Total Hip Arthroplasty After In Situ Fixation of Minimally Displaced Femoral Neck Fractures in Elderly Patients

Nicholas M. Hernandez, Brian P. Chalmers, Kevin I. Perry, Daniel J. Berry, Brandon J. Yuan, Matthew Abdel

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background In situ screw fixation remains the most common treatment for minimally displaced femoral neck fractures (FNFs). Total hip arthroplasty (THA) can be used as a salvage procedure, but the results of conversion THA in this population have not been evaluated. The goals of this study were to evaluate (1) unique complications associated with conversion THA, (2) implant survivorship free of revision and reoperation, (3) radiographic results, and (4) clinical outcomes in patients undergoing conversion THA after in situ fixation of nondisplaced FNFs. Methods Between 2000 and 2014, 62 consecutive patients >65 years of age who underwent THA after in situ fixation of minimally displaced FNFs were identified. Indications were osteonecrosis (44%), post-traumatic/degenerative arthritis (35%), and nonunion (21%). Mean age was 78 years, and 73% patients were women. Mean follow-up was 5.5 years. Results One patient was revised for aseptic femoral loosening at 11 years. One patient underwent debridement and modular component exchange at 10 years for acute hematogenous periprosthetic joint infection. Two patients underwent acute reoperation without component exchange (one superficial wound infection, one hematoma evacuation). Survivorship free of reoperation for any indication was 97% at 5 years. No patients with surviving implants had radiographic evidence of loosening at 5 years. Harris hip scores improved from 35-85 (P <.01) after THA. Conclusion Conversion THA was associated with clinical improvement, a low rate of complications, and excellent implant durability. Risks of loosening, dislocation, and periprosthetic fracture can be minimized with appropriate operative strategies and perioperative management.

Original languageEnglish (US)
Pages (from-to)144-148
Number of pages5
JournalJournal of Arthroplasty
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Femoral Neck Fractures
Arthroplasty
Hip
Reoperation
Survival Rate
Periprosthetic Fractures
Osteonecrosis
Debridement
Wound Infection
Thigh
Osteoarthritis
Hematoma
Joints
Infection

Keywords

  • closed reduction percutaneous pinning
  • conversion total hip arthroplasty
  • femoral neck fractures
  • nonunion
  • screw fixation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Total Hip Arthroplasty After In Situ Fixation of Minimally Displaced Femoral Neck Fractures in Elderly Patients. / Hernandez, Nicholas M.; Chalmers, Brian P.; Perry, Kevin I.; Berry, Daniel J.; Yuan, Brandon J.; Abdel, Matthew.

In: Journal of Arthroplasty, Vol. 33, No. 1, 01.01.2018, p. 144-148.

Research output: Contribution to journalArticle

Hernandez, Nicholas M. ; Chalmers, Brian P. ; Perry, Kevin I. ; Berry, Daniel J. ; Yuan, Brandon J. ; Abdel, Matthew. / Total Hip Arthroplasty After In Situ Fixation of Minimally Displaced Femoral Neck Fractures in Elderly Patients. In: Journal of Arthroplasty. 2018 ; Vol. 33, No. 1. pp. 144-148.
@article{bb9b02fe352c49569676d7ad7c779155,
title = "Total Hip Arthroplasty After In Situ Fixation of Minimally Displaced Femoral Neck Fractures in Elderly Patients",
abstract = "Background In situ screw fixation remains the most common treatment for minimally displaced femoral neck fractures (FNFs). Total hip arthroplasty (THA) can be used as a salvage procedure, but the results of conversion THA in this population have not been evaluated. The goals of this study were to evaluate (1) unique complications associated with conversion THA, (2) implant survivorship free of revision and reoperation, (3) radiographic results, and (4) clinical outcomes in patients undergoing conversion THA after in situ fixation of nondisplaced FNFs. Methods Between 2000 and 2014, 62 consecutive patients >65 years of age who underwent THA after in situ fixation of minimally displaced FNFs were identified. Indications were osteonecrosis (44{\%}), post-traumatic/degenerative arthritis (35{\%}), and nonunion (21{\%}). Mean age was 78 years, and 73{\%} patients were women. Mean follow-up was 5.5 years. Results One patient was revised for aseptic femoral loosening at 11 years. One patient underwent debridement and modular component exchange at 10 years for acute hematogenous periprosthetic joint infection. Two patients underwent acute reoperation without component exchange (one superficial wound infection, one hematoma evacuation). Survivorship free of reoperation for any indication was 97{\%} at 5 years. No patients with surviving implants had radiographic evidence of loosening at 5 years. Harris hip scores improved from 35-85 (P <.01) after THA. Conclusion Conversion THA was associated with clinical improvement, a low rate of complications, and excellent implant durability. Risks of loosening, dislocation, and periprosthetic fracture can be minimized with appropriate operative strategies and perioperative management.",
keywords = "closed reduction percutaneous pinning, conversion total hip arthroplasty, femoral neck fractures, nonunion, screw fixation",
author = "Hernandez, {Nicholas M.} and Chalmers, {Brian P.} and Perry, {Kevin I.} and Berry, {Daniel J.} and Yuan, {Brandon J.} and Matthew Abdel",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.arth.2017.07.035",
language = "English (US)",
volume = "33",
pages = "144--148",
journal = "Journal of Arthroplasty",
issn = "0883-5403",
publisher = "Churchill Livingstone",
number = "1",

}

TY - JOUR

T1 - Total Hip Arthroplasty After In Situ Fixation of Minimally Displaced Femoral Neck Fractures in Elderly Patients

AU - Hernandez, Nicholas M.

AU - Chalmers, Brian P.

AU - Perry, Kevin I.

AU - Berry, Daniel J.

AU - Yuan, Brandon J.

AU - Abdel, Matthew

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background In situ screw fixation remains the most common treatment for minimally displaced femoral neck fractures (FNFs). Total hip arthroplasty (THA) can be used as a salvage procedure, but the results of conversion THA in this population have not been evaluated. The goals of this study were to evaluate (1) unique complications associated with conversion THA, (2) implant survivorship free of revision and reoperation, (3) radiographic results, and (4) clinical outcomes in patients undergoing conversion THA after in situ fixation of nondisplaced FNFs. Methods Between 2000 and 2014, 62 consecutive patients >65 years of age who underwent THA after in situ fixation of minimally displaced FNFs were identified. Indications were osteonecrosis (44%), post-traumatic/degenerative arthritis (35%), and nonunion (21%). Mean age was 78 years, and 73% patients were women. Mean follow-up was 5.5 years. Results One patient was revised for aseptic femoral loosening at 11 years. One patient underwent debridement and modular component exchange at 10 years for acute hematogenous periprosthetic joint infection. Two patients underwent acute reoperation without component exchange (one superficial wound infection, one hematoma evacuation). Survivorship free of reoperation for any indication was 97% at 5 years. No patients with surviving implants had radiographic evidence of loosening at 5 years. Harris hip scores improved from 35-85 (P <.01) after THA. Conclusion Conversion THA was associated with clinical improvement, a low rate of complications, and excellent implant durability. Risks of loosening, dislocation, and periprosthetic fracture can be minimized with appropriate operative strategies and perioperative management.

AB - Background In situ screw fixation remains the most common treatment for minimally displaced femoral neck fractures (FNFs). Total hip arthroplasty (THA) can be used as a salvage procedure, but the results of conversion THA in this population have not been evaluated. The goals of this study were to evaluate (1) unique complications associated with conversion THA, (2) implant survivorship free of revision and reoperation, (3) radiographic results, and (4) clinical outcomes in patients undergoing conversion THA after in situ fixation of nondisplaced FNFs. Methods Between 2000 and 2014, 62 consecutive patients >65 years of age who underwent THA after in situ fixation of minimally displaced FNFs were identified. Indications were osteonecrosis (44%), post-traumatic/degenerative arthritis (35%), and nonunion (21%). Mean age was 78 years, and 73% patients were women. Mean follow-up was 5.5 years. Results One patient was revised for aseptic femoral loosening at 11 years. One patient underwent debridement and modular component exchange at 10 years for acute hematogenous periprosthetic joint infection. Two patients underwent acute reoperation without component exchange (one superficial wound infection, one hematoma evacuation). Survivorship free of reoperation for any indication was 97% at 5 years. No patients with surviving implants had radiographic evidence of loosening at 5 years. Harris hip scores improved from 35-85 (P <.01) after THA. Conclusion Conversion THA was associated with clinical improvement, a low rate of complications, and excellent implant durability. Risks of loosening, dislocation, and periprosthetic fracture can be minimized with appropriate operative strategies and perioperative management.

KW - closed reduction percutaneous pinning

KW - conversion total hip arthroplasty

KW - femoral neck fractures

KW - nonunion

KW - screw fixation

UR - http://www.scopus.com/inward/record.url?scp=85028052986&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028052986&partnerID=8YFLogxK

U2 - 10.1016/j.arth.2017.07.035

DO - 10.1016/j.arth.2017.07.035

M3 - Article

VL - 33

SP - 144

EP - 148

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

SN - 0883-5403

IS - 1

ER -