Okuno Ryuji, Baba Tomonori, Ozaki Yu, Homma Yasuhiro, Kaneko Kazuo, Ishijima Muneaki
Department of Orthopedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Orthopedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, Japan.
SICOT J. 2025;11:39. doi: 10.1051/sicotj/2025034. Epub 2025 Jul 16.
Dementia patients with femoral neck fractures (FNFs) are unable to understand their dislocated limb positioning, which may impair rehabilitation and result in poorer functional recovery. Recently, good clinical results have been reported for the direct anterior approach for total hip arthroplasty (DAA-THA) using a dual mobility cup (DMC) for displaced FNFs. This study aimed to investigate differences in the clinical outcome of THA for displaced FNFs in patients with and without dementia.
This study was retrospective and included 151 patients who underwent DAA-THA with DMC for displaced FNFs. Patients diagnosed with dementia prior to injury were classified into a dementia group (43 patients) and a non-dementia control group (control group, 108 patients). The evaluation items were age, sex, body mass index (BMI), preoperative Fracture Mobility Score (FMS), waiting period, preoperative anesthetic assessment, blood loss, operation time, complications, 1-year mortality, and 1-year FMS after surgery. The FMS was scored as: walking alone: 1, walking with a cane: 2, walking with a walker: 3, hand-guided walking: 4, and wheelchair: 5.
Significant differences were found in age, weight, BMI, and operation time. Postoperative dislocation was not observed in both groups. FMS was compared before and after injury in three categories: (1) unchanged from before injury, (2) one rank down, and (3) two or more ranks down. No significant differences were found in any of these categories (p = 0.09). Functional outcomes showed no significant difference in mobility recovery. The 1-year mortality rate was 9.35% (16 patients), with no significant difference between the two groups (p = 0.17).
DAA-THA using DMC for displaced FNFs may have similar functional outcomes and mortality rates in both patients with and without dementia.
股骨颈骨折（FNF）的痴呆患者无法理解其脱位肢体的位置，这可能会妨碍康复并导致功能恢复较差。最近，有报道称采用双动杯（DMC）的直接前路全髋关节置换术（DAA-THA）治疗移位型FNF取得了良好的临床效果。本研究旨在调查有痴呆和无痴呆患者移位型FNF的全髋关节置换术临床结果的差异。
本研究为回顾性研究，纳入了151例行DAA-THA并使用DMC治疗移位型FNF的患者。受伤前被诊断为痴呆的患者被分为痴呆组（43例患者）和非痴呆对照组（对照组，108例患者）。评估项目包括年龄、性别、体重指数（BMI）、术前骨折活动度评分（FMS）、等待期、术前麻醉评估、失血量、手术时间、并发症、1年死亡率以及术后1年的FMS。FMS评分如下：独自步行：1分，拄拐杖步行：2分，使用助行器步行：3分，手辅助步行：4分，轮椅：5分。
在年龄、体重、BMI和手术时间方面发现了显著差异。两组均未观察到术后脱位。FMS在受伤前后按以下三类进行比较：（1）与受伤前无变化，（2）下降一级，（3）下降两级或更多级。在这些类别中均未发现显著差异（p = 0.09）。功能结果显示活动恢复方面无显著差异。1年死亡率为9.35%（16例患者），两组之间无显著差异（p = 0.17）。
使用DMC的DAA-THA治疗移位型FNF在有痴呆和无痴呆的患者中可能具有相似的功能结果和死亡率。
