Total hip arthroplasty in treating elderly femoral neck fracture with hemiplegia

Abstract

Objective To investigate the clinical effects of high restrictive anti-dislocation prosthesis total hip arthroplasty (THA) in treating elderly femoral neck fracture patients with hemiplegia. Methods From June 2015 to January 2017, Forty-three elderly femoral neck fracture patients with hemiplegia were treated with CombiCup THA system. There were 15 males and 28 females with an average age of 71.5±5.6 years (60-84 years). The left side was involved in 20 cases, while the right side in 23 cases. There were 15 cases with Garden III type and 28 cases with type IV. Lower limb muscle strength grade were 20 cases in grade 3, 19 cases in grade 4, and 5 cases in grade 5. Sixteen cases walked independently before injury, while 27 of them walked with the aid of crutches. The duration between injuries to operation ranged from 2 days to 5 days. The size of the prosthesis and off-set distance were recorded by template technique pre-operation. The appropriate type of prosthesis was selected to restore the offset and to reconstruct the abductor muscle arm, according to the actual measurement in the operation and the preoperative plan. Based on the bone mineral density and medullary cavity morphology, biological or cemented femoral stem prosthesis was selected. The quality of the implant and the length of both lower limbs were evaluated by pelvic X-ray immediately after operation. The patients were followed-up at 2 weeks, 1 months, 2 months, 3 months, 6 months, 1 and 2 years. Functional exercise guidance and complications were recorded at the follow-up duration. At the last follow-up, the hip function and limb function were evaluated according to the Harris score and Fugl-Meyer motor function assessment respectively. Results Based on pelvic X-ray evaluation after operation, all prosthesis position were favorable with the average angle of acetabular abduction 45.1±2.3 degrees and the length difference of both limbs less than 5 mm (average 2.2±0.8 mm). The follow-up duration ranged from 6 to 24 months with an average of 11.2±3.5 months. There was no complication such as prosthesis dislocation and infection. Deep venous thrombosis in calf occurred in 3 patients at 2 days after operation, who underwent recanalization after thrombolysis. At the last follow-up, the average score of Harris hip function and Fugl-Meyer were 90.2±3.8 (77 to 96) and 97.1±2.5 (83 to 100), respectively. No dislocation, infection, loosening, subsidence and osteolysis phenomenon was found during the follow-up. Conclusion The elderly patients with Garden type III or IV femoral neck fractures accompanied with hemiplegia can be treated with anti-dislocation prosthesis THA. It does have the advantages of low dislocation rate and improved hemiplegic limb function. Key words: Femoral neck fractures; Hemiplegia; Aged; Arthroplasty, replacement, hip