Complications of hip hemiarthroplasty in patients with dementia

Age is one of the most important parameters influencing the occurrence of hip fractures in patients over the age of 65, whereas their mental state is a decisive factor. Older adults have eight times higher risk of dying of a hip fracture if we compared to those people without a hip fracture. The risk of death is very high in the first three months and it remains in first ten years. High incidence of hip fracture and dementia worldwide includes Europe and Middle East part of Europe, South America, Canada, United States and Asia. There is a very high probability that patients with hip fractures and dementia may develop delirium that will result in prolonged hospitalization and poor mobility. Death is a rare complication of hip arthroplasty. Less than 1% patients in United States died, however in the first 90 days the postoperative mortality rate is somewhat higher than 1%. Otherwise, after revision surgery this rate increases. The most common complications of hip hemiarthroplasty that can be avoided by surgeons are: dislocation (posterior approach), and infection (the most common are Gram-positive Staphylococcus aureus-MRSA and Gram-negative bacillus). In one year the mortality rates will be over than half in the patients with deep infection and approximately 65% of patients with dislocation prosthesis in 6 months but also depends by type of prosthesis: monobloc (Austin Moore) or bipolar, cemented or uncemented. Other patient-related complications in the order in which they appear are pulmonary embolism, hematoma formation, unusual ossification, thromboembolism, nerve injury, fracture (periprosthetic). In patients who receive antiplatelet, anti-inflammatory, or anticoagulant therapy, it is necessary to stop the preoperative medication and to perform intraoperative hemostasis. During surgery, there is a risk to damage obturator vessels, perforating branch of femoralis artery and injury iliac vessels when drilling medial acetabular wall. In the last two decades thromboembolism has been prevented by physical therapy and socks with gradual compression. Depending on the type of surgeon's preferred type of proceedings, the following nerves may be injured: femoral nerve, sciatic nerve, and superior gluteal nerves. Conclusion: The most common complications after hip arthroplasty are death, dislocation and infection. Monopolar Austin Moore and bipolar hemiarthroplasty has a beneficial effect on the patient by reintegration into everyday life, the ability to move and increases life expectancy.