Background: Hip arthroplasty for the treatment of nonunion at the
site of a femoral neck fracture has provided good short-term results. The
purpose of the present study was to evaluate the long-term results and
complications of total hip arthroplasty for the treatment of femoral neck
nonunion.
Methods: The records of ninety-nine patients who had been managed
with total hip arthroplasty with use of a cemented Charnley acetabular
component and a cemented Charnley monoblock femoral component for the
treatment of a femoral neck nonunion were retrospectively reviewed. The
average age at the time of the arthroplasty was sixty-eight years. Eighty-four
patients (85%) were followed until death, revision, or component removal or
for at least two years (mean, 12.2 years) postoperatively.
Results: Twelve patients were treated with revision (eleven) or
resection arthroplasty (one), eleven were lost to follow-up, and four died
less than two years postoperatively. Of the remaining seventy-two unrevised
hips that were followed for at least two years, sixty-nine (96%) had no or
mild hip pain at the time of the last follow-up. The rate of component
survival free of revision or removal for any reason was 93% at ten years and
76% at twenty years. The risk factors that were significantly associated with
revision for aseptic loosening included an age of less than sixty-five years
at the time of the arthroplasty (p = 0.045), a body-mass index of =30 (p
< 0.01), and male gender (p = 0.02). The second most common complication
after loosening was dislocation, which occurred in nine patients (9%).
Conclusions: Total hip arthroplasty is an effective method for the
treatment of nonunion of the femoral neck and provides satisfactory long-term
results. However, the rate of implant survival is poorer than that reported in
most other studies of Charnley total hip arthroplasty in the general
population.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.