Indications for using proper type of prosthesis in elderly patients with femoral neck fractures

Abstract

Introduction. Femoral neck fractures in the elderly are frequent due to the increase in life expectancy. These injuries represent a great health care problem and have a significant impact on health insurance costs. Hip replacement for this kind of fractures is a common and safe procedure, which will allow to mobilize patients shortly after surgery. Types of endoprosthesis used in elderly include unipolar, bipolar hemiarthroplasty, or total hip arthroplasty. Over ¾ of cases occur after the age of 60, with the main predisposing factor being osteoporosis, so a minor trauma involving an accidental fall is sufficient to produce a fracture. In young people, to produce such a fracture, a much stronger impact is required. Aim of the study. Summarizing of indications and contraindication of using a certain type of prosthesis for the treatment of the femoral neck fractures in elderly patients. Materials and methods. For the study were used the materials collected in the 2nd Department of the PMSI Clinical Hospital for Orthopedics and Traumatology during the 2012-2017 period, that included data of 464 elderly patients with femoral neck fracture. The main focus was: the Garden classification of the fracture, age of the patient, their general condition, osteoporosis and osteoarthritis degrees. Results. In 2nd department were hospitalized patients with Garden III and IV type of the femoral neck fracture. Unipolar prosthesis was used in 171 cases (36.9%), only in patients over 80 years; bipolar hemiarthroplasty in 192 cases (41.5%), age variation was of 60 - 80 years; also a total hip arthroplasty was selected for 101 (21.6%) patients with advanced degrees of osteoarthritis. In our study, unipolar hemiarthroplasty was used for the patients who are physiologically older with comorbidities. They were satisfied after surgery, being able to perform their daily activity. Advantages of monopolar and bipolar arthroplasties include short operation time and quick mobilization of the patient, which is very good to prevent complications. Disadvantages of unipolar and bipolar hemiarthroplasty is that they increase biomechanical stresses on the acetabulum with consecutive destruction of the acetabular fosa with developing of cotiloidites. The appearance of cotiloiditis may require surgical re-intervention and conversion to the total hip prosthesis. 85% were patients over 70 years of age, respectively the prostheses used were mostly bipolar and monopolar, but there were also those who required total prosthesis. Total hip replacement is advantageous for active, healthy, lucid patients, with a long life expectancy. Conclusions. The discussions of using total hip arthroplasty vs monopolar or bipolar hemiarthroplasty are still open. Total hip replacement seems to be preferred for avoiding surgical re-intervention with possible patient risks and additional costs. Also these aspects should be evaluated to avoid the risks of prolonged and invasive surgical intervention occurring in total hip arthroplasty.