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Clinical Outcomes of Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Patients 80 Years of Age and Older Selected by Clinical Frailty Score

Hip & Pelvis 2020년 32권 3호 p.148 ~ 155
조승환, 이세환, 윤선중,
소속 상세정보
조승환 ( Jo Sueng-Hwan ) - Chosun University School of Medicine Department of Orthopaedic Surgery
이세환 ( Lee Se-Hwan ) - Chonbuk National University Hospital Department of Orthopedic Surgery
윤선중 ( Yoon Sun-Jung ) - Chonbuk National University Hospital Department of Orthopedic Surgery

Abstract


Purpose: The utility of total hip arthroplasty (THA) for the treatment of displaced femoral neck fractures in elderly patients (≥80 years of age) remains controversial as a patient's general condition is an essential factor impacting recovery. This study aims to determine if THA is a valuable option for appropriately selected elderly patients.

Materials and Methods: All patients underwent cementless THA using a direct lateral approach with a rectangular stem. Eighty-two patients ≥80 years of age underwent THA due to a displaced femoral neck. Clinical frailty scale (CFS) scores <5 were indicated for THA. The modified Harris hip score (mHHS), visual analogue scale (VAS), and patient satisfaction were used to assess outcomes.

Results: Nine of 82 patients died in the study period with another underlying disease. One, a 90-year-old male with pneumonia expired in the intensive care unit at 7-day postoperatively, while the other eight died due to causes unrelated to THA. Of the remaining 73 patients: (i) mean mHHS score increased to 80.57±21.36 at 1-year postoperatively; (ii) VAS was 2.3±0.9 points six-months postoperatively; and (iii) 78.7% of patients reported that they were very satisfied or satisfied 1-year postoperatively. The number of perioperative complications was 10.8% (9 hips) without the need for revision surgery.

Conclusion: The use of THA in patients ≥80 years of age with low CFS scores (<5) described here yielded favorable results and a relatively low rate of complications. However, a well-controlled comparative study or randomized trial is required to further refine selection criteria for THA in this patient population.

키워드

Femoral neck fractures; Osteoporosis; Elderly; Total hip replacement; Frailty

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