Femoral Preparation Before Head Dislocation in Hip Hemiarthroplasty for Fractured Neck of Femur Saves Time and Keeps the Acetabulum Clean of loose bone fragments: A Retrospective Study and Technical Report

Abstract

Introduction: Femoral neck fractures are the most common traumatic injuries associated with increasing age and osteoporosis, occurring most in older females. The femoral neck is under constant strain from externally and internally generated forces, approximately 500 – 200 micro-strains from daily activities. Common causes are falls in the elderly and road traffic accidents in younger patients. There is a significant in-house mortality and one-year mortality rate associated with femoral fractures. Fractures can be classified using the Garden Classification or the 2018 AO/OTA classification. Management includes open reduction and internal fixation, cannulated or sliding screws and hemiarthroplasty or total hip arthroplasty. This study examines the benefits of femoral preparation before head dislocation in hip hemiarthroplasties by assessing differences between pre-operative and post-operative haemoglobin levels and surgical times. Methods: We report the surgical techniques of hip hemiarthroplasty where the femur is prepared before the femoral head is removed and the hip is reduced in the flexion position. A retrospective review of electronic patient records of patients who underwent hemiarthroplasties from June 2022 to June 2023 was conducted. Results: Surgical times for this surgical technique were 30 minutes faster than traditional methods while the differences in haemoglobin levels were minimal. Conclusion: Longer surgical times are associated with adverse events such as infections and wound dehiscence while increasing risks via surgeon fatigue and longer anaesthesia durations. Innovations in surgical techniques should thus aim to minimise surgical time without compromising procedures. This technique saves 30 min on average while having similar levels of blood loss to traditional techniques, maintaining standards, and not compromising on patient safety. Femoral preparation before dislocating the femoral head reduces the steps taken in leg repositioning which saves time and effort by the assistant. The reduction technique also avoids any risk of intra-operative iatrogenic fracture that can happen, especially if the assistant is a junior surgeon who lacks experience with hip reduction.