Turan Bilge Kizkapan1, Abdulhamit Misir2, Erdal Uzun3, Sinan Oguzkaya4, Mustafa Ozcamdalli5. 1. Department of Orthopedics and Traumtology, Bursa Cekirge State Hospital, Bursa, Turkey. Electronic address: turanbilge.kizkapan@gmail.com. 2. Department of Orthopedics and Traumatology, Health Sciences University Gaziosmanpasa Training and Research Hospital, Karayollari Mah. Osmanbey Cad. 621. Sk Gaziosmanpasa, 34255 Istanbul, Turkey. Electronic address: misirabdulhamitmd@gmail.com. 3. Department of Orthopedics and Traumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey. Electronic address: nuzuladre@gmail.com. 4. Department of Orthopedics and Traumtology, Sivas Sarkisla State Hospital, Sivas, Turkey. Electronic address: sinanoguzkaya@hotmail.com. 5. Faculty of Medicine, Department of Orthopedics and Traumatology, Ahi Evran University, Kirsehir, Turkey. Electronic address: mustafaozcamdalli@hotmail.com.
Abstract
PURPOSE: This study aimed to investigate the anatomic risk factors associated with dislocation following bipolar hemiarthroplasty for the treatment of femoral neck fracture. MATERIALS AND METHODS: We retrospectively reviewed 208 consecutive patients (133 women, 75 men) with femoral neck fractures who were treated with bipolar hemiarthroplasty between 2015 and 2018. A comparative analysis was performed between dislocation (n = 18) and non-dislocation (n = 190) groups in terms of patient demographics, surgical and pelvic morphologic factors, and clinical outcomes, including postoperative Harris and modified Harris hip scores. Independent risk factors affecting dislocation were also evaluated. RESULTS: The mean follow-up period was 30.8 ± 2.0 (range, 12-48) months. The mean age was 79.2 ± 7.4 (range, 71-94) years. The dislocation rate was 8.6% (18/208), and the mean dislocation time after operation was 2.0 ± 1.1 (range, 1-4) months. Patient-related factors did not differ between the dislocated and non-dislocated groups. As regards dislocation, statistically significant difference was observed in surgical and pelvic morphologic factors, including femoral offset, residual femoral neck length, trochanter upper end and femoral head center distance, and height of the hip center of the operated side (p = 0.025, p = 0.013, p = 0.002, p = 0.008, respectively). Moreover, the femoral offset, height of the hip center, and femoral neck-shaft angle of the non-operated side are significantly different between the groups (p = 0.007, p = 0.001, p = 0.027, respectively). Decrease in the center edge (CE) angle, offset of prosthesis, and increase in femoral head extrusion index (FHEI) of the operated side and decrease in the height of the hip center of the non-operated side increased the risk of dislocation (p = 0.030, OR: 1,306; p = 0.041, OR: 8.15; p = 0.020, OR: 1.038; p = 0.010, OR: 2.02, respectively). CONCLUSIONS: Pelvic morphologic features and surgical factors were found to affect dislocation. Patients with smaller OP, CE angle of the operated side, and higher FHEI and smaller height of the hip center of the non-operated side should be carefully monitored to decrease postoperative dislocation.
PURPOSE: This study aimed to investigate the anatomic risk factors associated with dislocation following bipolar hemiarthroplasty for the treatment of femoral neck fracture. MATERIALS AND METHODS: We retrospectively reviewed 208 consecutive patients (133 women, 75 men) with femoral neck fractures who were treated with bipolar hemiarthroplasty between 2015 and 2018. A comparative analysis was performed between dislocation (n = 18) and non-dislocation (n = 190) groups in terms of patient demographics, surgical and pelvic morphologic factors, and clinical outcomes, including postoperative Harris and modified Harris hip scores. Independent risk factors affecting dislocation were also evaluated. RESULTS: The mean follow-up period was 30.8 ± 2.0 (range, 12-48) months. The mean age was 79.2 ± 7.4 (range, 71-94) years. The dislocation rate was 8.6% (18/208), and the mean dislocation time after operation was 2.0 ± 1.1 (range, 1-4) months. Patient-related factors did not differ between the dislocated and non-dislocated groups. As regards dislocation, statistically significant difference was observed in surgical and pelvic morphologic factors, including femoral offset, residual femoral neck length, trochanter upper end and femoral head center distance, and height of the hip center of the operated side (p = 0.025, p = 0.013, p = 0.002, p = 0.008, respectively). Moreover, the femoral offset, height of the hip center, and femoral neck-shaft angle of the non-operated side are significantly different between the groups (p = 0.007, p = 0.001, p = 0.027, respectively). Decrease in the center edge (CE) angle, offset of prosthesis, and increase in femoral head extrusion index (FHEI) of the operated side and decrease in the height of the hip center of the non-operated side increased the risk of dislocation (p = 0.030, OR: 1,306; p = 0.041, OR: 8.15; p = 0.020, OR: 1.038; p = 0.010, OR: 2.02, respectively). CONCLUSIONS: Pelvic morphologic features and surgical factors were found to affect dislocation. Patients with smaller OP, CE angle of the operated side, and higher FHEI and smaller height of the hip center of the non-operated side should be carefully monitored to decrease postoperative dislocation.
Keywords:
CE angle; Dislocation; Femoral head extrusion index; Height of the hip Center; Hemiarthroplasty; Offset; Pelvic morphology; Posterolateral; Risk factor
Authors: Johannes Karl Maria Fakler; Markus Rositzka; Nicolas Schopow; Andreas Roth; Dirk Zajonz; Mohamed Ghanem; Christian Kleber; Georg Osterhoff Journal: Eur J Trauma Emerg Surg Date: 2022-03-30 Impact factor: 2.374