1. Dislocation Rates in Furlong Hemiarthroplasty General Characteristics
Menakaya C, Shah MA, Ingoe H, Malhotra R, Boddice T, Mannan A, Muthukumar N, Mohsen A
Hull and East Yorkshire NHS Trust , Anlaby Road , Hull, HU3 2JZ. United Kingdom
Introduction
Hemiarthroplasty of the hip with a bipolar prosthesis is a primary management option in treatment of the displaced intracapsular hip fracture in the elderly patient. Early dislocation is a major complication with a documented mortality rate of up to 40% at 6 months. Previous studies have considered both patient and surgery related factors that would predispose to dislocation. However data looking at current design stems in literature has been lacking
Objectives
To compare the dislocation rates to those of uncemented and older prosthesis in use prior to the Furlong implant
To report factors associated with hip dislocation in patients having Furlong hemiarthroplasty
Methods
Clinical and radiological records were reviewed to determine dislocations and associated factors. Two treatment groups:
Group I: Consecutive patients treated with cemented prosthesis from August 2011 to February 2012 (N132)
Group II: Historical cohort from June 2010 to July 2011(N274)
RESULTS
General Characteristics
N = 406
Average age = 81
F>M
Nursing home admissions 18%
Independently mobile > Use walking aids (Group I N67 =Group II N147)
AMTS <5= Group I N37 vs Group N71 .
Dislocation Data
Average Age = 78 years
AMTS <5 = `100%
Dislocations
Group I N7 (6 cemented, 1 uncemented) vs
Group II N3
Small or extra small stem = 50%
Capsular repair = 5 cases
Greater trochanter fracture during reduction = N1
Girdlestone = N5
CONCLUSIONS
There is increased dislocation rate following use of cemented Furlong prosthesis although not statistically significant in this cohort. This could be secondary to the fixed offset of the cemented prosthesis since majority of these cases were reported as stable intraoperatively with capsular repair. We believe that this should be used with great caution in patients with reduced AMT and performed by appropriately trained specialist
REFERENCE
1. The management of hip fracture in adults. June NICE full clinical guideline (CG124) 2. Outcome of dislocation after hemiarthroplasty for fractured neck of femur in a district general hospital. Journal of Bone and Joint Surgery (Br) vol 88B, No. SUPP 1, Factors predisposing to dislocation of the Thompson hemiarthroplasty, Pajarinen et al. Acta Orthop Scand (1): Dislocation after bipolar hemiarthroplasty of the hip. Barnes et al. The Journal of Arthroplasty. Vol 10 (5) 1995, 667 – Dislocation after hemiarthroplasty of the hip: A comparison of dislocation rate after posterior and lateral approaches to the hip. Unwin et al. Annals of the Royal College of Surgeons of England. 1994: 76; Stability of hip hemiathroplasties. Parker et al. International Orthopaedics :