Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures?

Détails

ID Serval
serval:BIB_595A6E8553A7
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures?
Périodique
Orthopaedics & traumatology, surgery & research
Auteur(s)
Guyen O.
ISSN
1877-0568 (Electronic)
ISSN-L
1877-0568
Statut éditorial
Publié
Date de publication
02/2019
Peer-reviewed
Oui
Volume
105
Numéro
1S
Pages
S95-S101
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Résumé
The optimal treatment of recent femoral neck fractures remains debated. The available options are internal fixation, hemiarthroplasty (HA) and total hip arthroplasty (THA). There is a consensus in favour of internal fixation in younger patients. In elderly individuals who are institutionalised and have limited physical activity, HA is usually performed when the joint line is intact. Whether HA or THA deserves preference in patients aged 60 years or over is unclear. In addition, there are two types of HA, unipolar and bipolar, and two types of THA, conventional and dual-mobility. Both HA types provide similar outcomes with satisfactory stability but a risk of acetabular wear that may eventually require conversion to THA. THA is associated with better functional outcomes and a lower risk of revision surgery in self-sufficient, physically active patients. Instability is the leading complication of conventional THA and occurs with a higher incidence compared to HA. With all implant types, preoperative factors associated with mortality and complications include walking ability and level of self-sufficiency, nutritional status, and haematocrit. An evaluation of these factors before surgery is of paramount importance. Factors amenable to treatment should be corrected by working jointly with geriatricians to develop a preoperative management strategy. In patients who are self-sufficient, physically active, and free of risk factors, THA remains the option of choice, as it provides better functional outcomes. A dual-mobility implant deserves preference to prevent instability. HA is indicated in patients whose self-sufficiency and physical activity are limited. A unipolar implant should be used, as no evidence exists that bipolar implants provide additional benefits. When performing HA, the posterior approach should be avoided given the risk of instability. For THA, in contrast, the posterior approach is a reliable option in the hands of an experienced surgeon using a dual-mobility cup. Cement fixation of the stem is recommended to minimise the risk of peri-prosthetic fracture.
Mots-clé
Bipolar hemiarthroplasty, Dual-mobility implants, Intracapsular femoral neck fracture, Total hip arthroplasty, Unipolar hemiarthroplasty
Pubmed
Web of science
Création de la notice
18/12/2018 13:30
Dernière modification de la notice
20/08/2019 14:12
Données d'usage