Proth猫se de hanches 脿 double mobilit茅 comme traitement des fractures d茅plac茅es du col du f茅mur du sujet 芒g茅. Une 茅tude prospective, syst茅matique, multicentrique plus particuli猫rement focalis茅e sur le risque de luxation postop茅ratoire

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• 作者：P. Adam^a ; ^{philippe.adam@chru-strasbourg.fr} ; R. Philippe^b ; M. Ehlinger^a ; O. Roche^b ; F. Bonnomet^a ; D. Molé ; ^b ; M.-H. Fessy^c ; French Society of Orthopaedic Surgery ; Traumatology (SoFCOT)¹
• 关键词：Femoral neck fracture ; Total hip arthroplasty ; Dual mobility ; Elderly
• 刊名：Revue de Chirurgie Orthop篓娄dique et Traumatologique
• 出版年：2012
• 期刊代码：pca328_18770517
• 类别：med
• 出版时间：May, 2012
• 卷：98
• 期：3
• 页码：258-259
• 文件大小：195 K

摘要

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Summary

Introduction

Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty. The type of arthroplasty to be used, either hemi- or total hip arthroplasty, remains controversial as total hip replacements potentially have a higher rate of dislocation.

Hypothesis

Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck.

Patiants and method

In a multicenter prospective study, conducted in France over an inclusion time of 3 months, all displaced fractures of the femoral neck treated with arthroplasty were operated on with insertion of a dual mobility cup. Patients had clinical and radiological assessment at 3, 6, and 9 months postoperative.

Results

Two hundred and fourteen hips in 214 patients with a mean age of 83 years (range, 70-103 years) were included. None of the patients was lost to follow-up. The mortality rate after 9 months was 19%. Two patients (1%) had early postoperative infection successfully treated with m>lavagem> and antibiotics. Three patients (1.4%), operated through a posterior approach, presented one postoperative dislocation, all of which were posterior. Reduction was performed through closed external manipulation under general anesthesia. There was no recurrence of dislocation.

Discussion

This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemi-arthroplasties. Dual mobility cups might therefore be considered a valuable option to prevent postoperative dislocation when treating displaced intracapsular fractures of the proximal femur in elderly patients if a total hip replacement is recommended. Further study is needed before extending the indications for total hip arthroplasty following a fracture of the femoral neck, to assess the potential cost and complications of a longer procedure with its potential acetabular complication, and weigh them against the potential benefits.

Level of evidence

Level III prospective, case study.