2000-2019. 206 patients underwent endoprosthetic surgery without cement fixation; in 133 cases bone cement was used. 151 (44.8%) patients had total hip replacement with Deriuh and Zimmer implants performed within 1 to 2 days. 66 (19.5%) patients underwent surgery within 5 days, and the remaining 120 (35.5%) patients underwent endoprosthetic surgery within 8-10 days. When diagnosis has been made, the patient should undergo endoprosthetic surgery as early as possible. Preoperative preparation of this group of patients, in addition to standard procedure, also included the dopplerography, densitometry, and biochemical blood tests to determine the level of calcium. Summing up these diagnostic parameters, the severity of osteoporosis was determined that in turn allowed clinicians to choose the optimal tactics for hip replacement. The average duration of the operation was about 1 hour. In the postoperative period, patients were monitored in the intensive care unit for a day. A day after the operation, the patient can move relatively freely in bed. He can be allowed to sit down if he can. It is necessary to perform deep breathing exercises. Movements in the knee joint can be started from the first day. Next day, depending on the general condition, the patient can be allowed to sit on a chair near the bed or even walk with crutches. Before getting patients on their feet on the 2-3 day after the operation, dopplerography is performed. Walking with crutches lasts 2-3 days, but patients should not avoid the load on the operated limb; after this period the patient should walk with a stick, and in a few days without a stick. Walking with additional support is recommended for up to 10 days. The average period of inpatient treatment of this group of patients was up to 12 days. 151 patients, who had endoprosthetic surgery performed on within 5 days, had no hypostatic complications, thrombosis and thromboembolism; 3 patients were found to have cardiovascular insufficiency and one patient had bedsores. In 188 patients who had hip replacement performed on in 5 days and over since the fracture, the percentage of complications was as follows: hypostatic complications thrombosis and thromboembolism was found in 3 cases, heart failure – in 4 cases, bedsores – in 7 cases. Hip replacement in femoral neck fractures in the elderly and senile age should requires as early intervention as it possible thus, providing the main prevention of hypostatic complications and early rehabilitation of patients.