ABSTRACT
Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.
ABSTRACT
Objective:To compare the mid-term clinical efficacy of total hip replacement (THR) and closed reduction and external fixation (CREF) in treatment of intertrochanteric fractures in the elderly.Methods:A retrospective case-control study was conducted to analyze the clinical data of 155 elderly patients with unilateral intertrochanteric fractures admitted to Second Affiliated Hospital of Army Medical University from June 2011 to June 2019, including 63 males and 92 females, aged 70-98 years [(80.1±7.0)years]. According to Jensen-Evans classification, the type of fracture was type I in 2 patients, type II in 21, type III in 24, type IV in 36, type V in 67, and type R in 5. A total of 85 patients were treated by THR (THR Group) and 70 patients by CREF (CREF group). The operation time, intraoperative blood loss, blood transfusion rate, length of hospital stay, postoperative complication rate, Harris hip score at postoperative 1 year, excellent and good rate of hip joint function, and 12-item short form health survey (SF-12) physical component summary score (SF-12PCS) of postoperative quality of life, mortality rate within 1 year and survival rate were compared between the two groups.Results:The follow-up time was 1.0-9.5 years [(3.9±2.4)years]. A total of, 140 patients were followed up for more than one year, 2 patients were lost, 13 patients died within 1 year after surgery. The operation time [77(60, 100)minutes] and intraoperative blood loss [(290.6±182.3)ml] in THR group were significantly longer or more than those in CREF Group [55(50, 70)minutes, (30.5±25.0)ml] ( P<0.05). The blood transfusion rate [78%(66/85)] in THR group was significantly higher than that in CREF Group [21%(15/70)] ( P<0.05). The length of hospital stay and incidence of postoperative complications were similar between the two groups ( P>0.05). One year after operation, the Harris hip score [(84.4±15.1)points], excellent and good rate of hip joint function [76%(63/83)] and SF-12 PCS score [(16.2±1.0)points] in THR group were significantly higher than those in CREF group [(69.0±21.6)points, 43%(27/63), (14.1±2.2)points] ( P<0.05). The mortality within 1 year after operation was similar between the two groups ( P>0.05). The survival curve analysis showed that the survival status in THR group was better than that in CREF group ( P<0.05). Conclusion:Compared with CREF, THR has better joint function and quality of life, as well as a higher overall survival rate when applied to treat intertrochanteric fractures in the elderly patients.