The Femoral Offset Reconstruction And Its Clinical Significance In Total Hip Arthroplasty For Femoral Neck Fracture

Objective: Femoral neck fracture (FNF) is a common and frequently encountered disease to elderly people in orthopedics, mainly due to osteoporosis, elderly hip muscle groups degeneration or light trauma, occurred more in women than in men. Its incidence rises with the increase of the elderly people, bringing patients serious physical, psychological and economic burden. The total hip arthroplasty would be needed to some patients.The femoral offset (FO) reconstruction in the operation is a very important. If the reconstruction is not satisfied, it will influence the recovery of the hip joint function to some degree, but has not yet been paid great attention to. The topic is about the influence of femoral offset reconstruction on the hip joint function in total hip arthroplasty of the femoral neck fracture.Methods:The clinical information(including medical record、imaging material and follow-up data) of the patients,suffered femoral neck fracture and treated by artificial total hip arthroplasty form January2010to January2012in orthopedics of Wuhan General Hospital of Guangzhou Command,were collected and analyzed through the electronic medical records system and PACS system. The research objects were selected based on inclusion criteria、 exclusion criteria having been made. A regular following-up plan,included the postoperative function recovery and imaging data of the joint, was draw up for all patients included in the study. The anteroposterior pelvic films were read on computer to measure the postoperative ipsilateral hip’s and the contralateral hip’s femoral offset,with graphics system provided by Neusoft software. If the difference of the FO between the two sides is less than4mm, it is regarded that the femur eccentricity is rebuilt. And all cases included were divided into the reconstruction group and no-reconstruction group. Based on the Harris hip score gotten on the last follow-up, the data of the two groups were statistically analyzed. And the relationship between FO rebuild and postoperative hip function was assessed with the related literature.Results: The50patients with the completed following-up datas were collected from January2010to January2012. Of them,30cases accorded with the inclusion criteria and exclusion criteria.There were10male and20female with a mean age of71years-old(range from62to82y/o) in all30cases followed-up3months to2years postoperatively(mean,9months). The definition of the FO reconstruction was less than4mm in FO difference between the operated side and the healthy one. According to this standard, there were22cases of patients met the requirements,while8cases did not met.30cases of postoperative ipsilateral FO measurements are (35.95±5.55)mm; the contralateral FO are (37.01±4.22)mm.Based on Harris scores, about25cases (83.3%)were excellent,3cases (10%) were good, and the remaining(6.67%)was acceptable. The over all excellent and good rate was93.3%. No hip dislocation was found in the30cases. The difference between femoral offset and the contralateral was greater than4mm in4patients, complained pain in hip.Conclusion:In total hip replacement, the rebuilding of FO is an important factor that Influence in the postoperative recovery of the joint function. The FO should be rebuilt as much as possible,so that the hip function would be fully restored.