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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.
Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck.
Patients and methods
In a multicenter prospective study conducted in France over an inclusion time of 3months, 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 9months postoperative.
Two hundred and fourteen hips in 214 patients with a mean age of 83years (range, 70–103years) were included. None of the patients was lost to follow-up. The mortality rate after 9months was 19%. Two patients (1%) had early postoperative infection successfully treated with lavage 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.
This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemiarthroplasties. 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.Le texte complet de cet article est disponible en PDF.
Keywords : Femoral neck fracture, Total hip arthroplasty, Dual mobility, Elderly