Abstract
Press-fit un-cemented hemiarthroplasty used in the treatment of elderly osteoporotic patients with femoral neck fracture requires technical skills in order to avoid iatrogenic complications. This study was performed in order to correlate the complication rate and the grade of the operating surgeon (middle-grade residents as compared to consultants). In this comparative retrospective study, 75 consecutive patients (mean age 80.5 years) were treated for displaced intra-capsular fracture of the neck of the femur with a hydroxy-apatite-coated (HAC) Furlong bipolar hip press-fit hemiarthroplasty. Residents performed the operation without supervision in 50 cases and in the remaining 25 patients, senior colleagues (consultants) performed the operation. The following complications were encountered; ten intra-operative and two postoperative pertrochanteric proximal femoral fractures, two cases of prosthetic loosening, one case of deep wound infection and one case of dislocation of the prosthesis. Re-operation rate was 9% revision (two for loosening, two for early postoperative pertrochanteric fracture and one for infection and one for dislocation). The complications, the intra-operative blood loss and operative time was higher in the hands of junior surgeons. Furlong HAC prosthesis hemiarthoplasty in the elderly was found to be associated with significant technical problems in the hands of junior as compared to the senior colleagues. Inadequate or overzealous reaming of the greater trochanter in order to accommodate the lateral fin of the Furlong press-fit prosthesis in our experience was the main reason for the high incidence of pertrochanteric fractures in this series. Unlike younger patients, osteoporotic patients have a lower threshold for pertochanteric fracture when press-fit prosthesis is used. Training the junior surgeons, the change of design of the press-fit prosthesis and the availability of a wide range of sizes are helpful hints reducing the complication rate. We suggest changing the current design when used in elderly.
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More From: European Journal of Orthopaedic Surgery & Traumatology
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