Treatment of senile femoral neck fractures using bipolar hemiarthroplasty with enhanced repair of a U-shaped capsular flap via a modified posterior mini-incision

Abstract

Objective To evaluate the efficacy of bipolar hemiarthroplasty with enhanced repair of a U-shaped capsular flap via a modified posterior mini-incision for senile femoral neck fractures. Methods Between June 2008 and June 2013, 86 senile patients with femoral neck fracture were treated operatively. They were 20 males and 66 females, 80 to 95 years of age (mean, 84.6 years). There were 70 cases of Garden type Ⅲ and 16 cases of Garden type Ⅳ. They all underwent bipolar hemiarthroplasty via a modified posterior mini-incision. A U-shaped posterior capsular flap with its base close to the acetabulum was made before exposure of the hip joint. Next this flap and short external rotators were repaired particularly after the bipolar prostheses were implanted. Incision length, surgical time, intra-operative loss of blood, and length of lower limb were measured. Malposition of prosthesis, hip dislocation and other complications were monitored. The outcomes were assessed according to Harris hip score at the last follow-up. Results The mean incision length was 9.2 cm (range, 8 to 12 cm). The mean surgical time was 75.2 min (range, 55 to 130 min). The mean intra-operative loss of blood was 250.1 mL (range, 120 to 620 mL). The proximal skin margin of the incision was bruised in 3 cases, deep venous thrombosis occurred at the lower limb 3 weeks postoperatively in one case, and length discrepancy between bilateral lower limbs was observed in 6 cases. No dislocation, incision infection, sciatic nerve injury, or component malpositioning happened in this group. All patients were evaluated after a mean follow-up period of 14 months (from 12 to 35 months). One patient died from lung cancer one year postoperatively. According to the Harris hip scores at the last follow-up, 68 cases were excellent, 15 good and 3 fair, giving an excellent to good rate of 96.5%. Conclusions The modified posterior mini-incision for localization of body surface is accurate, reliable and simple for senile femoral neck fractures. The bipolar hemiarthroplasty with enhanced repair of U-shaped capsular flap via this modified posterior mini-incision is in favor of early ambulation of the patients, and effective in reducing perioperative complications. Key words: Femoral neck fracture; Arthroplasty, replacement, hip; Surgical operation, minimally invasive; Surgical approach; Elderly people, aged 80 or over