Kapil Mani K C
Civil Service Hospital, Nepal
Kapil Mani K.C. is currently working in Civil Service Hospital of Nepal, Minbhavan, Kathmandu as an orthopedic surgeon since Second July 2011. He is actively involved to attend the patients in OPD and Emergency department as well as to perform the operations in routine and emergency basis every day. Besides he is involved in teaching and learning activities in the hospital.
Background: The management of displaced subcapital femoral neck fracture in elderly patients is controversial because of high rate of complications associated with internal fixations, hemiarthroplasty, and bipolar arthroplasty. To avoid some of these complications, we did primary total hip replacement for these elderly patients of age more than 65 years. There is high chance of nonunion of fracture with internal fixations, significantly increased wear of bone in hemiarthroplasty and even bipolar arthroplasty resulting difficult total hip replacement like revision arthroplasty. Because of less mobility of patients, replacing the total hip after 65 years for fracture neck of femur, the joint sustains for longer time, and there may not be the need of revision arthroplasty. Patients and Methods: A total of 12 total hip replacements was performed for displaced femoral neck fracture of elderly patients of age more than 65 years in Civil Service Hospital of Nepal and National Academy of Medical Sciences, Bir Hospital for past two and half years. All the patients were operated through modified Harding’s approach. Non-cemented arthroplasty was performed in 8 cases and cemented arthroplasty was performed in 4 cases. In case of cemented arthroplasty, both hybrid and reverse hybrid type were done. Patients were evaluated at 3 months and 1 year after surgery. Results: There were 8 male and 4 female patients of age range from 65 to 77 years. Seven patients were fracture in right side and 5 patients in left side. None of the patients died and developed medical complications after surgery till now. Similarly none of them developed wound problems and landed into the dislocation. Every patient was assessed using Harris Hip Scoring method. Nine of them had excellent and 3 patients had good results. Gait analysis was performed in all patients. We found normal speed and step length at 3 month and one year after surgery. Conclusion: Total hip replacement is one of the best management for displaced sub-capital fracture neck of femur for independently mobile, mentally competent, elderly patients of age more than 65 years with better rehabilitation potential and function of hip and very low revision rate. However, long term follow-up has to be awaited for final results.
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