Faculty of Medicine

Dislocation of Total Hip Arthroplasty of Femoral Neck Fracture in the Elderly: A Narrative Review

English

Femoral neck fracture (FNF) is a common and devastating injury in the elderly population. The incidence of FNF is expected to increase in the future, particularly in the aging population. The displaced intracapsular FNF is replaced with a reconstruction prosthesis. These treatment options typically include hemiarthroplasty (HA) or total hip arthroplasty (THA). Dislocation after THA can be a significant complication, leading to increased hospital costs and patient dissatisfaction. This narrative review aims to investigate the potential risk factors for dislocation following THA after FNF.
A systematic literature search was conducted, and 21 studies met the inclusion criteria. The studies included a total of 1703 patients who underwent THA after FNF. The majority of the patients were women, and the average age of participants was 76.2 years. The studies were primarily conducted by the orthopedic and traumatology departments. The surgical approach used for THA varied, with the anterior approach being associated with lower dislocation rates compared to the posterior approach.
The analysis of surgical volume revealed that high-volume hospitals had lower dislocation rates compared to low-volume hospitals. Eight studies reported postoperative Harris Hip Scores (HHS), with higher HHS scores correlating with lower dislocation rates. Body mass index (BMI) was mentioned in 11 studies, and a normal BMI range was associated with lower dislocation rates compared to the overweight group.
Rehabilitation protocols, particularly early initiation of physiotherapy, showed promising results in reducing dislocation rates. Additionally, the type of prosthesis used in the acetabulum was found to influence dislocation rates, with dual mobility cups demonstrating lower rates compared to single cups.
In conclusion, several factors may contribute to the risk of dislocation following THA after FNF. These include the surgical approach, surgical volume, postoperative HHS scores, BMI, rehabilitation protocols, and the type of acetabular cup used. Further research is needed to better understand these risk factors and develop strategies to minimize dislocation rates and improve patient outcomes.

2023

Emmanouil Skotidis
Kyriakos Bekas
Ioannis Kechagias
Ioannis Tsakonas - Ntervakos
Spyridon Galanakos
Konstantinos Kateros

CUREUS

Springer Science and Business Media LLC

15

10

1-11

Fracture femoral neck, Hemi arthroplasty, Hip dislocation, Surgical approach, Total hip arthroplasty

Health Sciences

https://doi.org/10.7759/cureus.46307

10.7759/cureus.46307

Overmann AL, Richards JT, O'Hara NN, D'Alleyrand JC, Slobogean GP: Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: a systematic review and meta-analysis. Injury. 2019, 50:2158-66. 10.1016/j.injury.2019.09.039
Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, Saleh KJ: Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop Relat Res. 2001, 383:229-42. 10.1097/00003086-200102000-00027
Lizaur-Utrilla A, Sanz-Reig J, Miralles-Muñoz FA: [Cementless total hip arthroplasty after acute femoral neck fracture in active patients. Prospective matched study with a minimum follow-up of 5 years]. Rev Esp Cir Ortop Traumatol. 2014, 58:152-9. 10.1016/j.recot.2014.01.005
Zhang Y, Yao Z, Shi P, Wang C, Liu J, Yang Y, Zhang C: Morphological risk factors associated with dislocation after bipolar hemiarthroplasty of the hip in patients with femoral neck fractures-a nested case-control study. J Orthop Surg Res. 2019, 14:395. 10.1186/s13018-019-1409-1
Dimitriou D, Helmy N, Hasler J, Flury A, Finsterwald M, Antoniadis A: The role of total hip arthroplasty through the direct anterior approach in femoral neck fracture and factors affecting the outcome. J Arthroplasty. 2019, 34:82-7. 10.1016/j.arth.2018.08.037
Turgut A, Kumbaracı M, Kalenderer Ö, İlyas G, Bacaksız T, Karapınar L: Is surgeons' experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture?. Acta Orthop Traumatol Turc. 2016, 50:601-5. 10.1016/j.aott.2015.11.004
Bensen AS, Jakobsen T, Krarup N: Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. Int Orthop. 2014, 38:1241-5. 10.1007/s00264-013-2276-8
Seitz S, Koehne T, Ries C, et al.: Impaired bone mineralization accompanied by low vitamin D and secondary hyperparathyroidism in patients with femoral neck fracture. Osteoporos Int. 2013, 24:641-9. 10.1007/s00198-012-2011-0
Bagi CM, Ammann P, Rizzoli R, Miller SC: Effect of estrogen deficiency on cancellous and cortical bone structure and strength of the femoral neck in rats. Calcif Tissue Int. 1997, 61:336-44. 10.1007/s002239900344
Hauer G, Heri A, Klim S, Puchwein P, Leithner A, Sadoghi P: Survival Rate and Application Number of Total Hip Arthroplasty in Patients With Femoral Neck Fracture: An Analysis of Clinical Studies and National Arthroplasty Registers. J Arthroplasty. 2020, 35:1014-22. 10.1016/j.arth.2019.11.033
Sassoon A, D'Apuzzo M, Sems S, Cass J, Mabry T: Total hip arthroplasty for femoral neck fracture: comparing in-hospital mortality, complications, and disposition to an elective patient population. J Arthroplasty. 2013, 28:1659-62. 10.1016/j.arth.2013.01.027
Noticewala M, Murtaugh TS, Danoff J, Cunn GJ, Shah RP, Geller J: Has the risk of dislocation after total hip arthroplasty performed for displaced femoral neck fracture improved with modern implants?. J Clin Orthop Trauma. 2018, 9:281-4. 10.1016/j.jcot.2017.09.002
Lim JW, Ng GS, Jenkins RC, Ridley D, Jariwala AC, Sripada S: Total hip replacement for neck of femur fracture: Comparing outcomes with matched elective cohort. Injury. 2016, 47:2144-8. 10.1016/j.injury.2016.07.019
Kim MW, Chung YY, Lee JW, Kim CH: Measuring the impact of femoral head size on dislocation rates following total hip arthroplasty. Hip Pelvis. 2017, 29:91-6. 10.5371/hp.2017.29.2.91
Liao L, Zhao Jm, Su W, Ding Xf, Chen Lj, Luo Sx: A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures. Arch Orthop Trauma Surg. 2012, 132:1021-9. 10.1007/s00402-012-1485-8
Nilsson LT, Jalovaara P, Franzén H, Niinimäki T, Strömqvist B: Function after primary hemiarthroplasty and secondary total hip arthroplasty in femoral neck fracture. J Arthroplasty. 1994, 9:369-74. 10.1016/0883-5403(94)90046-9
Kim YT, Yoo JH, Kim MK, Kim S, Hwang J: Dual mobility hip arthroplasty provides better outcomes compared to hemiarthroplasty for displaced femoral neck fractures: a retrospective comparative clinical study. Int Orthop. 2018, 42:1241-6. 10.1007/s00264-018-3767-4
Assi CC, Barakat HB, Caton JH, Najjar EN, Samaha CT, Yammine KF: Mortality rate and mid-term outcomes of total hip arthroplasty using dual mobility cups for the treatment of femoral neck fractures in a middle eastern population. J Arthroplasty. 2019, 34:333-7. 10.1016/j.arth.2018.10.030
Boukebous B, Boutroux P, Zahi R, Azmy C, Guillon P: Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: a retrospective case-control study of 199 hips. Orthop Traumatol Surg Res. 2018, 104:369-75. 10.1016/j.otsr.2018.01.006
Lavernia CJ, Guzman JF: Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995, 10:133-40. 10.1016/s0883-5403(05)80119-6
Sköldenberg O, Ekman A, Salemyr M, Bodén H: Reduced dislocation rate after hip arthroplasty for femoral neck fractures when changing from posterolateral to anterolateral approach. Acta Orthop. 2010, 81:583-7. 10.3109/17453674.2010.519170
Gjertsen JE, Lie SA, Fevang JM, Havelin LI, Engesaeter LB, Vinje T, Furnes O: Total hip replacement after femoral neck fractures in elderly patients: results of 8,577 fractures reported to the Norwegian Arthroplasty Register. Acta Orthop. 2007, 78:491-7. 10.1080/17453670710014130
Anakwe RE, Middleton SD, Jenkins PJ, Butler AP, Aitken SA, Keating JF, Moran M: Total hip replacement in patients with hip fracture: a matched cohort study. J Trauma Acute Care Surg. 2012, 73:738-42. 10.1097/TA.0b013e3182569ee4
Tarasevicius S, Busevicius M, Robertsson O, Wingstrand H: Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture. BMC Musculoskelet Disord. 2010, 11:175. 10.1186/1471-2474-11-175
Tarasevicius S, Robertsson O, Dobozinskas P, Wingstrand H: A comparison of outcomes and dislocation rates using dual articulation cups and THA for intracapsular femoral neck fractures. Hip Int. 2013, 23:22-6. 10.5301/HIP.2013.10632
Nich C, Vandenbussche E, Augereau B, Sadaka J: Do dual-mobility cups reduce the risk of dislocation in total hip arthroplasty for fractured neck of femur in patients aged older than 75 years?. J Arthroplasty. 2016, 31:1256-60. 10.1016/j.arth.2015.11.041
Thürig G, Schmitt JW, Slankamenac K, Werner CM: Safety of total hip arthroplasty for femoral neck fractures using the direct anterior approach: a retrospective observational study in 86 elderly patients. Patient Saf Surg. 2016, 10:12. 10.1186/s13037-016-0100-2
Homma Y, Baba T, Ozaki Y, et al.: In total hip arthroplasty via the direct anterior approach, a dual-mobility cup prevents dislocation as effectively in hip fracture as in osteoarthritis. Int Orthop. 2017, 41:491-7. 10.1007/s00264-016-3332-y
Konan S, Rhee SJ, Haddad FS: Total hip arthroplasty for displaced fracture of the femoral neck using size 32 mm femoral head and soft tissue repair after a posterior approach. Hip Int. 2009, 19:30-5. 10.1177/112070000901900106
Low AK, Gursel AC: Mid-term outcome of total hip replacement using the posterior approach for displaced femoral neck fractures. Hip Int. 2012, 22:203-8. 10.5301/HIP.2012.9210
Canton G, Moghnie A, Cleva M, Kostoris FM, Murena L: Dual mobility total hip arthroplasty in the treatment of femoral neck fractures: a retrospective evaluation at mid-term follow-up. Acta Biomed. 2019, 90:98-103. 10.23750/abm.v90i1-S.8070
Ochi H, Baba T, Homma Y, et al.: Total hip arthroplasty via the direct anterior approach with a dual mobility cup for displaced femoral neck fracture in patients with a high risk of dislocation. SICOT J. 2017, 3:56. 10.1051/sicotj/2017048
Klein GR, Parvizi J, Vegari DN, Rothman RH, Purtill JJ: Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem. J Arthroplasty. 2006, 21:1134-40. 10.1016/j.arth.2006.01.023
Chammout G, Muren O, Laurencikas E, et al.: More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. Acta Orthop. 2017, 88:145-51. 10.1080/17453674.2016.1262687
Flury A, Finsterwald M, Dimitriou D, Helmy N, Hasler J, Antoniadis A: Should advanced age be a contraindication to total hip arthroplasty in femoral neck fracture patients? A matched-control, retrospective study. J Orthop. 2020, 17:25-9. 10.1016/j.jor.2019.08.007
Gang W, Gu GS, Li D, Sun DH, Zhang W, Wang TJ: Comparative study of anterolateral approach versus posterior approach for total hip replacement in the treatment of femoral neck fractures in elderly patients. Chinese J Traumatol - English Ed. 2010, 13:234-9. 10.3760/cma.j.issn.1008-1275.2010.04.008
Enocson A, Hedbeck CJ, Tidermark J, Pettersson H, Ponzer S, Lapidus LJ: Dislocation of total hip replacement in patients with fractures of the femoral neck. Acta Orthop. 2009, 80:184-9. 10.3109/17453670902930024
Graversen AE, Jakobsen SS, Kristensen PK, Thillemann TM: No dislocations after primary hip arthroplasty with the dual mobility cup in displaced femoral neck fracture in patients with dementia. A one-year follow-up in 20 patients. SICOT J. 2017, 3:9. 10.1051/sicotj/2016050
Abboud JA, Patel RV, Booth RE Jr, Nazarian DG: Outcomes of total hip arthroplasty are similar for patients with displaced femoral neck fractures and osteoarthritis. Clin Orthop Relat Res. 2004, 151-4. 10.1097/01.blo.0000127114.67635.19
Sanchez-Sotelo J, Berry DJ: Epidemiology of instability after total hip replacement. Orthop Clin North Am. 2001, 32:543-52. 10.1016/S0030-5898(05)70225-X
Enocson A, Lapidus G, Törnkvist H, Tidermark J, Lapidus LJ: Direction of hip arthroplasty dislocation in patients with femoral neck fractures. Int Orthop. 2010, 34:641-7. 10.1007/s00264-009-0943-6
Nilsdotter A, Bremander A: Measures of hip function and symptoms: harris hip score (HHS), hip disability and osteoarthritis outcome score (HOOS), oxford hip score (OHS), lequesne index of severity for osteoarthritis of the hip (LISOH), and american academy of orthopedic surgeons (AAOS) hip and knee questionnaire. Arthritis Care Res (Hoboken). 2011, 63:S200-7. 10.1002/acr.20549
Peterson CM, Thomas DM, Blackburn GL, Heymsfield SB: Universal equation for estimating ideal body weight and body weight at any BMI. Am J Clin Nutr. 2016, 103:1197-203. 10.3945/ajcn.115.121178
Wang CG, Li YM, Zhang HF, Li H, Li ZJ: Anterior approach versus posterior approach for pipkin I and II femoral head fractures: aq systemic review and meta-analysis. Int J Surg. 2016, 27:176-81. 10.1016/j.ijsu.2016.02.003
Enocson A, Tidermark J, Tornkvist H, Lapidus LJ: Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthop. 2008, 79:211-7. 10.1080/17453670710014996
Cebatorius A, Robertsson O, Stucinskas J, Smailys A, Leonas L, Tarasevicius S: Choice of approach, but not femoral head size, affects revision rate due to dislocations in THA after femoral neck fracture: results from the Lithuanian Arthroplasty Register. Int Orthop. 2015, 39:1073-6. 10.1007/s00264-014-2618-1

https://pergamos.lib.uoa.gr/uoa/dl/object/3433226/file.pdf

https://pergamos.lib.uoa.gr/uoa/dl/object/3433226