Shinde Kapil, Kumar Rohit S, Awasthi Prashant, Al-Dahan Tarik, Ahmed Emadeldin, Sanka Sravan, Arif Muhammad Asad, Seidahmed Salih
Trauma and Orthopaedics, Queen Elizabeth The Queen Mother Hospital, Margate, GBR.
Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR.
Cureus. 2024 Dec 6;16(12):e75205. doi: 10.7759/cureus.75205. eCollection 2024 Dec.
Femoral neck fractures in elderly individuals cause significant morbidity, and their management is particularly challenging in rural areas where healthcare access is limited. The recommended treatment for displaced femoral neck fractures in elderly patients with poor mobility, cognitive dysfunction and multiple comorbidities is a hemiarthroplasty, which can be performed with various implants, including monopolar implants like Austin Moore prosthesis (AMP) and bipolar prosthesis (BP). In developing countries like India, rural areas often have constraints with healthcare resources. Furthermore, the per-capita income is low, limiting access to affordable healthcare. As a result, treatment is often tailored to ensure affordability, and AMP continues to be used as it is a relatively inexpensive implant. The objective of our study is to assess and compare the mortality, infection rate and functional outcomes (Harris hip score [HHS]) of AMP and BP in treating femoral neck fractures one year following surgery in a resource-constrained setting in a rural district general hospital in India.
This retrospective observational study analysed all patients who underwent a hemiarthroplasty for acutely displaced femoral neck fractures between 1 January 2017 and 31 December 2017, with a minimum one-year follow-up following surgery. Pathological hip fractures, patients with pre-existing hip pathologies and those with an abbreviated mental test score of six or less were excluded. Medical records were reviewed, and demographic data, mortality, infection rates and HHS one year following surgery were recorded and compared for patients who underwent hemiarthroplasty with an AMP and BP.
A total of 118 patients underwent hemiarthroplasty, with two (1.69%) lost to follow-up. Therefore, 116 patients were included, comprising 81 (69.83%) women and 35 (30.17%) men, with similar demographics between both groups. No statistically significant difference was found in mortality rate (AMP 1, 1.79%, vs. BP 1, 1.67%, = 0.96), infection rate (AMP 1, 1.82%, vs. BP 1, 1.69%, = 0.96) and HHS (AMP 85.2 vs. BP 88.5; = 0.08). No dislocations or periprosthetic fractures were noted at one-year follow-up in both groups.
While AMP and BP have similar clinical and functional outcomes, AMP is more cost-effective and perhaps more suitable in low socioeconomic demographics and low-resource settings. Further research is suggested to evaluate long-term outcomes in underserved populations with a low per-capita income.
老年患者的股骨颈骨折会导致严重的发病率，在医疗服务有限的农村地区，其治疗尤其具有挑战性。对于行动不便、认知功能障碍和多种合并症的老年患者，移位型股骨颈骨折的推荐治疗方法是半髋关节置换术，可使用各种植入物进行，包括单极植入物如奥斯汀·摩尔假体（AMP）和双极假体（BP）。在印度等发展中国家，农村地区往往存在医疗资源限制。此外，人均收入较低，限制了获得负担得起的医疗服务的机会。因此，治疗通常会进行调整以确保可承受性，AMP因其是相对便宜的植入物而继续被使用。我们研究的目的是评估和比较在印度农村地区一家 district 综合医院资源受限的环境中，AMP和BP治疗股骨颈骨折术后一年的死亡率、感染率和功能结局（Harris髋关节评分 [HHS]）。
这项回顾性观察性研究分析了2017年1月1日至2017年12月31日期间所有因急性移位型股骨颈骨折接受半髋关节置换术且术后至少随访一年的患者。排除病理性髋部骨折、既往有髋部病变的患者以及简易精神测试评分在6分及以下的患者。查阅病历，记录并比较接受AMP和BP半髋关节置换术患者的人口统计学数据、死亡率、感染率和术后一年的HHS。
共有118例患者接受了半髋关节置换术，2例（1.69%）失访。因此，纳入116例患者，其中女性81例（69.83%），男性35例（30.17%），两组的人口统计学特征相似。死亡率（AMP组1例，1.79%，BP组1例，1.67%，= 0.96）、感染率（AMP组1例，1.82%，BP组1例，1.69%，= 0.96）和HHS（AMP组85.2分 vs. BP组88.5分；= 0.08）均无统计学显著差异。两组在一年随访时均未发现脱位或假体周围骨折。
虽然AMP和BP具有相似的临床和功能结局，但AMP更具成本效益，可能更适合社会经济人口统计学特征较低和资源匮乏的环境。建议进一步研究以评估人均收入较低的服务不足人群的长期结局。
