Video Gallery

Chapter 02 Video 1: Treatment of Displaced Femoral Neck with Total Hip Arthroplasty

December 16, 2016

Contributors: Laura Matsen Ko, MD; Vivek Natarajan, MD; Clay James Carnahan, PA-C, MS; Venessa A Stas, MD, FRCSC; Paul J Duwelius, MD

This video is a demonstration of a total hip arthroplasty for a displaced femoral neck fracture in a 74 year old male which resulted from a ground level fall. The patient’s age should be considered in such a case, as a bipolar or unipolar hemiarthroplasty could run the risk of chondrolysis. The literature indicates that a total hip has a superior long term outcome and pain relief compared to a bipolar hemiarthroplasty. Leg length cannot be determined in the same manner as a non-traumatic total hip, so preoperative planning is important. A cut is made 15 mm above the lesser trochanter, an intercalary cut is made, and the head of the femur is removed. The femur is prepared first so that anteversion is known. Retractors are placed, and the acetabulum is reamed down to the cotyloid fossa until bleeding bone is achieved. The acetabular component is fixed with screws into the posterior column since the fracture was the result of a ground-level fall, and an acetabular insertion guide is used to build in anteversion and abduction. The femoral head is trialed, and the total version is 45°. Range of motion is aggressively tested. A highly cross linked liner is used, and a calcar wire is passed around the femur. A coated tapered stem is used. The joint is reduced, and the capsule is closed by mobilizing the anterior portion to the posterior portion. A stress test and a provocative test for dislocation are performed, and closure is performed. Postoperative radiographs demonstrate a stem in appropriate valgus.