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Approach, fixation contribute to success of THR to treat displaced femoral neck fractures

Issue: January 2019

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Tad M. Mabry

ORLANDO — The two main options for treating displaced femoral neck fractures are hemiarthroplasty and total hip replacement which, among older patients, are indicated, respectively, for patients with lower activity levels who live in nursing homes and for cognitively intact patients who are living independently or with limited assistance, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting.

Tad M. Mabry, MD, said THR and hemiarthroplasty (HA) are on a par with each other in terms of their ability to relieve a patient’s pain and improve function, but there are key reasons to consider THR when a patient presents with a displaced femoral neck fracture.

“I think it is important to realize that the benefits – the clinical benefit – of total hip is actually seen early; as early as 3 or 4 months in some studies,” Mabry said.

However, he noted, when deciding to perform THR instead of HA in these cases, “we are going to bring along some increased risks for instability and some problems on the acetabular side, such a fracture or loosening.”

Mabry said orthopedic surgeons must be prepared for these possible situations. They can do that by selecting the best approach and performing it with “meticulous soft tissue handling,” choosing the appropriate method of implant fixation since that has been shown in studies to have an effect on later risk of revision, and taking steps to maximize hip stability, he said.

A treatment algorithm that addresses approach, fixation and maximizing hip stability is helpful to refer to when developing a treatment strategy for patients with these types of hip fractures, Mabry said. – by Susan M. Rapp

Reference:

Mabry TM. Paper 14. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-15, 2018; Orlando.

Disclosure: Mabry reports no relevant financial disclosures.