Study of acetabular erosion and activity level after hemiarthroplasty, in neck of femur fracture patients after a minimum period of 2 years

Vinayaga Moorthy, A (2014) Study of acetabular erosion and activity level after hemiarthroplasty, in neck of femur fracture patients after a minimum period of 2 years. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Neck of femur fractures are one of the devastating injuries of the old age. It is well recognized even from the era of Hippocrates. The exact number of hip fractures worldwide is impossible to determine, but the global incidence in the year 2000 has been estimated at 1.6 million and the projections for the future suggest further increasing numbers. In addition to the suffering of the individual the economic strain on society due to hip fracture is immense. Management of displaced intracapsular hip fracture in elderly remains controversial. Options include hemiarthroplasty or total hip arthroplasty. Total hip arthroplasty has shown better pain relief and clinical outcome, but in the elderly frail population who often suffer from fracture of the neck of the femur, mortality rates are high. Hemiarthroplasty is one of the commonest procedures done for neck of femur fractures. It provides pain relief and early mobilization.The Austin – Moore and Thompson prostheses have been successful implants in treating fracture neck of femur. Disabling pain and acetabular erosions are frequent complications after the use of Moore prosthesis. So in an attempt to retard the acetabular wear, prolong the life of the implant and delay the need for revision surgery the bipolar prosthesis was developed by James E Bateman in Toronto in 1974, which had the advantage of hip motion occuring at 2 interfaces, primarily at the prosthetic interface and secondarily at the metal – cartilage interface, thus minimising the articular wear. This prosthesis was found to be very useful and results were encouraging. However in longterm studies show that the bipolar prosthesis start acting as unipolar prosthesis with time and hence leads to some erosion. However not all patients with acetabular erosions are symptomatic.In our study we have evaluated the acetabular erosion after hemiarthroplasty, in neck of femur fracture patients after a minimum period of 2 years and have tried to correlate it with activity level of the patient. AIM: 1. Early detection of acetabular erosion. 2. To assess the functional outcome after minimum of 2 years after hemiarthroplasty by modified UCLA score. 3. To correlate the functional activity level and radiological acetabular erosion. MATERIALS AND METHODS: Source of data: This is a retrospective radiological and clinical study. The post hemiarthroplasty plain radiographs, showing AP view of hip joint taken in the Department of Radiodiagnosis, PSGIMS&R will be studied along with activity level assessment. Mode of data collection: By Convenient sampling method, all the patients undergone hemiarthroplasty, for fracture neck of femur after minimum of 2 years were assessed both radiologically and clinically. Inclusion criteria: All patients operated for neck of femur fracture with hemiarthroplasty after a minimum period of 2 years. Exclusion criteria: 1.) Surgical site hip Infection. 2.) Any pre existing pathologies around the hip. 3) Previous hip surgeries. 4.) Post-operative periprosthetic fractures. 5). Neurological conditions like CVA, Parkinsonism. X-ray technique: A plain anteroposterior view of the operated hip joint is taken and assessed for acetabular erosion grading. Patient positioned in supine, using digital X-RAY, casette tube distance is set to 100cms and the beam is centered directly over the hip. Radiological assessment Activity level assessment: LITERATURE REVIEW: Thompson Hemiarthroplasty and Acetabular erosion: T.W. Philips, London, Ontario, Canada, from the Orthopaedic research laboratory, St.Joseph health centre and division of Orthopaedic surgery, University of Western Ontario, London The prevalence, severity and clinical importance of acetabular erosion secondary to hemiarthroplasty of the hip are largely unknown. The factor that had the highest correlation with severity of the erosion were the level of physical activity and the duration of follow-up. Author`s analysis shows that the erosion progressed at an average of 3% per year in active patients. Post operative level of activity is determined by patient`s age and type of residence at the time of fracture. Clinical relevance of acetabular erosion in young patients with a bipolar hip prosthesis: G. Kiekens, J. Somville, A. Taminiau- University Hospital Antwerp, UZA, Belgium, Department of Orthopaedics and Trauma, University Hospital Leiden, LUMC, The Netherlands, Department of Orthopaedics. Young patients who had undergone bipolar hemiarthroplasty for proximal femur malignant tumor resection were followed up for a mean time of 81.8 months. The erosion and activity were assessed by x-rays and clinical examination. They did not report pain and had a good quality of life. The risk of late acetabular erosions were predicted by anticipated longevity of the patient and the level of activity. Degeneration of acetabular articular cartilage to bipolar hemiarthroplasty: Kyoung Ho Moon, Jun soon kang, Tong joo lee, Sang hyeop lee, Sung wook choi and Man hee won- Department of Orthopaedics, Inha university Hospital, Incheon, Korea. Considering the life expectancy and activity of patients who require hip arthroplasty, it could be predicted by radiologically measuring the degeneration rate of the acetabular articular cartilage. Measurement of acetabular erosion: The effect of pelvic rotation on common landmarks. R.G. Wetherel, A.A. Amis, F.W. Heatley from St. Thomas` hospital and imperial college, London. The line drawn between acetabular margins are significantly more accurate for proximal migration, than teardrop, sacroiliac or sacroiliac-symphysis line. Line drawn tangential to the brim and through the horizontal mid-point of the obturator foramen is more accurate than Kholer`s line, ilio-ischial or iliopubic line. In combination the two lines can give more accurate assessment and they are less affected by the difference in rotation commonly found in plain radiographs. Retrospective evaluation of bipolar hemiarthroplasty in fracture of the proximal femur North American Journal of Medical Sciences 2010 September, Vol 2. No.9 The aim of the study is to find out which treatment option can lead to a best clinical and functional outcome. It is concluded as 2 years result of bipolar hemiarthroplasty is good but THR- total hip replacement was found to be better. CONCLUSION: As the duration after surgery and activity level increases, the acetabular erosion rate increase. Long term study is needed to assess the erosion level which will give an insight into the factors influencing erosion and it can be prevented.

Item Type: Thesis (Masters)
Uncontrolled Keywords: acetabular erosion ; hemiarthroplasty ; neck of femur fracture patients ; 2 years study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 26 Sep 2017 01:10
Last Modified: 26 Sep 2017 01:10

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