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
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
<p>Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck.Patiants and method
<p>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
<p>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
<p>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
<p>Level III prospective, case study.
