Role of hemiarthroplasty -30th aug 2015
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Transcript of Role of hemiarthroplasty -30th aug 2015
ROLE OF HEMIARTHROPLASTY--HIP
Dr Uday Kumar MS(Orth) DNB(Orth) Sagar Hospitals Sindhi Hospital Chinmaya Hospital Bangalore
6th September 2015 Asram MC Eluru
Displaced Fractures ORIF• ORIF is an option in elderly
• Complications• Nonunion 10 -33%• AVN 15 – 33%
• AVN related to displacement • Early ORIF no benefit
• Loss of reduction / fixation failure 16%
Hemi-arthroplasty of hip
Absolute indications
• Patients over 65 yrs
• Fracture neck not satisfactorily reduced
• Loss of fixation after several weeks of operation
• Pathological fracture
• Old undiagnosed fracture • Neck # with complete dislocation of head
Absolute indications
Relative indications
• Advanced physiological age with life expectancy more than 10-15 yrs
• Parkinsonism, hemiplegia or other neurological disease.
Contraindications
• Active sepsis
• Active young person
• Preexisting acetabular disease (e.g.,
rheumatoid arthritis)
Hemi associated with
Lower reoperation rate (6-18% vs. 20-36%)
Improved functional scores
Slightly increased short term mortality
Mathew –JBJS –2010Matsen---CORR-2014
--allows faster full weight bearing
--It eliminates non-union
osteonecrosis
failure of fixation risks (>20% to 30% of cases with ORIF require secondary surgery).
Hemi-arthroplasty vs ORIF
Disadvantages
• Removal of anatomical head
• More extensive procedure --greater blood loss
-A risk of acetabular erosion exists in active individuals
HemiarthroplastyUnipolar vs. Bipolar
• Bipolar theoretical advantages• Lower dislocation rate• Less acetabular wear/ protrusio• Less Pain• More motion
• Bipolar• Disadvantages
• Cost• Dislocation often requires open reduction
• Loss of motion interface• Polyethylene wear/ osteolysis
Hemiarthroplasty Cemented vs. Non-cemented
• Conclusion:
• Cement gives better results• Function• Mobility• Implant Stability• Pain• Cost-effective
• risk of sudden cardiac death
• Use cement with cautionn
THR versus hemiarthroplasty
• Studies have reported better functional results compared with hemiarthroplasty
• It eliminates the potential for acetabular erosion
Disadvantages over hemiarthroplasty
Include a more extensive surgical procedure
Increased implant cost
Higher risk of prosthetic dislocation
THR versus hemiarthroplasty
ORIF vs. cemented bipolar hemi vs. THA
37% fixation failure (AVN/nonunion)
similar dislocation rate hemi vs. THA (3%)
ORIF 8X more likely to require revision surgery than hemi and 5X more likely than THA
Keating et alOTA--2012
CONCLUSION--Bipolar arthroplasty is better than ORIF for fracture neck femur in patients between 65 to 75 years.
-- Cemented modular bipolar hemiarthroplasty has more advantages in in osteoporotic fractures.
--Above 75 years bipolar arthoplasty is indicated