Abstract
Aim:To determine the outcome of patients whose hemiarthroplasty dislocate after treatment for displaced fracture of the neck of femur in a district general hospital.
Method: A retrospective analysis of 636 hemiarthroplasties performed in Weston General Hospital between 1998 and 2003, data collected from case records. A simple method of scoring from literature was used for this study based on two factors: Status and Mobility. Patients were scored for both status and mobility four times: prefracture, at 1,3 and finally 6 months after surgery.
Results: The overall dislocation rate was 1.2% (8 ) of which 2 were male and 6 female. The mean time to dislocate was 14 days (2–21 ) and subsequent relocation time 7.5hr (4–8). Three patients had cemented Bipolar hemiarthroplasty and five had cemented Thompsons hemiarthroplasty. Three had died within 6 months of surgery, three died two years after surgery, mortality rate of 37.5% at 6 months. There was a high rate of dislocation 87.5% (7), four had undergone Thompsons and other three had Bipolar hemiarthroplasty. Six of them underwent further procedures. Two of the cemented Thompsons were revised to a similar prosthesis, another Thompsons was converted to a Girdlestone due to comorbid factors, remaining Thompsons did not undergo any further surgery. In the Bipolar group one was converted to a Total hip replacement, another was revised to monopolar hemiarthroplasty and the third patient in this group was initially revised to bipolar hemiarthroplasty which was also unstable and had to be converted to a girdlestone. The overall mortality following redislocation was 40% at 6 months. Comparing the surviving and non-surviving group, the predictor for favourable outcomes were prefracture status and mobility scores. Mean prefracture status score for the surviving group was 5 compared with 3.5(2–5) in the non-surviving group and the mean prefracture mobility score for the surviving group was 5 compared with 3.3(2–5) in the non surviving group.
Conclusion: In this review we have found that 37.5% of patients will not survive 6 months after dislocation of hemiarthroplasty and if redislocation occurs in this group then the 6 month mortality increqases to 40%. Careful surgical technique and proper implant choice will reduce dislocation and probably lead to increased survival mainly in patients who have higher prefracture status and mobility scores.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
