Aches & Joints

Michael Weaver, MD is an Orthopaedic Trauma Surgeon, at Brigham & Women’s Hospital.

The reduction and fixation of displaced femoral neck fractures has an unacceptably high rate of failure, particularly in the geriatric population. Reconstruction with either hemiarthroplasty or total hip arthroplasty (THA) is the accepted treatment for these fractures. In active patients reconstruction with a total hip has advantages in terms of pain relief, functional outcome, and prosthesis longevity (1).

While many surgeons are skilled in performing THA for degenerative conditions of the hip – including osteoarthritis and avascular necrosis – patients with femoral neck fractures present several unique challenges. Here are my experiences:

Intraoperative Fracture
Femoral neck fractures are fragility fractures associated with poor bone quality, a marker of osteoporosis. The trend in arthroplasty has been toward press-fit femoral components that allow for bone ingrowth and long-term stability. Thus, I use ingrowth femoral stems with a more canal-filling geometry instead of taper-type stems to reduce hoop stresses and prevent fracture. A doubled up 16-gauge circlage wire should be placed prophylactically between the greater and lesser trochanters prior to broaching.
Care must also be taken with placement and impacting of the acetabular component. There is usually no subchondral sclerosis, and it can be easy to breach the medial wall with the acetabular reamers. Supplementing acetabular fixation with at least 2 screws can prove useful.

Pre-operative pelvic AP is the template to guide radiographic placement of the cup. Adjust the C-arm orientation to recreate this image.

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Filed under: Hip, Joint Replacement, Physician Education, Trauma, Trauma Rounds | Tagged: fractures, hip replacement, Physician Education, total hip replacement, Trauma | 2 Comments »