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Journal of Long-Term Effects of Medical Implants
SJR: 0.145 SNIP: 0.491 CiteScore™: 0.89

ISSN Imprimer: 1050-6934
ISSN En ligne: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2019030607
pages 71-78

Large Diameter Total Hip Replacement for Acute Displaced Femoral Neck Fracture

James Pritchett
Hansjörg Wyss Hip and Pelvis Center, Swedish Medical Center, Seattle, WA


Background: Total hip replacement for acute femoral neck fracture is the preferred treatment for younger, physically and socially active patients. The risks, particularly dislocation, are higher than for elective total hip replacement for arthritis. Larger diameter bearings provide increased stability and can be used in this higher risk setting.
Methods: In this study, 391 patients with acute femoral neck fractures were treated with total hip replacement using 40-mm and 44-mm femoral heads. These femoral heads were placed in thin, two-piece, highly cross-linked polyethylene-lined acetabular shells. The procedures were performed by community orthopedic surgeons using the posterior approach. Patients were mobilized immediately and with only routine postoperative precautions. Patients were followed for 5 years. Follow-up radiographs were measured to determine component position.
Results: There were no dislocations in the first 3 years following surgery, but there were 3 late dislocations. There were 29 revisions performed for impingement (n = 8), infection (n = 12), periprosthetic fracture (n = 3), instability (n = 2), and component loosening (n = 4). No instances of polyethylene wear or trunnion corrosion were identified. Overall, 37% of acetabular components simultaneously met the safe zone targets for inclination and anteversion. The mean Harris hip score was 90.
Conclusions: The dislocation rate in this study was lower than in prior studies, as was the overall revision rate. Using a femoral head ≥ 40 mm is a simple measure that reduces the dislocation rate without adding additional cost or complexity to the procedure. This device is available to all surgeons and may be an advantage to the hip surgeon treating femoral neck fractures with total hip replacement.


  1. Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, Bhandari M, Poolman RW. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop. 2012;36:1549-60.

  2. Pritchett JW. The Maricopa Medical Center experience with hemiarthroplasty. Ariz Med. 1982;39:654-57.

  3. Woo RY, Morrey BF. Dislocations after total hip arthro-plasty. J Bone Joint Surg Am. 1982;64(9):1295-306.

  4. Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemi-arthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res. 2012;470:2235-43.

  5. Perry DC, Metcalfe D, Griffin XL, Costa ML. Inequalities in use of total hip arthroplasty for hip fracture: population based study. BMJ. 2016:353:i2021.

  6. Ravi B, Jenkinson R, Austin PC, Croxford R, Wasserstein D, Escot B, Paterson JM, Kreder H, Hawker GA. Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ. 2014;348:g3284.

  7. Thurig G, Schmitt JW, Slankamenac K, Werner CM. Safety of total hip arthroplasty for femoral neck fractures using the direct anterior approach: a retrospective observational study in 86 elderly patients. Patient Saf Surg. 2016;10:12.

  8. Bozic KJ, Ong K, Kurtz S, Lau E, Vail TP, Rubash H, Berry D. Short-term risk of revision THA in the Medicare population has not improved with time. Clin Orthop Relat Res. 2016;474:156-63.

  9. Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau H. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469:319-29.

  10. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217-20.

  11. Barrack RL, Krempec JA, Clohisy JC, McDonald DJ, Ricci WM, Ruh EL, Nunley RM. Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg. 2013;95A:1760-68.

  12. Darrith B, Courtney PM, Delia Valle CJ. Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2018;100-B:11-19.

  13. Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res. 2011;469:503-7.

  14. Kostensalo I, Seppaanen M, Makela K, Virolainen P, Herviniemi J. Early results of large head metal-on-metal hip arthroplasties. Scand J Surg. 2012;101:62-65.

  15. Australian Orthopaedic Association National Joint Replacement Registry. Hip, knee and shoulder arthroplasty. Annual report 2017. Accessed 16 March, 2019. Available from: https://aoanjrr.sahmri.com/annual-reports-2017.

  16. Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC. High incidence of pseudotumor formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br. 2012;94:755-61.

  17. Pritchett JW. Letter to the editor. Poor survivorship and frequent complications at a median of 10 years after metal-on-metal hip resurfacing revision. Clin Orthop Relat Res. 2017;475:1747-48.

  18. Charnley J. Total hip replacement by low-friction arthro-plasty. Clin Orthop Relat Res. 1970;72:7-21.

  19. Howie DW, Holubowycz OT, Callary SA. The wear rate of highly cross-linked polyethylene in total hip replacement is not increased by large articulations: a randomized controlled trial. J Bone Joint Surg Am. 2016 98:178-93.

  20. Pritchett JW. Hip resurfacing using highly cross-linked polyethylene: prospective study at 8.5 years. J Arthroplasty. 2016;31:2203-8.

  21. Pritchett JW. Very large diameter polymer acetabular liners show promising wear simulator results. J Long Term Eff Med Implants. 2016;26:311-19.

  22. Zi-Sheng A, You-Shui G, Zhi-Zhen J, Ting Y, Chang-Qing Z. Hemiarthroplasty vs primary total hip arthroplasty for displaced fractures of the femoral neck in the elderly: a meta-analysis, J Arthroplasty. 2012;27:583-90.

  23. Waddell BS, Koch C, Trivellas M, Burket JC, Wright T, Padgett D. Have larger femoral heads reduced prosthetic impingement in total hip arthroplasty? Hip Int. 2019;29:83-88.

  24. Phan DL, Bederman SS, Schwarzkopf R. The influence of sagittal spinal deformity on anteversion of the acetabular component in total hip arthroplasty. Bone Joint J. 2015;97B:1077-1123.

  25. Riviere C, Lazic S, Villet L, Wiart Y, Allwood SM, Cobb J. Kinematic alignment technique for total hip and knee arthroplasty: the personalized implant positioning surgery. EFORT Open Rev. 2018;3:98-105.

  26. Elson L, Dounchis J, Illgen R, Marchand RC, Padgett DE, Bragdon CR, Malchau H. Precision of acetabular cup placement in robotic integrated total hip arthroplasty. Hip Int. 2015;25:531-36.

  27. Pritchett JW. Curved-stem hip resurfacing: minimum 20-year followup. Clin Orthop Relat Res. 2008;466:1177-85.

  28. Townley CO. Complications in total hip replacement: etiology, prevention and the role of a ceramic articulation. Ceramic Trans. 1995 48:23-34.

  29. Amanatullah DD, Masini MA, Roger DJ, Pagnano MW. Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty. Bone Joint J. 2016;98B:1036-42.

  30. Marchetti E, Krantz N, Berton C, Bocquet D, Fouilleron N, Girard J. Component impingement in total hip arthro-plasty: frequency and risk factors. A continuous retrieval analysis series of 416 cups. Orthop Traumatol Surg Res. 2011;97:127-33.

  31. Steinhoff A, Hakim V, Walker R, Cowell CW Jr, Copp SN. Ceramic liner fracture and impingement in total hip arthro-plasty. HSS J. 2015;11:50-55.

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