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Abstract

Introduction:

Dislocation following hip hemiarthroplasty is a serious complication. It remains unclear if acetabular morphology is associated with a higher risk of dislocation. The aim of our study was to investigate whether there are differences in hip morphology radiological parameters between patients who have suffered a dislocation episode, and those who have not suffered a dislocation.

Material and methods:

Between January 2015 and December 2018, a nested case-control study was performed. From 707 patients who underwent hip hemiarthroplasty because of femoral neck fracture, 50 patients (50 hips) suffered an episode of dislocation. They were randomly matched with 94 patients (100 hips) without dislocation (ratio 1:2). Clinical data regarding demographics, medical comorbidities and surgical and radiological parameters were studied.

Results:

Statistically significantly smaller lateral centre-edge angle (LCEA) and femoral offset (FO) and greater Tönnis angle were found in the dislocation group. No differences in acetabular angle were seen. Neurological impairment prevalence was statistically significantly higher in patients who suffered a dislocation (60% vs. 44%, p = 0.011).

Conclusions:

The current study suggests that a smaller LCEA and FO, a greater TA, and neurological impairment could be related to a higher risk of hip hemiarthroplasty dislocation after femoral neck fracture in the elderly. We consider that preoperative templating could be helpful in identifying abnormal parameters and carefully planning surgery could lead to changes in treatment strategy, such as choosing a dual-mobility total hip arthroplasty.

Keywords

Acetabulum morphology femoral neck fractures hemiarthroplasty hip dislocation preoperative planning radiological parameters

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References

Jongjit

Komsopapong

Songjakkaew

, et al. Health-related quality of life after hip fracture in the elderly community-dwelling. Southeast Asian J Trop Med Public Health 2003; 34: 670–674.

Gullberg

Johnell

Kanis

JA.

World-wide projections for hip fracture. Osteoporos Int 1997; 7: 407–413.

Neuburger

Currie

Wakeman

, et al. The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data. Med Care 2015; 53: 686–691.

Moran

Wenn

Sikand

, et al. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 2005; 87: 483–489.

Brox

Roberts

Taksali

, et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on management of hip fractures in the elderly. J Bone Joint Surg Am 2015; 97: 1196–1199.

Bhandari

Devereaux

Tornetta

, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am 2005; 87: 2122–2130.

HEALTH

Investigators

Bhandari

Einhorn

, et al. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med 2019; 381: 2199–2208.

Metcalfe

Judge

Perry

, et al. Total hip arthroplasty versus hemiarthroplasty for independently mobile older adults with intracapsular hip fractures. BMC Musculoskelet Disord 2019; 20: 226.

Gill

Kiliyanpilakkill

Parker

MJ.

Management and outcome of the dislocated hip hemiarthroplasty. Bone Joint J 2018; 100-B: 1618–1625.

10.

Blewitt

Mortimore

Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury 1992; 23: 320–322.

11.

Burgers

Van Geene

Van den Bekerom

, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop 2012; 36: 1549–1560.

12.

Piggott

Smithwick

Murphy

CG.

Hip hemiarthroplasty in neurologic or cognitively impaired patients: a case series of post-operative dislocations. J Orthop Case Rep 2018; 8: 18–22.

13.

Ren

Liu

, et al. What are the risk factors for dislocation of hip bipolar hemiarthroplasty through the anterolateral approach? A nested case-control study. Clin Orthop Relat Res 2016; 474: 2622–2629.

14.

Jones

Briffa

Jacob

, et al. The dislocated hip hemiarthroplasty: current concepts of etiological factors and management. Open Orthop J 2017; 11: 1200–1212.

15.

Salem

Shannak

Scammell

, et al. Predictors and outcomes of treatment in hip hemiarthroplasty dislocation. Ann R Coll Surg Engl 2014; 96: 446–451.

16.

de Palma

Procaccini

Soccetti

, et al. Hospital cost of treating early dislocation following hip arthroplasty. Hip Int 2012; 22: 62–67.

17.

Zhang

Yao

Shi

, et al. Morphological risk factors associated with dislocation after bipolar hemiarthroplasty of the hip in patients with femoral neck fractures—a nested case-control study. J Orthop Surg Res 2019; 14: 395.

18.

Kim

Joo

, et al. Risk factors associated with dislocation after bipolar hemiarthroplasty in elderly patients with femoral neck fracture. Hip Pelvis 2016; 28: 104.

19.

Madanat

Mäkinen

Ovaska

, et al. Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case–control study. Int Orthop 2012; 36: 935–940.

20.

Mukka

Lindqvist

Peyda

, et al. Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: a cohort study. Int Orthop 2015; 39: 1277–1282.

21.

Della Valle

Padgett

Salvati

EA.

Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg 2005; 13: 455–462.

22.

Sierra

Schleck

Cabanela

ME.

Dislocation of bipolar hemiarthroplasty: rate, contributing factors, and outcome. Clin Orthop Relat Res 2006; 442: 230–238.

23.

Wilkin

Ibrahim

Smit

, et al. A contemporary definition of hip dysplasia and structural instability: toward a comprehensive classification for acetabular dysplasia. J Arthroplasty 2017; 32: S20–S27.

24.

Ninh

Sethi

Hatahet

, et al. Hip dislocation after modular unipolar hemiarthroplasty. J Arthroplasty 2009; 24: 768–774.

25.

National Institute for Health and Care Excellence (UK). Hip fracture: management (CG124), http://www.ncbi.nlm.nih.gov/books/NBK553768/ (2017, accessed 24 June 2020).

26.

HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet 2020; 395: 698–708.

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