Summary

1.86% dislocation rate in a year is commonly due to surgical error and is preventable with pre-operative templating

Abstract

Background-
1. 63,284 patients presented with neck of femur fractures in England in 2020 (NHFD report 2021)
2. To maximise theatre efficiency during the first wave of COVID-19, NHSE guidance recommended the use of HA for most patients requiring arthroplasty.
3. The literature reports an incidence of Hemiarthroplasty dislocations of 1-15%.

Aims-
1. To study the number and possible causes of dislocations in patients with Primary hemiarthroplasty for fracture neck of femur
2. To compare our data with national and international data in terms of dislocation and revision rates for Hemiarthroplasty

Methods-
1. Retrospective study
2. Duration- 1st April 2021-31st March 2022
3. Inclusion criteria- Patients with neck of femur fracture treated with Hemiarthroplasty
4. Exclusion criteria- Patients treated with other surgical options for neck of femur fractures

Results-
1. No. of neck of femur patients- 444
2. No. of patients treated with Hemiarthroplasty- 214
3. No. of dislocations- 4
4. 75% were female, 75% had AMTS>7, 50% were operated within 36 hours of trauma, 75% dislocated within a month of surgery, 75% of the dislocations were revised
5. One dislocation was due to >72 hour delay to surgery, second dislocation was due to smaller offset and shortening, third was due to acetabular dysplasia, fourth was due to larger head used.

Discussion-
1. Our 1.86% dislocation rate matches that in the literature of 1-6%
2. 75% dislocated within a month of surgery matches that in the literature that maximum dislocations occur within one month
3. Closed reduction as definitive method of management of dislocation 25% matches that in the literature of 22-25%
4. 75% dislocations revised similar to literature of 75-80% revision rate

Conclusion-

Pre-operative templating can reduce surgical error involving limb length discrepancy and shortening to prevent dislocations