Surgeons who performed
femoral neck fractures using a direct lateral approach, but
did not restrict the patients activities, found no postoperative
dislocations occurred in the group, according to findings of an ongoing study.
We have a very interesting trend toward a better functional
outcome in those without restrictions, but still I cannot say that it is the
way it is going to end. But it looks very hopeful, Cecilia Rogmark, MD,
PhD, of Skane University Hospital, Malmo, Sweden, told Orthopaedics Today
Rogmark presented the findings at the
SICOT XXV Triennial World Congress 2011 in Prague.
She said, This study was actually a request from our
physiotherapist and our occupational therapist [
] the physical therapists
are the ones who are going to train the patients and it is very difficult to do
that with all these restrictions in mind.
Trend presents challenges
Movement restrictions of any kind can be costly to hospitals and time
consuming for physical and occupational therapists to implement, Rogmark said.
Routine treatment for patients with displaced femoral neck fractures at
her institution consisted of hemiarthroplasty via the direct anterolateral
approach with movement restrictions postoperatively. However, once the
therapists noticed that the dislocation rate after hip fractures at Skane
University Hospital averaged 0.6% in 2008 vs. 2% to 14% elsewhere and
realized that such restrictions were not evidence-based they questioned
what they were doing differently and why they were ordering movement
restrictions at all.
Therefore, Rogmarks study sought to determine if such restrictions
were actually beneficial. The literature on this topic, including postoperative
total hip arthroplasty (THA), is scarce, according to Rogmark.
Rogmark and colleagues conducted a pseudo-randomized study of patients
who underwent hemiarthroplasty via the direct lateral approach for displaced
femoral neck fractures dividing them into two cohorts: 32 patients were given
no restrictions or aids, and 40 control patients were required to use various
aids and restrict their hip flexion 90° maximum. Control patients could not
cross their legs and those with dementia wore knee braces to restrict them from
Pictured here is an aid for putting on
socks to limit motion after hip hemiarthroplasty.
Image: Rogmark C
Investigators determined the patients health-related quality of
life, need to use aids for activities of daily living pre-fracture and at 5
days, 6 weeks and 3 months postoperatively, and postoperative function at 5
days and 3 months. Based on the medical records, they quantified the
dislocations and falls in each group.
Some patients dropped out of the study and those not available for the 3
month follow-up were excluded.
The surgical team used the direct lateral approach in all patients, a
technique that Rogmark explained could, in itself, hinder dislocation and
possibly prevent subsequent reoperations.
Rogmark and colleagues observed no dislocations in the group without
restrictions and two dislocations in the motion-restricted control group.
Even if they are free of restriction and they do not need any
mandatory aids, we do not see any increase in dislocation, Rogmark said.
The working time for the physical therapist is much less when they do not
need to do all this standard talking, giving standard advice to patients. They
can focus on doing a customized training for the patients. So it is less time
consuming for the physiotherapist, she noted.
Investigators plan to follow these patients up to 3.5 years, hoping to
enroll 800 patients. As of November 2011, Rogmark had enrolled 200 patients in
the study 100 patients per group. Her team also plans to study THA
dislocation rates due to their increasing incidence in Sweden.
In several countries, it is regarded as quite exotic that we do
total hip replacements in hip fracture patients because hemiarthroplasties are
always considered to be the gold standard. But we have seen better clinical
results in [
] more healthy elderly [patients] with displaced femoral neck
fractures, Rogmark said. by Renee Blisard
- Rogmark C, Nilsson I, Dahlqvist L, et al. Is movement restrictions
after hemiarthroplasty treatment of femoral neck fractures necessary? Paper
#29881. Presented at the SICOT XXV Triennial World Congress 2011. Sept. 6-9.
- Cecilia Rogmark, MD, PhD, can be reached at the Department of
Orthopaedic Surgery, Skane University Hospital, Lund University, 205 02 Malmo,
Sweden; +46 040-33 10 00; email: firstname.lastname@example.org.
- Disclosure: Rogmark has no relevant financial disclosures.