JBJS, October 1, 2004, Volume 86, Issue 10

Long-Term Results of Total Hip Arthroplasty for Femoral Neck Fracture Nonunion

Tad M. Mabry, MD Branko Prpa, MD George J. Haidukewych, MD W. Scott Harmsen, MS Daniel J. Berry, MD

Hip

Background: Hip arthroplasty for the treatment of nonunion at the site of a femoral neck fracture has provided good short-term results. The purpose of the present study was to evaluate the long-term results and complications of total hip arthroplasty for the treatment of femoral neck nonunion.

Methods: The records of ninety-nine patients who had been managed with total hip arthroplasty with use of a cemented Charnley acetabular component and a cemented Charnley monoblock femoral component for the treatment of a femoral neck nonunion were retrospectively reviewed. The average age at the time of the arthroplasty was sixty-eight years. Eighty-four patients (85%) were followed until death, revision, or component removal or for at least two years (mean, 12.2 years) postoperatively.

Results: Twelve patients were treated with revision (eleven) or resection arthroplasty (one), eleven were lost to follow-up, and four died less than two years postoperatively. Of the remaining seventy-two unrevised hips that were followed for at least two years, sixty-nine (96%) had no or mild hip pain at the time of the last follow-up. The rate of component survival free of revision or removal for any reason was 93% at ten years and 76% at twenty years. The risk factors that were significantly associated with revision for aseptic loosening included an age of less than sixty-five years at the time of the arthroplasty (p = 0.045), a body-mass index of ≥30 (p < 0.01), and male gender (p = 0.02). The second most common complication after loosening was dislocation, which occurred in nine patients (9%).

Conclusions: Total hip arthroplasty is an effective method for the treatment of nonunion of the femoral neck and provides satisfactory long-term results. However, the rate of implant survival is poorer than that reported in most other studies of Charnley total hip arthroplasty in the general population.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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