Favorable Functional Recovery and Stem Stability after Hip Arthroplasty with a Short Metaphyseal Stem in Elderly Patients with Osteoporotic Femoral Neck Fractures

Abstract

Purpose: Short stems have recently become widely used; however, concerns about the initial secure fixation of a short stem in osteoporotic bone remain. The aim of this study was to evaluate the short-term clinical and radiological results of using a short cementless metaphyseal stabilizing tapered stem for senile osteoporotic femoral neck fractures.

Materials and methods: Thirty-eight arthroplasties (31 bipolar hemiarthroplasties and 7 total hip arthroplasties) were performed for osteoporotic femoral neck fractures in patients older than 65 years (10 males and 28 females). The mean age was 76.1 years and the mean follow-up was 2.9 years. We retrospectively evaluated clinical results, focusing on walking performance, thigh pain, and radiologic results, with special regard to signs of stem stability and osteointegration.

Results: Mean Harris hip score was 84.3 points and 68.4% of patients regained their preoperative walking performance. No patients complained about thigh pain. No osteolysis or loosening was observed during the follow-up, and all but 1 stem showed signs of stable bone ingrowth.

Conclusion: Short, metaphyseal stabilizing tapered stems could be a reliable treatment option for osteoporotic femoral neck fractures.

Keywords: Arthroplasty; Femoral neck fractures; Hip replacement; Osteoporosis.

Fig. 1. Flowchart of the patients with inclusion and exclusion criteria.

Fig. 2. Preoperative (A) and postoperative (B) walking performance according to the Koval grade.

Fig. 3. (A) Preoperative X-ray of an 80-year-old female patient with a history of femoral shaft fracture treated with plate fixation shows a displaced femoral neck fracture. (B) Postoperative 2.5-year X-ray shows stable fixation of the femoral stem without removal of the plate or screw.

Fig. 4. (A) Preoperative X-ray of a 76-year-old female patient shows a displaced femoral neck fracture. (B) Immediate postoperative X-ray shows distal engaging of the stem. (C) Postoperative 3.6-year X-ray shows a radiolucent line around the greater trochanter (black arrows); however, she had no complaints about pain or discomfort.