Hip fracture is a significant
public health issue, with up to 75,000 cases presenting per year at an annual
cost of approximately £2 billion in the UK. Globally there are over 1.5 million
femoral neck fractures with 740,000 deaths, with this figure rising to 3.9
million by 2050. The increasing ageing population dictates that the burden of
this condition is only set to rise to 100,000 in the UK annually by 2033, risk
stratification and operative planning will be essential to avoid the burden of
complications from unsuitable patient selection, the revision rate from hip
hemiarthroplasty has been reported to be as high as 20% at 9 years follow up.
There are various types of hip
hemiarthroplasty prostheses available for the treatment of femoral neck
fractures. Recent developments have favoured the smooth stem prosthesis
inserted with cement, which is supported by NICE (National institute of
clinical excellence CG124. This design
of prosthesis has commonly been used for total hip replacement in the elective
setting with good long term survivorship. A Cochrane review in 2006
reported that patients with cemented prostheses have less pain and a tendency
to better mobility than those with uncemented prostheses.
Previous studies assessing the
common cemented implants, the ETS and Thompson hemiarthroplasty, have found
these prostheses to be equivalent in radiographic outcomes and surgical
complications. Although the ETS has been found surgical easier to insert than
the Thompson counterpart, due to the tapered smooth stem nature. To date there
has been no research comparing the ETS to a modular cemented equivalent in the
treatment of intra-capsular neck of femur fractures.
No comments:
Post a Comment