Date: Mon, 22 Nov 2004 11:58:45 -0800
Subject: Femoral Neck Fracture
From: Eitan Melamed
Dear list members,
A 53 year old lady on heavy glucocorticoid therapy sustained a displaced femoral neck fracture. She is a community ambulator, and wishes to walk again.
Would you do ORIF or primary THR?
Thanks,
Eitan Melamed
Date: Tue, 23 Nov 2004 04:09:29 +0000
From: aobonedoc
I never perform primary THA for an acute femoral neck fx (not yet in 8 years of practice). I understand primary THA for acute fx has higher rate of dislocation than elective THA for OA.
Sincerely and respectively,
M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
Arlington Heights, Illinois 60005
Date: Tue, 23 Nov 2004 07:41:55 -0800
From: Eitan Melamed
Would you offer her cannulated- screw fixation despite her terrible osteoporosis?
Eitan
Date: Mon, 22 Nov 2004 23:42:25 -0600
From: Obremskey, William T
This is a topic that I think will change in our careers.
See attached slides.
|
|
Arthroplasty has slight increased risk of infection long term and IF has significant risk of reoperation.
Recent RCT of THA vs IF in healthy alert elderly patients has a 2% risk of dislocation at 1 and 2 years. I believe it is the STARS trial out of England. I have seen data presented, but not published. A group is also attempting to organize an international RCT of IF vs hemi vs THA.
Bill
Date: Tues, 23 Nov 2004 9:03 AM EST
From: Bill Burman
>RCT of IF vs hemi vs THA
See OTA 2004 Scientific Poster #87 Geriatric (age 65 and older)
Date: Tue, 23 Nov 2004 11:11:30 -0500
From: James Carr
I don't have any science to quote, but a hemiarthroplasty will give a Harris hip score in the 70's to 80's, while a total hip will give one in the 90's. I agree that selection is the key, based on preoperative function and other factors. Hopefully with improvement of bearing surfaces that allow bigger head components, and techniques like the posterior capsular flap, the dislocations can be minimized. I know in my younger hip replacement patients where I use the 36 mm metal on metal heads the stability is awesome.
Jim Carr