Yusuf ÖZTÜRKMEN, Mahmut KARAMEHMETOĞLU, İBRAHİM AZBOY, İlhan AÇIKGÖZ, Mustafa CANİKLİOĞLU

İleri yaştaki olgularda ayrılmış femur boynu kırıklarında primer artroplastinin, başarısız internal tespit sonrası erken kurtarıcı artroplasti ile karşılaştırılması

Amaç: İleri yaştaki hastalarda ayrılmış femur boynu kırıklarında yapılan primer total kalça artroplastisi (TKA) ile internal tespit sonrası başarısızlık nedeniyle erken dönemde TKA ile revizyon yapılan olguların sonuçları karşılaştırıldı. Çalışma planı: Çalışmaya, ayrılmış femur boynu kırığı (Garden tip III, IV) nedeniyle başarısız internal tespit sonrası erken kurtarıcı artroplasti yapılan 34 olgu (8 erkek, 26 kadın; ort. yaş 68; dağılım 60-75) ve primer olarak TKA yapılan 34 olgu (8 erkek, 26 kadın; ort. yaş 67.5; dağılım 60-75) alındı. Bütün hastalara çimentosuz TKA uygulandı. Her iki gruptaki olgular travma öncesinde sosyal ve fizyolojik olarak aktifti. Olgular Merle D’Aubigne kalça skorlaması ile değerlendirildi. Hastaların internal tespit öncesi veya sonrası erken grafilerinde prognostik risk faktörleri araştırıldı. Ortalama takip süresi revizyon grubunda 5.2 yıl, primer TKA grubunda 5 yıl idi. Sonuçlar: Artroplasti sonrası ilk yıl içinde revizyon grubunda 16 olguda 21 komplikasyon, primer TKA grubunda altı olguda dokuz komplikasyon gelişti (p

Anahtar Kelimeler:

Femur boynu kırıkları, Kırık tespiti, internal, Yaşlı, Kalça, Reoperasyon, Artroplasti, replasman

Comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation for displaced femoral neck fractures in elderly patients

Objectives: We compared the results of primary total hip arthroplasty (THA) with those of early salvage THA following failure of internal fixation for acute displaced femoral neck fractures in elderly patients. Methods: Patients with displaced femoral neck fractures (Garden type III, IV) were treated with either early salvage arthroplasty following failure of internal fixation (n=34; mean age 68 years) or THA (n=34; mean age 67.5 years). Both groups consisted of 8 men and 26 women with the same age range (60 to 75 years). Uncemented THA was performed in both groups. All patients were physiologically and socially active before the initial trauma. The hips were evaluated with the use of the Merle D’Aubigne scoring system. Prognostic risk factors were determined on radiographs obtained before or shortly after internal fixation. The mean follow-up was 5.2 years in the secondary and 5 years in the primary THA groups. Results: During the first year of THA, there were 21 complications in 16 patients and nine complications in six patients in the secondary and primary THA groups, respectively (p<0.05). The results with respect to pain were worse and reoperation rate was higher in the revision group (p<0.05). The mean Merle D’Aubigne hip scores for pain, mobility, and walking were higher in the primary THA group. Radiographs taken before or after internal fixation showed prognostic risk factors in 32 patients (94.1%). Conclusion: Primary THA is a good choice of treatment for femoral neck fractures in physiologically and socially active elderly patients with a high life expectancy and cognition level.

Keywords:

Femoral Neck Fractures, Fracture Fixation, Internal, Aged, Hip, Reoperation, Arthroplasty, Replacement,

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