PROSPECTIVE STUDY OF MANAGEMENT OF FRACTURE NECK OF FEMUR BY HEMIARTHROPLASTY WITH CEMENTED BIPOLAR

BACKGROUND AND OBJECTIVES Fracture neck of femur is a leading cause of hospital admissions in elderly age group. The number of such admissions is on a rise because of increased longevity, osteoporosis and sedentary habits. Conservative methods of treatment is not acceptable because it results in nonunion with unstable hip and limitation of hip movement as well as complications of prolonged immobilization like bed sores, deep vein thrombosis and respiratory infections. Hemiarthroplasty remains the most common modality of treatment in our country. The time-tested unipolar prosthesis is being slowly replaced by bipolar prosthesis, which is claimed to have a lower incidence of complications. This study was conducted to analyze the results of surgical management of fracture neck of femur using modular bipolar hemiarthroplasty. MATERIALS AND METHODS The present study was a prospective study of 50 cases of fracture neck of femur admitted to Basaweshwar Hospital attached to MR Medical College, Kalburagi, between the study periods of July 2014 to July 2015. Cases were selected according to inclusion and exclusion criteria, i.e., patients with intra-capsular fracture neck of femur above the age of 55yrs. Medically unfit and patients not willing for surgery were excluded from the study. RESULTS In our series of 50 cases, there were 19 males and 31 females with a maximum age of 92 yrs, minimum age of 58 yrs, and an average age of 65 years. There was a slight predominance of left-sided fractures when compared to the right. The mean duration of hospital stay was 5 days. At the final one year follow-up assessment with Harris Hip Score, 18 patients (35%) achieved 'Excellent' result, 22 patients (45%) achieved 'Good' result, 5 patients (10%) achieved 'Fair' result and 5 patients (10%) achieved 'Poor' result. Overall, 80% of the patients achieved an excellent or good result. On enquiry regarding the overall satisfaction with the procedure and return to pre-fracture levels of activity, 18 patients (35%) were 'Very Satisfied,' 25 (50%) were 'Fairly Satisfied' and 7 (15%) were 'Not Satisfied.' CONCLUSION Modular bipolar hemiarthroplasty for fractures of the femoral neck provides better range of movement, freedom from pain and more rapid return to unassisted activity with an acceptable complication rate. The end functional results depend on the age of the patient, associated co-morbidity and optimum post-operative rehabilitation. The advantage of the system is in the modularity obtained from the different sized stems, shell which are available in increments of size allow exact matching of the head and the ease with which the system can be converted to total hip arthroplasty without replacing the femoral stems. The long-term results using modular bipolar hemiarthroplasty needs further study for a longer period in a larger sample.