Published: 2016-12-30

An evaluation of merits of total hip arthroplasty done for traumatic and non-traumatic displaced fracture neck of femur

Vipul Agarwal, Manjeet Singh Dhanda, Abhishek Singh, Harnam Singh Madan, Shewtank Goel, Sarina Agarwal, Pooja Goyal


Background: There is ongoing controversy about the relative merits of different types of arthroplasty among specific groups of patients. Paucity of quality data provides an opportunity for extension of this debate. The aim of this study was planned to evaluate merits (outcomes and complications) of total hip arthroplasty done for traumatic and non traumatic displaced fracture neck of femur.

Methods: A comparative evaluation was undertaken among 50 patients who underwent total hip replacement at a tertiary care center. A retrospective cohort of fifty patients treated with total hip replacement for traumatic causes of displaced fracture neck of femur (25 patients) and non-traumatic causes of displaced fracture neck of femur (25 patients) were included in this study. The inclusion criteria’s for the traumatic group were acute displaced fracture neck of femur above 50 years and fracture neck with fracture head with dislocation above 50 years. Patients having nonunion fracture neck of femur, failed cancellous screw fixation, intertrochantric fractures and associated acetabulum fractures were excluded from this study.

Results: On clinical and functional evaluation, patients scored 84% excellent/good in non-traumatic group whereas 68% excellent/good score in traumatic group. 12% and 16% patients scored poor in non-traumatic group and in traumatic group respectively. In non-traumatic group, following complications were observed. Dislocation rate of 4% (one hip), 4% incidence of aseptic acetabular loosening (one hip), and 16% incidence of heterotrophic ossification (four hips). In traumatic group, we observed 2 (8%) dislocations, 4 (16%) heterotopic ossifications. Loosening of acetabulum and subsidence were observed in two (8%) patients.

Conclusions: There are higher chances of dislocation among patients undergoing total hip replacement for a traumatic indications as compared to their non-traumatic indications. Chances of dislocation can be curtailed by keeping known factors in mind along with careful patient selection, adherence to postoperative protocol and use of a lateral approach with large head in high risk patients.



Merit, Complication, Dislocation, Fracture neck of femur, Posterior approach, Total hip replacement

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Pivec R, Johnson AJ, Mears SC, Mont MA. Hip arthroplasty. Lancet. 2012;380(9855):1768-77.

Ram G, Thamodaran B, Varthi V. Analysis of functional and radiological outcome of total hip replacements in rheumatoid and osteoarthritis patients. Open J Rheumatol Autoimmune Dis. 2013;3:246‐50.

Hummel MT, Malkani AL, Yakkanti MR, Baker DL. Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplasty. 2009;24(6 Suppl):73-6.

Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res. 1998;355:224-8.

Jonsson B, Larsson SE. Functional improvement and costs of hip and knee arthroplasty in destructive rheumatoid arthritis. Scand J Rheumatol. 1991;20:351‐7.

Crawford RW, Murray DW. Total hip replacement: Indications for surgery and risk factors for failure. Ann Rheum Dis. 1997;56:455‐7.

Liang MH, Cullen KE, Larson MG, Thompson MS, Schwartz JA, Fossel AH, et al. Cost‐effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum. 1986;29:937‐43.

Schmidt AH, Leighton R, Parvizi J, Sems A, Berry DJ. Optimal arthroplasty for femoral neck fractures: Is total hip arthroplasty the answer? J Orthop Trauma. 2009;23:428‐33.

Mäkelä KT, Eskelinen A, Pulkkinen P, Paavolainen P, Remes V. Total hip arthroplasty for primary osteoarthritis in patients fifty‐five years of age or older. An analysis of the Finnish arthroplasty registry. J Bone Joint Surg Am. 2008;90:2160‐70.

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end‐result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737‐55.

Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629‐32.

Wykman A, Olsson E. Walking ability after total hip replacement. A comparison of gait analysis in unilateral and bilateral cases. J Bone Joint Surg Br. 1992;74:53‐6.

Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem‐type femoral components: A radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:14‐7.

Ganesan GR, Varthi VP. Is dislocation rate higher in total hip arthroplasty done for acute displaced fracture neck of femur? J Orthop Allied Sci. 2015;3:59‐62.

Goldstein WM, Gleans TF. Prevalence of dislocation after total hip arthroplasty through a poster lateral approach with partial capsulotomy and capsulorrhaphy. J Bone Joint Surg. 2001;83(2 suppl 1):S2 -7.

Phillips CB, Barrett JA, Losina E, Mahomed NN, Lingard EA, Guadagnoli E, et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg. 2003;85-A(1):20-6.

Yuan L, Shih C. Dislocation after total hip arthroplasty. Arch Orthop Trauma Surg. 1999;119:263‐6.

Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation following total hip replacement. J Bone Joint Surg Br. 1981;63‐B:214‐8.

Morrey BF. Instability after total hip arthroplasty. Orthop Clan North Am. 1992;23:237‐48.