Cemented Monoblock Hemiarthroplasty: A dependable option in femoral neck fracture in elderly.

Presenting Author - Santosh Kumar
Background: Femoral neck fracture in elderly continues to pose treatment dilemma over the years. Associated co-morbidities and high mortality (1-year mortality of 25–30% and only 25% survivorship at 10 years) often skews the surgical decision. The underlying treatment goal being minimum revision and maximum functional outcome. An element of uncertainty and lack of clear guidelines is reflected by the continued debate regarding their management which include osteosynthesis vs arthroplasty; hemiarthroplasty vs total hip arthroplasty, unipolar vs bipolar and cemented vs uncemented. Review of joint registries, uniformly suggest that cemented fixation in elderly patient results in early mobilization, less residual pain and the lowest risk of revision. Despite this, the phenomenal popularity of uncemented hip all over the world is paradoxical. We analyze clinical outcome of cemented monoblock hemi-arthroplasty (modified design) in femoral neck fracture in this population. Materials & Method: 94 cemented hemiarthroplasty, performed since January 2009, with a minimum follow up of 4 years are included in the study. Mean modified Harris Hip score at 2 year, 3 year and in the last follow up was 88 (72-91), 84 (70-89) and 81 (65-86) respectively. Acetabular erosion was noted in three patients (3.19%) (of which only one was symptomatic) and aseptic loosening in another two patients (2.12%). No other major complications such as deep wound infection, dislocation or peri-prosthetic fracture was noted in any patient. Discussion: Result of the present study is consistent to marginally superior when compared to cemented Thompson monoblock and the cemented bipolar prostheses. We attribute this to routine use of cement in the elderly osteoporotic bone along with design modification of the monoblock stem. Long term result of THA is marginally (not statistically significant) better compared to hemiarthroplasty. However it is associated with prolonged surgery, more blood loss and higher dislocation rate. The rates of dislocation following THA, bipolar and unipolar arthroplasty were 11%, 3%, and 2% respectively. Conclusion- Cemented monoblock hemiarthroplasty is effective and viable option in displaced femoral neck fracture in elderly in terms of excellent functional outcome, low reoperation without adversely affecting morbidity and mortality. Being cost effective procedure this may be considered as first line surgical option especially in socio-economically disadvantaged section of the society. Key words: hemiarthroplasty, monoblock, cement, neck of femur, elderly.