Hip resection arthroplasty for acute femoral neck fractures in the non-ambulator

Abstract

Objectives: Hemiarthroplasty (HA) is the current standard of care for displaced femoral neck fractures (FNFs) in non-ambulators. Despite excellent outcomes, arthroplasty-specific risks remain, including dislocation, implant failure, periprosthetic fracture and infection, and fat embolization syndrome. To eliminate the possibility of these complications, should non-ambulatory patients with acute, native hip FNFs be treated with simple hip resection arthroplasty (HRA) instead of HA? Design: Retrospective case series. Setting: Large, urban level-1 trauma center. Patients/Participants: Five non-ambulatory patients (6 hips) with acute, native hip FNF underwent femoral head and neck resection. Also, the most recent 10 FNFs treated with HA were also identified for comparison purposes. Intervention:HRA was performed via a Smith-Peterson approach with an oscillating saw or osteotome to complete the fracture or perform a fresh neck cut. MainOutcomeMeasurements: Outcomes included postoperative vs preoperative VAS pain scores and narcotics usage, and return to baseline functional status (sit up in bed or a chair postoperatively). Procedure time for HRA was compared with the 10 most recent patients with FNF treated with HA. Results:HRA resulted in decreased postoperative vs preoperative VAS pain scores (7.7 vs 3.3, P=.002), and decreased operative times (59.2 minutes for HRA, 111.8 minutes for HA, P