Abstract
BackgroundIn our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. To our knowledge, there are no reports on the knot position of the greater trochanter reattachment. The aim of this study was to determine influence of two knot positions (anterior or posterior) on the complications of the greater trochanter.MethodsThis is a prospective non-randomized study conducted on 95 elderly patients (95 hips) from September 2013 to December 2017. The knot position was changed from anterior to posterior alternately. The X-ray images obtained immediately after the operation were compared with those obtained at 3 months postoperatively; thereafter, the status of the greater trochanter was classified into three types: type A, no apparent shifting and fracture; type C, over 1-mm shifting of the fragment; and type F, fracture of the greater trochanter.ResultsRegarding age at operation, sex, BMI, size of the greater trochanteric fragment, stem type, and surgeon, there was no significant difference between two groups. In the anterior group, 34 hips (72.3%), 5 hips (10.6%), and 8 hips (17.0%) were classified under type A, C, and F, respectively. In the posterior group, 44 hips (91.7%), 1 hip (2.1%), and 3 hips (6.3%) were classified under type A, C, and F, respectively. There were significantly fewer greater trochanteric complications in the posterior group.ConclusionsThe posterior knot position improved the union of the greater trochanter after BHA compared with the anterior knot position.Trial registrationWe had approved IRB at our hospital clinical research review committee. Retrospectively registered.
Highlights
In our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach
All elderly patients who had displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach [5], in which the greater trochanter was cut partially with the gluteus medius muscle
Two studies previously reported that ultra-high molecular weight polyethylene (UHMWPE) fiber cables yielded a sufficient degree of fixation equal to that in metal wires in spinal fusion surgery [6, 7]
Summary
All elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. All elderly patients who had displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach [5], in which the greater trochanter was cut partially with the gluteus medius muscle. The modified Dall approach is a superior approach in that it can provide sufficient visualization during total hip arthroplasty (THA) or BHA. This approach can be used in cases requiring bone grafting because of acetabular dysplasia and can avoid excessive detachment of the soft tissues. There were some cases in which the fragments were displaced or fracture occurred at the greater trochanter
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