Functional outcome of cemented hemiarthroplasty in elderly patients with fracture neck of femur

M. Mobaraque Hossain; A. B. M. Rashedul Amir; M. Zahurul Islam

doi:10.18203/issn.2455-4510.IntJResOrthop20263885

Authors

M. Mobaraque Hossain Department of Orthopedic Surgery, Pirganj Upazila Health Complex, Rangpur, Bangladesh
A. B. M. Rashedul Amir Department of Orthopedic Surgery, Rangpur Medical College Hospital, Rangpur, Bangladesh
M. Zahurul Islam Department of Orthopedic Surgery, Kaunia Upazila Health Complex, Rangpur, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263885

Keywords:

Cemented hemiarthroplasty, Femoral neck fracture, Functional outcome, Harris hip score

Abstract

Background: Fracture of the neck of the femur in elderly patients is a major cause of morbidity, mortality, and functional dependency. Due to osteoporosis and poor bone quality, displaced intracapsular fractures are commonly managed with arthroplasty rather than internal fixation. Cemented hemiarthroplasty provides immediate stability, early mobilisation, and improved functional recovery in osteoporotic bone. This study aimed to evaluate the functional outcome of cemented hemiarthroplasty in elderly patients with fracture of the neck of the femur.

Methods: This descriptive observational study was conducted in two healthcare centres in Rangpur, Bangladesh, involving 40 elderly patients aged 60-80 years with displaced femoral neck fractures managed with cemented hemiarthroplasty. Patients with pathological fractures, multiple injuries, or medical unfitness for surgery were excluded. Data were collected through clinical evaluation, radiological confirmation, and postoperative follow-up. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25. Functional outcome was assessed using the Harris hip score and overall functional grading, classified as excellent, good, fair, or poor.

Results: The mean age was 71.4±6.2 years, with a female predominance. Most fractures were Garden type III and IV. The mean Harris Hip Score was 85.6±8.3. Functional outcome was excellent in 45%, good in 35%, fair in 12.5%, and poor in 7.5% of patients. Overall, 80% of patients achieved good to excellent results. Complications were observed in 15% of cases, and the mortality rate was 7.5% at follow-up. The mean hospital stay was 9.5±3.2 days.

Conclusions: Cemented hemiarthroplasty was associated with satisfactory short-term functional recovery and acceptable complication and mortality rates in elderly patients with displaced femoral neck fractures. It appears to be a reliable surgical option for carefully selected patients with osteoporotic hip fractures.

References

Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015;29(3):121-9.

Schemitsch EH. Total hip arthroplasty or hemiarthroplasty for hip fracture. Orthop Proceed. 2021 103(3):61-1.

Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteopor Int. 2011;22(5):1277-88.

Cheung CL, Ang SB, Chadha M, Chow ES, Chung YS, Hew FL, et al. An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteopor Sarcopen. 2018;4(1):16-21.

Ali M, Uddin Z, Hossain A. Prevalence and patterns of risk of osteoporosis in bangladeshi adult population: an analysis of calcaneus quantitative ultrasound measurements. Osteology. 2021;1(4):187-96.

Lewis DP, Waever D, Thorninger R, Donnelly WJ. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplast. 2019;34(8):1837-43.

Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomised trials. Int Orthop. 2012;36(8):1549-60.

Fernandez MA, Achten J, Parsons N, Griffin XL, Png ME, Gould J, et al. Cemented or uncemented hemiarthroplasty for intracapsular hip fracture. N Engl J Med. 2022;386(6):521-30.

Kristensen TB, Dybvik E, Kristoffersen M, Dale H, Engesæter LB, Furnes O, et al. Cemented or uncemented hemiarthroplasty for femoral neck fracture? Data from the Norwegian Hip Fracture Register. Clin Orthop Rel Res. 2020;478(1):90-100.

He Y, Tang X, Liao Y, Liu S, Li L, Li P. The comparison between cemented and uncemented hemiarthroplasty in patients with femoral neck fractures: a systematic review and meta‐analysis of randomised controlled trials. Orthop Surg. 2023;15(7):1719-29.

Li T, Zhuang Q, Weng X, Zhou L, Bian Y. Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis. PloS One. 2013;8(7):e68903.

Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year follow-up of a randomized trial. Clin Orthop Rel Res. 2014;472(4):1291-9.

Haentjens P, Autier P, Barette M, Boonen S, Belgian Hip Fracture Study Group. Predictors of functional outcome following intracapsular hip fracture in elderly women: a one-year prospective cohort study. Injury. 2005;36(7):842-50.

Kashanian K, Bourget-Murray J, Horton I, Morris J, Group OA, Papp SR, et al. National Institute of Health and Care Excellence Guidelines for Displaced Intracapsular Hip Fractures: examining satisfaction with the guidelines and effects on outcomes. J Arthroplast. 2024;39(11):2761-6.

Switzer JA, O’Connor MI. AAOS management of hip fractures in older adults evidence-based clinical practice guideline. J Am Acad Orthop Surg. 2022;30(20):e1297-301.

Rogmark C, Johnell O, Sernbo I. A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur: functional outcome for 450 patients at two years. J Bone Joint Surg Br Vol. 2002;84(2):183-8.

Nicolaides V, Galanakos S, Mavrogenis AF, Sakellariou VI, Papakostas I, Nikolopoulos CE, et al. Arthroplasty versus internal fixation for femoral neck fractures in the elderly. Strat Trauma Limb Reconstr. 2011;6(1):7-12.

Ye CY, Liu A, Xu MY, Nonso NS, He RX. Arthroplasty versus internal fixation for displaced intracapsular femoral neck fracture in the elderly: systematic review and meta-analysis of short-and long-term effectiveness. Chinese Med J. 2016;129(21):2630-8.

Rogmark C, Leonardsson O. Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Joint J. 2016;98(3):291-7.

Health Investigators. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med. 2019;381(23):2199-208.

Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, et al. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7(10):e46175.