John, Decruz
(2008)
Outcome of fracture neck of femur treated by replacement surgery in the elderly.
Masters thesis, Universiti Sains Malaysia.
Abstract
In the new millennium we expect to see significant increase in life
expectancy, hence an increase in elderly population. Osteoporotic related
fractures such as femoral neck fractures are expected to be on the rise in
incidence and carry significant morbidity and mortality . The incidence of hip
fracture in Malaysia is 88 and 218 per 100,000 men and women respectively
(NOF, 2005).
The optimal surgical treatment of displaced femoral neck fractures in
elderly with Osteoporosis remains controversial. Surgical options include
prosthetic replacement (arthroplasty) and internal fixation. Arthroplasty options
include hemiarthroplasty, bipolar arthroplasty, and total hip arthroplasty.
The mortality rate ranged from 14%- 30% in the first year( Kenzora 1984).
The decision of whether to internally fix or replace a displaced femoral neck
fracture is based on life expectancy, the presence of chronic disease, bone
quality, and level of function at the time of fracture, as well as on expected
function.
A retrospective study to assess the outcome of traumatic fracture neck of
femur in the elderly aged above 65 years, from 1st January 2001 to 31st
December 2005 treated by replacement arthroplasty ( Unipolar or Bipolar
Hemiarthroplasty ), was conducted in Hospital Universiti Sains Malaysia.
Outcome was scored via follow up at Orthopaedic clinic or telephone interview
from the patient or primary care giver using the Harris Hip score ( Appendix 2).
Prevalence of Osteoporosis in these patients was also reviewed using Singh
Index (Appendix 3 ) .There were 45 cases of traumatic neck of femur fracture
treated with hemiarthroplasty or Bipolar Hemiarthroplasty that met the criteria for
this study All parameter was analysed using SPSS Version 12.0 .1 ( 2007). All data
obtained from this study underwent descriptive analysis with regards to
sociodemographic pattern. The mean age was 75.13 years (range, 65 to 89 years). There were 39
women (86.7%) and 6 men (13.3%).0ut of these 45 patients,15 (50 %) had
returned to their premorbid ambulatory status.
Functional Outcome , 7(15.6%) patients obtained a Harris Hip Score of
excellent (90-100), 13(28.9%) obtained a score of good (80--89), and 11(24.4%)
obtained a score of fair (70-79) ,3(6.7%) obtained a score of poor (60-69) and 1
(2.2%) obtained scores of failed (<60 ),6 represented (22.2%) patients who were
not amenable for scoring. A total of 68.9 % of patients had a cumulative fair
HHS score, which represented good functional outcome .Patients who had
Bipolar replacement had better functional outcome .11 out of 16 patients returned
to their premorbid status of being community ambulators and faired well in the
Harris Hip Scores .
Patients who were walking independently before trauma had a better
outcome than those who needed aid to walk. Only half ( 50% ) of the patients
who were initially community ambulators returned to their premorbid status .
The degree of Osteoporosis was assessed using the Singh index . 33
patients (73.3%) had significant established osteoporosis with Grade 1 ( 2
patients ),Grade 2 ( 9 patients) grade 3 (22 patients) respectively. Within 1 month of surgery, 2 (4.4 %) patients had died and subsequently 7 (15.6%) had
died after 1 year post operatively The functional outcome of Hemiarthroplasty was 68.9% of patients
obtaining good results which is acceptable and among these cases patients who
underwent Bipolar Hemiarthroplasty showed better outcome with 68.75% having
excellent to good outcome as compared to Unipolar Hemiarthroplasty . 11 out of
16 cases had returned to their premorbid status as community ambulators . Post
operative functional outcome in terms of ambulation showed 50 % of patients
returning back to their premorbid ambulatory status
There was a definite correlation between the incidence of fracture neck of
femur and Osteoporosis. In this study, 73.3 % of patients showed evidence of
established Osteoporosis. This would support the decision to choose
Replacement Arthroplasty rather than Internal fixation in Garden type 3 and 4.
The mortality rate in this study was 15.6 % within the first year of operation
which is within an acceptable range as compared to other studies which rates
was as high as 30 % .
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