SHORT TERM OUTCOME CEMENTLESS TOTAL HIP REPLACEMENT FOR

FRACTURE NECK FEMUR IN ELDERLY : A CASE REPORT

Indri Pratiwi Tobing MD, Noha R,Soekarno SpOT

RS Hermina Grand Wisata, Tambun Selatan, Indonesia

Abstract

When dealing Femoral Neck Femur in elderly with limited activity, hemiarthroplasty has been a
preferred choice to make the patient return to mobillity with less bleeding during the surgery and
speedy recovery and ambulatory. Nowadays, Elderly might have different life expectation and longer
live expectancy.

We present a case of elderly,fremoral neck fracture, 74 years old male with a hobby of travelling
around Indonesia, recreational sports and commnunal activity and high life expectation was
performed with a cementless total hip replacement with piriformis sparring technique.

The case was reviewed and followed for 4 months and scorring with Harris Hip Score and WOMAC
index score to address the successful outcome and function of this case on both the neck femur
correction and patient speedy recovery.

Keywords

Total Hip Replacement, Hip arthtroplasty ,Cementless, Fracture neck femur, Elderly

Introduction

Total hip arthroplasty (THA) Originally intended for elderly, with end-stage osteoarthritis of the hip,
providing patients with early return to their activities with significant improvement in their quality of
life

According to United Nations elderly or older persons are the people aged 60+ years. Currently elderly
might have different life expectation and longer live expectancy.

Femoral neck fractures are commonly sustained by older patients with the unsteadiness of gait and
reduced bone mineral density, predisposing to fracture. mechanism of injury varies from falls directly
onto the hip to a twisting mechanism in which the patient’s foot is planted and the body rotates.

The treatment of elderly patient depends on local conditions, patient profiles, personal preferences and
training of the surgeon. In geriatric population, the usage of conventional stems/straight stems or short
stems with either cementless or cemented fixation is generally preferred

the short stems reportedly an adequate treatment, providing rigid fixation, could decrease the
incidence of intraoperative periprosthetic fracture, Less blood loss and a lower transfusion rate and
also the shorter operative times compare to the straight stems.
The uncemented prosthesis can shorten the operation time and reduce the incidence of pulmonary
embolism, but the incidence of prosthetic-related complications was higher in uncemented patients .

Methodology

A Clinical follow up : the Harris Hip Score, WOMAC index and the Visual Analogue Scaale (VAS)
for pain at rest and on load as well as overall patient satisfation

Radiological follow up : AP-View pelvis radiograph.

Total Hip arhtroplasty was performed under spinal anesthesia via posterolateral approach with The
piriformis-sparing technique.
the head-neck fragment, acetabulum and the proximal femur was inspected and no impression of
lacking bone quality.
The acetabulum is progressively reamed to the appropriate size and depth to correcting the leg length,
and the stems was placed and cementless in proper anteversion and abduction angles and short
rotators are secured. The incision-suture time was 120 min. intraarticular drain was inserted.

Case Presentation

We present a 74-year-old male patient, 177 cm in height and weighing 90 kg, with pain in the right
hip. He described inguinal symptoms upon weight-bearing and at rest, with pain radiating into the
thigh and down to the knee over a period of approximately six weeks after incidentally fell down from
a 1 meter height stairs in his house.

Mobility in the right hip was markedly impaired, at extension/flexion (Ex/Flex) 0/0/90°, ext/int
rotation (ER/IR) 20/0/0° and abduction/adduction (Abd/Add) 20/0/10°. The Harris Hip Score
modified according to Haddad was 37, the WOMAC score was 103.

X-ray : femoral neck fracture of right hip joint with the joint gap obliterated centrocaudally (Fig. 1).

Day-1 Post Op : The perioperative blood loss was 250 ml. the serial blood test revealed no need of
blood transfusion. The wound healed primarily.

X-ray : normal position of the cementless THA, with a correctly adjusted leg length and offset.
(Fig.2)

Day-2 Post Op : still immobilized, drain was removed.

Day-4 Post Op : conducted to walking and followed up by the Physiotherapy team. The inflammatory
parameter was at normal (leukocytes 8640 g/dl)

Day-5 Post Op : The patient was discharged, patient was ambulatory with a walker device.
Two,3 and 4 months after the operation, the wound had healed completely, free of irritation and dry.

Week-4 Post op: xray showed Subsidence or a periprosthetic fracture were not present, the prosthesis
was now seen to be securely integrated in the bone. (Fig.3)

The range of motion (ROM) showed a good postoperative outcome, with Ex/Flex =0/0/90°, ER/IR
25/0/15°, and Abd/Add 25/0/15°. The HHS increased by 58 points to now 95 points and the
WOMAC dropped from 103 points to now 0 points postoperatively.

Discussion

The aim of this case report was to investigate complications and the clinical and radiological outcome
followed for this elderly patient who had been received the cementless total hip arthroplasty.

We asked the question if this particular cementless THA, which to date still is mainly used in young
and active patients, can be implanted safely in elderly patients.

To our knowledge, it is the first report of its kind as far as this short-term design is concerned.

The early clinical outcome of this patient is encouraging with zero scale for the mean VAS values of
rest pain, load pain, and great satisfaction after surgery.

Finally, since this report investigated only one case of short term, the present results cannot be
generalized to different cementless THA cases.

Conclusions

A post-surgical femoral neck femur was successfully treated with cementless total hip arthtroplasty

A 4-months follow up examination : neck femur fracture correction and patient speedy recovery and
early ambulation.

These results indicate that the correction of femoral neck fracture in elderly following cementless total
hip arhtroplasty is achieveable and might be a desirable clinical outcomes.

REFERENCES

1. Mited States social security area 1900–2100. Social Security Administration, Office of the
Chief Actuary, SSA Pub. No. 11-11536.
2. World Health Organisation. Health situation and trend assessment, Elderly population.
3. Karagas MR, Lu-Yao GL, Barrett JA et-al. Heterogeneity of hip fracture: age, race, sex, and
geographic patterns of femoral neck and trochanteric fractures among the US elderly. Am. J.
Epidemiol. 1996;143 (7): 677-82.
4. Robertson GA, Wood AM. Hip hemi-arthroplasty for neck of femur fracture: What is the
current evidence? World J Orthop. 2018 Nov 18;9(11):235-244. doi: 10.5312/wjo.v9.i11.235.
PMID: 30479970; PMCID: PMC6242732.
5. Macaulay W, Pagnotto MR, Iorio R, Mont MA, Saleh KJ. Displaced femoral neck fractures in
the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg.
2006;14:287–293.

6. Abdulkarim A, Ellanti P, Motterlini N, Fahey T, O’Byrne JM. Cemented versus uncemented

fixation in total hip replacement: a systematic review and meta-analysis of randomized
controlled trials. Orthop Rev (Pavia) 2013;5:e8. doi: 10.4081/or.2013.e8.