Objective: To evaluate the efficacy of capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients.
Methods: A retrospective study was designed. From June 2009 to June 2016, 53 senile patients (54 hips)with femoral neck fracture were treated operatively in Mianyang central hospital (Sichuan, China). There were 21 males and 32 females, ranging in age from 80 to 97.5 years old (mean, 84.7 years old). There were 11 hips of Garden type II, 26 hips of Garden type III and 17 hips of Garden type IV. All the patients underwent bipolar hemiarthroplasty with enhanced repair of hip capsular. The hip joint was opened by a T shaped incision over posterior capsule. The posterior hip capsular and short external rotators were repaired particularly after the bipolar prostheses were implanted. Surgical time, intra-operative blood loss, mean hospitalization time, deep venous thrombosis, mortality, hip dislocation, pain, periprosthetic fracture, and other complications were recorded. The functional outcome was evaluated using the Harris Hip Score at the last follow-up.
Results: The 53 patients (54 hips) were evaluated during the hospitalization period and a mean follow-up period of 11.5 months(ranged, 3 to 36 months). No dislocation, incision infection and periprosthetic fracture appeared in this group. The mean surgical time was 65 minutes(ranged, 50 to 95 min). The mean intra-operative blood loss was 213 ml(ranged, 100 to 420 ml) and the mean hospitalization time was 13.3 days(ranged, 5 to 27 days). Two patients with deep vein thrombosis, one patient with pulmonary embolism and 10 patients with venous plexus thrombosis of calf muscle were diagnosed postoperatively. The rate of venous thrombosis was 24.53% (13/53). The patient with pulmonary embolism died 8 days after operation and the other 3 patients died from heart failure 4, 6 and 7 months after operation respectively. The mortality during first year after hemiarthroplasty was 7.55% (4/53). At the latest follow-up, 42 patients (43 hips)had no pain, 9 patients had mild pain, and 2 patients had moderate pain. No patients were non-ambulatory. The mean Harris Hip Score was 91.25±8.39, functional outcome was excellent in 44 hips, good in 5, and fair in 5.
Conclusions: The bipolar hemiarthroplasty with capsular-enhanced repair with suture anchors is effective in reducing postoperative complications of prosthesis dislocation.
Keywords: Bipolar hemiarthroplasty; Capsular; Elderly patient; Femoral neck fracture; Repair.