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Gounot A, Charlot A, Guillon P, Schaefer A, Moslemi A, Boutroux P, Sautet A. The use of uncemented stems in femoral neck fractures in elderly patients: A comparative study of 671 cases. Orthop Traumatol Surg Res 2024; 110:103878. [PMID: 38582221 DOI: 10.1016/j.otsr.2024.103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/07/2023] [Accepted: 02/14/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The use of cemented stems in elderly patients is associated with the risk of intraoperative embolic complications. Uncemented stems eliminate this risk, but their use is controversial because of the risk of mechanical complications, with estimated subsidence between 3.6 and 30% and periprosthetic fractures between 2.1 and 11% at 6 weeks. A retrospective multicenter comparative study was conducted using a propensity score analysis to evaluate mechanical performances of uncemented stems in femoral neck fractures in elderly patients to (1) compare the risk of mechanical complications and (2) assess the use of metaphyseal-anchored stems for this indication. HYPOTHESIS There is no difference in the risk of mechanical complications, intraoperatively or postoperatively, between these stems. MATERIALS AND METHODS We conducted a multicenter retrospective comparative study including 358 uncemented and 313 cemented stems. The mean age was 84.5 years [83.9-85.1]. The inclusion criteria were patients 70 years and older and a follow-up of at least 6 weeks. The primary endpoint was a composite endpoint comprised of stem subsidence≥2mm or periprosthetic fracture (up to 3 months postoperatively). The secondary endpoints were infection, stem subsidence≥2mm, and operative time. These endpoints were analyzed using a propensity score to control confounding factors. A secondary analysis used the same endpoints to compare metaphyseal-anchored (short stems) versus Corail-like stems. RESULTS After adjusting for the propensity score, we found 11.17% mechanical complications in the uncemented group (n=40, 5.59% subsidence, and 5.59% fractures) versus 13.42% for the cemented group (n=42, 7.99% subsidence, and 5.43% fractures). There was no statistically significant difference between the 2 values (Odds Ratio [OR]=0.64 [95% Confidence Interval [CI]: 0.14-2.85] [p=0.7]). The mortality rate due to cement embolism was 1%. There was no difference in the rate of subsidence (OR=0.55 [95% CI: 0.02-12.5] [p=0.7]), periprosthetic fracture (OR=0.65 [95% CI: 0.13-3.12] [p=0.7]) or infection (OR=0.71 [95% CI: 0.32-1.55] [p=0.4]). However, the operative times were longer in the cemented group (p=0.03 for hemiarthroplasties [mean additional time 16minutes] and p=0.02 for total hip arthroplasties [mean additional time 22minutes]). No difference was observed between the metaphyseal-anchored (short stems) and Corail-like stems regarding operative time, rate of infection, and rate of stem subsidence or periprosthetic fractures. DISCUSSION This is one of the first studies to highlight cemented stem subsidence when used for femoral neck fractures in elderly patients. Using uncemented stems in this indication is still warranted, especially since they do not bring about more mechanical complications in the first few months. Metaphyseal-anchored short stems seem to give the same results as "standard" stems. However, these findings need to be assessed in the longer term. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Alexandre Gounot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - Anahita Charlot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Pascal Guillon
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Augustin Schaefer
- Département d'anesthésie, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Aymane Moslemi
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Pierre Boutroux
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Alain Sautet
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Rougereau G, Bourdier JA, Langlais T, Boisrenoult P, Pujol N. Is there a femoral morphology at risk of a cervical or pertrochanteric fracture? Description and validation of the "Neck shaft ratio" and the "Intertrochanteric distal ratio" after analyzing a continuous cohort of 126 bilateral fractures of the proximal femur. Orthop Traumatol Surg Res 2024; 110:103874. [PMID: 38556208 DOI: 10.1016/j.otsr.2024.103874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/24/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Proximal femur fractures constitute a public health concern given their high frequency and the aging population. The frequency of a contralateral fracture occurring can reach up to 15% of cases. Certain historical or demographic factors constitute risk factors for refracture, but the type of fracture, either of the femoral neck (FN) or pertrochanteric (PT), cannot be predicted. The objectives of this retrospective study were: firstly, to analyze several anatomical markers in order to determine whether they predispose to a certain type of fracture in the event of contralateral refracture, and secondly, to determine the predictive power of these possible radiological markers for the type of contralateral fracture. HYPOTHESIS The hypothesis was that the "Neck shaft ratio" (NSR) and the "Intertrochanteric distal ratio" (ITDR) made it possible to determine a proximal femoral morphology at risk of FN and/or PT fracture in the event of a second fracture. MATERIAL AND METHODS This continuous retrospective single-center series from January 2011 to December 2019 of patients who presented with bilateral fractures of the proximal femurs was analyzed. Radiographs, taken after the first fracture, of the contralateral femur were studied. Morphological measurements previously described in the literature were carried out as well as the NSR (ratio of the medial cortical thicknesses of the femoral neck at its narrowest and basicervical level) and the ITDR (ratio of the medial diaphyseal cortical thicknesses at 5mm and 20mm from the distal portion of the lesser trochanter). One hundred and twenty-six patients were included: 46/126 (36.5%) had bilateral FN, 50/126 (39.7%) bilateral PT and 30/126 (23.8%) one of each. RESULTS Only NSR and ITDR were significant predictive measures for FN or PT fracture type [0.54±0.11 vs. 0.81±0.16 (p<0.0001) and 0. 85±0.1 vs. 0.68±0.1 (p<0.0001), respectively]. These two ratios had an excellent predictive value for the type of fracture occurring on the contralateral side [NSR: AUC ROC = 0.91 (95% CI; 0.86-0.96); ITDR: AUC ROC = 0.81 (95% CI; %, 0.74-0.89)]. The NSR had excellent intra- and inter-observer reproducibility with an interclass correlation coefficient of 0.93 [95% CI: 0.86-0.97] and 0.91 [95% CI: 0.82-0.96] respectively, the same also applied for the ITDR with interclass correlation coefficient values of 0.93 [95% CI: 0.87-0.97] and 0.86 [95% CI: 0.73-0.93] respectively. DISCUSSION The NSR and ITDR ratios offer a simple and reproducible means to predict a morphological predisposition to a certain fracture type, respectively an FN and PT on the side contralateral to an initial osteoporotic proximal femur fracture. A prospective cohort study would be useful in defining a possible prognostic nature on the occurrence and/or time until refracture. LEVEL OF EVIDENCE III; retrospective control case.
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Affiliation(s)
- Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France; Service de chirurgie orthopédique, Université Sorbonne, Hôpital de la Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Jean-Arthur Bourdier
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Tristan Langlais
- Service de chirurgie orthopédique, Université de Toulouse, Hôpital des enfants Purpan, 330, avenue de Grande Bretagne, 31300 Toulouse, France
| | - Philippe Boisrenoult
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Nicolas Pujol
- Service de chirurgie orthopédique et traumatologique, Hôpital Mignot, Université Versailles Saint-Quentin-en-Yvelines, Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
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Sumi S, Takegami Y, Tokutake K, Nakashima H, Mishima K, Takatsu T, Imagama S. Risk factors of periprosthetic joint infection after hemiarthroplasty for displaced femoral neck fracture in the elderly: Analysis of 1619 cases in the multicenter database. Injury 2024; 55:111603. [PMID: 38761711 DOI: 10.1016/j.injury.2024.111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/25/2024] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This multicenter retrospective study focuses on understanding the incidence, causative bacteria, and risk factors for Periprosthetic Joint Infection (PJI) following hemiarthroplasty in elderly patients with displaced femoral neck fractures (FNF). METHODS From 2016 to 2020, 1,619 patients were diagnosed with displaced FNFs and treated surgically across 11 centers. After exclusions, 1,438 patients (399 men and 1,039 women) were included in the study, averaging 82.1 years in age and 20.2 kg/m² in BMI, observed over 25.7 months on average. Data on demographics, medical history, surgical details, and complications were described. RESULTS PJI occurred in 20 of the 1438 patients (1.4%). The causative organism was methicillin-susceptible Staphylococcus aureus in 6 patients and methicillin-resistant S. aureus in 6 patients. In patients' backgrounds, the average age was slightly higher in the non-PJI group (82.1 years) compared to the PJI group (80.4 years). There was a higher percentage of males in the PJI group (45%) than in the non-PJI group (27.5%). Drug history showed that the prevalence of anticoagulant use in the PJI group was 25%. Peripheral vascular disease and diabetes mellitus were more prevalent in the PJI group. Most patients in both groups were independent in daily activities. The blood transfusion rate was significantly higher in the PJI group (50%) than in the non-PJI group (23.8%). Notably, the incidence of hematoma was higher in the PJI group (40%). CONCLUSION This multicenter retrospective study demonstrates a low incidence (1.4%) of PJI in elderly patients undergoing hemiarthroplasty for FNF, primarily due to Staphylococcus aureus. Increased usage of antiplatelets and anticoagulants, as well as comorbidities related to atherosclerosis, like peripheral vascular disease and diabetes mellitus, were observed in patients with PJI. Additionally, these patients experienced higher rates of blood transfusion and postoperative hematomas, highlighting the need for careful management. It should be noted, however, that this finding is a conclusion limited by study design issues, including the retrospective design, small PJI sample size, and variability in treatment approaches.
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Affiliation(s)
- Satoshi Sumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Takatsu
- Department of Orthopaedic Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Esper GW, Meltzer-Bruhn AT, Anil U, Schwarzkopf R, Macaulay W, Konda SR, Ganta A, Egol KA. Periprosthetic fracture following arthroplasty for femoral neck fracture: is a cemented stem protective? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1927-1935. [PMID: 38462554 DOI: 10.1007/s00590-023-03830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/28/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Periprosthetic femoral fractures (PFF) carry significant morbidity following arthroplasty for femoral neck fracture (FNF). This study assessed fracture complications following arthroplasty for FNF and the effect of cement fixation of the femoral component on intraoperative and post-operative PFF. METHODS Between February 2014 and September 2021, 740 patients with a FNF who underwent arthroplasty were analyzed for demographics, surgical management, use of cement for fixation of the femoral component, and subsequent PFF. Variables were compared with Mann-Whitney or Chi-square as appropriate. Multivariate logistic regression was used to assess independent risk factors associated with intraoperative or post-operative PFF. RESULTS There were 163 THAs (41% cemented) and 577 HAs (95% cemented). There were 28 PFFs (3.8%): 18 post-operative and 10 intraoperative. Fewer post-operative PFFs occurred with cemented stems (1.63% vs. 6.30%, p = 0.002). Mean time from surgery to presentation with post-operative PFF was 14 months (0-45 months). Mean follow-up time was 10.3 months (range: 0-75.7 months). In multivariate regression, use of cement and THA was independently associated with decreased post-operative PFF (cement: OR 0.112, 95% CI 0.036-0.352, p < 0.001 and THA: OR 0.249, 95% CI 0.064-0.961, p = 0.044). More intraoperative fractures occurred during THA (3.68% vs. 0.69%, p = 0.004) and non-cemented procedures (5.51% vs. 0.49%, p < 0.001). In multivariate regression, use of cement was protective against intraoperative fracture (OR 0.100, CI 0.017-0.571, p = 0.010). CONCLUSIONS In patients with a FNF treated with arthroplasty, cementing the femoral component is associated with a lower risk of intraoperative and post-operative PFF. Choice of procedure may be based on patient factors and surgeon preference.
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Affiliation(s)
- Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Utkarsh Anil
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - William Macaulay
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
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Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. Comparative Interrupted Time Series Analysis of Direct Medical Expense and Length of Stay in Elderly Patients with Femoral Neck Fractures Who Underwent Total Hip Arthroplasty and Hemiarthroplasty: A Real World Nationwide Database Study. Clin Orthop Surg 2024; 16:217-229. [PMID: 38562640 PMCID: PMC10973615 DOI: 10.4055/cios23282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 04/04/2024] Open
Abstract
Background The objective of our study was to analyze the postoperative direct medical expenses and hospital lengths of stay (LOS) of elderly patients who had undergone either hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fractures and to determine the indication of THA by comparing those variables between the 2 groups by time. Methods In this comparative large-sample cohort study, we analyzed data from the 2011 to 2018 Korean National Health Insurance Review and Assessment Service database. The included patients were defined as elderly individuals aged 60 years or older who underwent HA or THA for a femoral neck fracture. A 1:1 risk-set matching was performed on the propensity score, using a nearest-neighbor matching algorithm with a maximum caliper of 0.01 of the hazard components. In comparative interrupted time series analysis, time series were constructed using the time unit of one-quarter before and after 3 years from time zero. For the segmented regression analysis, we utilized a generalized linear model with a gamma distribution and logarithmic link function. Results A total of 4,246 patients who received THA were matched and included with 4,246 control patients who underwent HA. Although there was no statistically significant difference in direct medical expense and hospital LOS for the first 6 months after surgery, direct medical expenses and hospital LOS in THA were relatively reduced compared to the HA up to 24 months after surgery (p < 0.05). In the subgroup analysis, the THA group's hospital LOS decreased significantly compared to that of the HA group during the 7 to 36 months postoperative period in the 65 ≤ age < 80 age group (p < 0.05). Direct medical expenses of the THA group significantly decreased compared to those of the HA group during the period from 7 to 24 months after surgery in the men group (p < 0.05). Conclusions When performing THA in elderly patients with femoral neck fractures, the possibility of survival for at least 2 years should be considered from the perspective of medical expense and medical utilization. Additionally, in healthy and active male femoral neck fracture patients under the age of 80 years, THA may be more recommended than HA.
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Affiliation(s)
- Seung-Hoon Kim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, Korea
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Ghanimeh J, Abusaq I, Villatte G, Descamps S, Boisgard S, Erivan R. Unipolar Hip Hemiarthroplasty in Geriatric Patients: A Prospective Study and Analysis of Clinical and Radiological Outcomes. Geriatr Orthop Surg Rehabil 2024; 15:21514593241228670. [PMID: 38288325 PMCID: PMC10823842 DOI: 10.1177/21514593241228670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 01/31/2024] Open
Abstract
Introduction Femoral neck fractures (FNF) in the geriatric population are commonly treated with hip replacement procedures, such as total hip arthroplasty, unipolar hip hemiarthroplasty (UHA), and bipolar hip hemiarthroplasty (BHA). The optimal treatment remains controversial, considering outcomes and cost-effectiveness, with UHA often being cheaper. This prospective observational study aims to evaluate UHA's clinical and radiological outcomes, safety, and survivorship compared to existing literature. Methods We followed 90 elderly patients who underwent UHA following FNF. We assessed patients using the Parker score before and after surgery, as well as Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) scores postoperatively. All complications, acetabular erosions and heterotopic ossifications (HO), were documented. Results One year post-surgery, 26.7% of patients had passed away, mostly due to declining general health status. Systemic complications occurred in 14.4% of cases, with a 1.1% rate of deep surgical site infections. A single dislocation resulted from excessive stem anteversion. UHA implant survival rate was 97.8% after 4 years. The Parker score remained stable, and HHS at 6 and 12 months was 71.5 ± 12.9 and 70.9 ± 11.8, respectively, while PMA score was 14.3 ± 2.4 and 14.5 ± 2.1, respectively. Five hips showed Baker I acetabular wear. HO were noted as Brooker I in 12 patients, II in 4 patients, and IV in 1 patient. Discussion UHA exhibited comparable systemic complication rates, implant survivorship, and dislocation rates to those in the literature for both UHA and BHA. The deep surgical site infection rate was lower than reported for BHA. Patients' functional and mental abilities did not decline based on clinical scores. Acetabular wear in UHA was similar to its bipolar counterpart, while HO were only minor findings with no clinical implications. Conclusion In elderly patients, UHA demonstrated clinical and radiological outcomes similar to BHA in existing literature. UHA may represent a cost-effective alternative for patients with limited life expectancy.
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Affiliation(s)
- Joe Ghanimeh
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Ibrahim Abusaq
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, Clermont-Ferrand, France
- Service d’orthopédie-traumatologie. CHU de Montpied Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Villatte
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, Clermont-Ferrand, France
| | - Stéphane Descamps
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, Clermont-Ferrand, France
| | - Stéphane Boisgard
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, Clermont-Ferrand, France
| | - Roger Erivan
- CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, Clermont-Ferrand, France
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Huang J, Liu Z, Ji C, Wang X, Li X, Yang X, Hu Y. Propensity score-matched analysis of enhanced recovery after surgery in total hip arthroplasty for displaced femoral neck fractures. Injury 2023; 54:111132. [PMID: 37883840 DOI: 10.1016/j.injury.2023.111132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/30/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE The concept of enhanced recovery after surgery (ERAS) has been proposed in recent years, which indeed bring about evident convenience for the patients. This prospective cohort study was aimed to investigate the impact of ERAS on the clinical outcome of patients who undergoing total hip arthroplasty due to displaced femoral neck fractures. METHODS Patients in two periods were included in our research, before ERAS (n = 194) and after ERAS (n = 65). The clinical outcome, such as patient statistics, details of perioperative management, length of stay (LOS), pain, Harris hip score, in-hospital complications, and interim postoperative survival were collected. This retrospective observational study addressed confounding bias using propensity score matching (PSM) analysis. RESULTS With PSM, 55 pairs of well-matched patients were generated for comparison (conventional vs. ERAS). LOS decreased to 13.0 ± 3.2 days for the ERAS group, compared to 15.7 ± 3.5 days in the conventional group. VAS pain scores decreased significantly in both groups, and the decrease in the ERAS group was more significant than that in the conventional group at 3, 7, and 14 days postoperatively. The Harris scores of both groups significantly improved, but were better for the ERAS group than the conventional group at 7 and 14 days and 1 month postoperatively. However, no significant difference was observed at 6 months postoperatively. Additionally, the incidence of complications during hospitalization was lower in the ERAS group than that in the conventional group. No significant difference was observed in the medium-term survival between the two groups. CONCLUSIONS ERAS apparently benefit patients in early rehabilitation by reducing complications and shortening hospital stays but not for the long-term hip function or survival.
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Affiliation(s)
- Jun Huang
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, China
| | - Zilin Liu
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, China
| | - Chuang Ji
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, China
| | - Xuezhong Wang
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, China
| | - Xuyang Li
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, China
| | - Xiaoming Yang
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, China.
| | - Yong Hu
- Department of Orthopedics, Renmin Hospital of Wuhan University, No. 99 Zhangzhidong Road, Wuchang District, Wuhan 430060, China.
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Baidya J, Gordon AM, Nian PP, Schwartz J, Golub IJ, Abdelgawad AA, Kang KK. Social determinants of health in patients undergoing hemiarthroplasty: are they associated with medical complications, healthcare utilization, and payments for care? Arch Orthop Trauma Surg 2023; 143:7073-7080. [PMID: 37697051 DOI: 10.1007/s00402-023-05045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Social determinants of health (SDOH) have previously been shown to impact orthopedic surgery outcomes. This study assessed whether greater socioeconomic disadvantage in patients undergoing hemiarthroplasty following femoral neck fracture was associated with differences in (1) medical complications, (2) emergency department (ED) utilization, (3) readmission rates, and (4) payments for care. METHODS A US nationwide database was queried for hemiarthroplasties performed between 2010 and 2020. Area Deprivation Index (ADI), a validated measure of socioeconomic disadvantage reported on a scale of 0-100, was used to compare two cohorts of greater and lesser deprivation. Patients undergoing hemiarthroplasty from high ADI (95% +) were 1:1 propensity score matched to a comparison group of lower ADI (0-94%) while controlling for age, sex, and Elixhauser Comorbidity Index. This yielded 75,650 patients evenly distributed between the two cohorts. Outcomes studied were 90-day medical complications, ED utilizations, readmissions, and payments for care. Multivariate logistic regression models were utilized to calculate odds ratios (ORs) of the relationship between ADI and outcomes. p Values < 0.05 were significant. RESULTS Patients of high ADI developed greater medical complications (46.74% vs. 44.97%; OR 1.05, p = 0.002), including surgical site infections (1.19% vs. 1.00%; OR 1.20, p = 0.011), cerebrovascular accidents (1.64% vs. 1.41%; OR 1.16, p = 0.012), and respiratory failures (2.27% vs. 2.02%; OR 1.13, p = 0.017) compared to patients from lower ADIs. Although comparable rates of ED visits (2.92% vs. 2.86%; OR 1.02, p = 0.579), patients from higher ADI were readmitted at diminished rates (10.57% vs. 11.06%; OR 0.95, p = 0.027). Payments were significantly higher on the day of surgery ($7,570 vs. $5,974, p < 0.0001), as well as within 90 days after surgery ($12,700 vs. $10,462, p < 0.0001). CONCLUSIONS Socioeconomically disadvantaged patients experience increased 90-day medical complications and payments, similar ED utilizations, and decreased readmissions. These findings can be used to inform healthcare providers to minimize disparities in care. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Joydeep Baidya
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA.
- Questrom School of Business, Boston University, Boston, MA, USA.
| | - Patrick P Nian
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jake Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Ivan J Golub
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Kevin K Kang
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
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9
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Amzallag N, Ashkenazi I, Factor S, Abadi M, Morgan S, Graif N, Snir N, Gold A, Warschawski Y. Addition of gentamicin for antibiotic prophylaxis in hip hemiarthroplasty does not decrease the rate of surgical site infection. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02406-6. [PMID: 38006566 DOI: 10.1007/s00068-023-02406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The addition of Gram-negative coverage to antibiotic prophylaxis protocols prior to elective total hip arthroplasty (THA) has been reported to reduce periprosthetic joint infection (PJI). However, it is unknown whether adding a Gram-negative-targeted antibiotic agent improves outcomes in the trauma population. This study aimed to investigate whether the addition of a single, pre-operative dose of Gentamicin is associated with lower rates of PJI in patients undergoing hemiarthroplasty (HA) as treatment for a hip fracture. METHODS We retrospectively reviewed cases of patients who underwent HA as treatment for a hip fracture from January 2011 to January 2022, and had a minimum 1-year of follow-up. Patients were divided into two groups based on the antibiotic prophylaxis they received during surgery: cefazolin (control group) or cefazolin with addition of Gentamicin (case group). The primary outcome was the rate of surgical site infections (SSI), and secondary outcomes included rates of prosthetic joint infection (PJI) and superficial SSIs. RESULTS The final study population consisted of 1521 patients. 336 patients (22.1%) were in the case group and 1185 (77.9%) patients were in the control group. Rates of SSI were comparable between the groups (3.8% for the case group vs. 2.8% in the control group, p = 0.34). This held true for both PJIs (3.5 vs. 2.5%, p = 0.3) and superficial SSIs (0.29 vs. 0.33%, p = 0.91). The distribution of the causing pathogen was similar between the groups (p = 0.84). Gentamicin susceptibility rates of the Gram-negative bacteria associated with PJI were similar between the cohorts (p = 0.51). CONCLUSIONS The addition of a single, pre-operative dose of Gentamicin to the antibiotic prophylaxis protocol of patients undergoing HA as treatment for a hip fracture was not associated with lower rates of SSI, PJI or superficial SSI. The findings of this study indicate that the prophylactic benefits of Gentamicin may not apply to HA as they do to THA.
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Affiliation(s)
- Nissan Amzallag
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
| | - Mohamed Abadi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Aviram Gold
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
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10
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Wang M, Zhao R, Hao Y, Xu P, Lu C. Return to work status of patients under 65 years of age with osteonecrosis of the femoral head after total hip arthroplasty. J Orthop Surg Res 2023; 18:783. [PMID: 37853426 PMCID: PMC10585778 DOI: 10.1186/s13018-023-04283-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE This aimed to evaluate the status of return to work (RTW) in patients with osteonecrosis of the femoral head (ONFH) after total hip arthroplasty (THA). METHODS The baseline characteristics of all patients in this retrospective study were obtained from the hospital patient database. The relevant changes in patients' working conditions, as well as the numerical rating scale (NRS), Harris Hip Score (HHS), self-assessment of work ability, and Likert scale satisfaction assessment were obtained through video call follow-ups. RESULTS 118 patients (response rate: 83%) were ultimately included in this study. The average length of time for the patients to stop working preoperatively was 20.7 weeks. Ninety-four patients (24 women and 70 men) who underwent THA had RTW status, with a mean RTW time of 21.0 weeks. Men had a significantly higher proportion of final RTW and a significantly faster RTW than women. Significant differences in smoking, drinking, cardiovascular diseases, changes in working levels, variations in the types of physical work, changes in working hours, and pain symptoms were observed between the RTW and Non-RTW populations. The patients with a positive RTW status had higher postoperative HHS scores, lower postoperative NRS scores, and higher self-assessment of work ability than patients who had a negative RTW status. CONCLUSION Ultimately, 80% of patients achieved RTW status. Drinking, sex, change in working level, variation in the type of physical work, change in working hours, post-surgery HHS score and self-assessment of work ability can serve as predictive factors for RTW.
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Affiliation(s)
- Mengfei Wang
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
- Shaanxi University of Traditional Chinese Medicine, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Rushun Zhao
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
- Shaanxi University of Traditional Chinese Medicine, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Yangquan Hao
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
| | - Peng Xu
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China
| | - Chao Lu
- Department of Joint Surgery, Xi'an Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, No. Youyi East Road, Nanshaomen, Xi'an, 710054, Shaanxi Province, People's Republic of China.
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11
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Erivan R, Villatte G. Comments to: "Total hip arthroplasty reduces the risk of dislocation after femoral neck fracture" by C. Pangaud, C. Pioger, V. Pauly, V. Orléans, L. Boyer, J.-N. Argenson, M. Ollivier, published in Orthop Traumatol Surg Res 2023;109(4):103575. Orthop Traumatol Surg Res 2023; 109:103666. [PMID: 37499748 DOI: 10.1016/j.otsr.2023.103666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Roger Erivan
- CHU de Clermont-Ferrand, université de Clermont-Auvergne, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Guillaume Villatte
- CHU de Clermont-Ferrand, université de Clermont-Auvergne, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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12
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Page BJ, Parsons MS, Lee JHS, Dennison JG, Hammonds KP, Brennan KL, Lee Brennan M, Lee Stahl D. Surgical Approach and Dislocation Risk After Hemiarthroplasty in Geriatric Patients With Femoral Neck Fracture With and Without Cognitive Impairments-Does Cognitive Impairment Influence Dislocation Risk? J Orthop Trauma 2023; 37:450-455. [PMID: 37053111 DOI: 10.1097/bot.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To determine whether there is an association between surgical approach and dislocation risk in patients with cognitive impairment compared with those without cognitive impairment treated with hemiarthroplasty for femoral neck fracture. DESIGN Retrospective study. SETTING Large, multicenter health system. PATIENTS/PARTICIPANTS One thousand four hundred eighty-one patients who underwent hemiarthroplasty for femoral neck fractures. 828 hips met inclusion criteria, 290 (35.0%) were cognitively impaired, and 538 (65.0%) were cognitively intact. INTERVENTION Hemiarthroplasty. MAIN OUTCOME MEASURE Prosthetic hip dislocation. RESULTS The overall dislocation rate was 2.1% (17 of 828), 3.4% (10 of 290) in the cognitively impaired group, and 1.3% (7 of 538) in the cognitively intact group with a median time to dislocation of 20.5 days (range 2-326 days), 24.5 days (range 3-326 days), and 19.0 days (range 2-36 days), respectively. In the entire cohort, there were no dislocations (0 of 58) with the direct anterior approach (DA); 1.1% (6 of 553) and 5.1% (11 of 217) dislocated with the modified Hardinge (MH) and posterior approaches (PA), respectively. In the cognitively impaired group, there were no dislocations with the DA (0 of 19); 1.5% (3 of 202) and 10.1% (7 of 69) dislocated with the MH and PA, respectively. In the cognitively intact group, there were no dislocations (0 of 39) with the DA; 0.85% (3 of 351) and 2.7% (4 of 148) dislocated with the MH and PA, respectively. There were statistically significant associations between surgical approach and dislocation in the entire cohort and the cognitively impaired group when comparing the MH and PA groups. This was not observed in the cognitively intact group. Patients who dislocated had 3.2 times (95% CI 1.2, 8.7) ( P = 0.0226) the hazard of death compared with patients who did not dislocate. Dislocation effectively increased the risk of death by 221% (HR 3.2 95% CI 1.2, 8.7) ( P = 0.0226). CONCLUSIONS In this patient population, the PA has a higher dislocation rate than other approaches and has an especially high rate of dislocation when the patients were cognitively impaired. The authors of this study suggest careful consideration of surgical approach when treating these injuries. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian Joseph Page
- Hospital for Special Surgery, Limb Lengthening and Complex Reconstruction Service, New York, NY
| | | | - Josh Ho-Sung Lee
- Baylor Scott & White, Department of Orthopaedic Surgery, Temple, TX
| | | | | | | | - Michael Lee Brennan
- Baylor Scott & White, Department of Orthopaedic Surgery, Trauma Section, Temple, TX
| | - Dan Lee Stahl
- Baylor Scott & White, Department of Orthopaedic Surgery, Trauma Section, Temple, TX
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Gnanendran D, Yanaganasar Y, Rajan JM, Hassan ZB, Balbir Singh N, Min Yi L, Nadzree MF. Clinical Effectiveness of Total Hip Arthroplasty Compared With Hemiarthroplasty in Adults Undergoing Surgery for Displaced Intracapsular Hip Fracture: A Single-Centre Retrospective Cohort Study. Cureus 2023; 15:e45807. [PMID: 37876402 PMCID: PMC10591270 DOI: 10.7759/cureus.45807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) recommends offering total hip arthroplasty (THA) over hemiarthroplasty (HA) for displaced intracapsular hip fractures, taking the premorbid functionality, present co-morbidities, and functional benefit beyond two years into account. Concerns remain whether the higher surgical burden and incidence of complications in THA would outweigh the potential benefits in the elderly. METHOD This retrospective cohort study evaluates the differences in surgical outcomes of THA vs HA in 85 patients with displaced intracapsular fractures, based on the time taken for patients to ambulate to walking frame/crutches and wheelchair post-operatively and the incidence of post-operative complications. RESULTS Patients who received HA were significantly older (p<0.0001, <0.05) and had poorer pre-operative ambulatory function (p=0.032, p<0.05) than those of the THA group. HA patients had a significantly faster recovery to walking frame/crutches (20.2 days) compared to THA patients (47.3 days) (Mann-Whitney U=447.500, n=46, p=0.043, <0.05 two-tailed). While no significant differences were found in deep vein thrombosis (DVT), infected prosthesis, or dislocation incidence, hospital-acquired pneumonia (HAP) was more prevalent in THA patients (p=0.044, <0.05). Time to the walking frame had a significant effect on DVT/PE (p<0.001, CONCLUSION HA patients showed favourable outcomes in time to ambulate post-operatively and incidence of HAP among patients with advanced age and those with poorer pre-operative ambulatory function.
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Affiliation(s)
| | | | | | | | | | - Lau Min Yi
- Trauma and Orthopaedics, Hospital Sultan Ismail, Johor Bahru, MYS
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14
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Park SJ, Kim BG. Effects of exercise therapy on the balance and gait after total hip arthroplasty: a systematic review and meta-analysis. J Exerc Rehabil 2023; 19:190-197. [PMID: 37662528 PMCID: PMC10468294 DOI: 10.12965/jer.2346290.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023] Open
Abstract
The situation is such that there is a lack of research analyzing the effect of exercise therapy during the rehabilitation period of patients after total hip arthroplasty (THA). Therefore, the purpose of this systematic review and meta-analysis is to analyze the effects of exercise therapy on the balance and gait of patients after THA. The studies selected for this study were based on the PICO as follows: P (Patient)-patients after THA, I (Intervention)-exercise therapy, C (Comparison)-control and other therapy groups, O (Outcome)-balance and gait. Additional criteria for this study were study design (randomized controlled study), language (English), publication status (journal), and the year of publication were not limited. Eleven studies were included. The effects of exercise therapy on balance and gait in patients after THA were significantly different. Balance: standardized mean difference (SMD), 0.51; 95% confidence intervals (CI), 0.24-0.78; I2=22%. Gait: SMD, 0.39; 95% CI, 0.01-0.76; I2=66%. Rehabilitation specialists recommend that exercise therapy be included in rehabilitation programs to improve balance and gait in patients after THA. Further research is needed in the future, including more studies and a network meta-analysis that analyzes the effect size of each exercise therapy.
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Affiliation(s)
- Se-Ju Park
- Department of Rehabilitation, Songwon University, Gwangju,
Korea
| | - Byeong-Geun Kim
- Department of Rehabilitation, Songwon University, Gwangju,
Korea
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15
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Chi W, Pang P, Luo Z, Liu X, Cai W, Li W, Hao J. Risk factors for hypoxaemia following hip fracture surgery in elderly patients who recovered from COVID-19: a multicentre retrospective study. Front Med (Lausanne) 2023; 10:1219222. [PMID: 37497272 PMCID: PMC10366448 DOI: 10.3389/fmed.2023.1219222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
Objectives To explore the risk factors associated with postoperative hypoxaemia in elderly patients who have recovered from coronavirus disease (COVID-19) and underwent hip fracture surgery in the short term. Design Multicentre retrospective study. Setting The study was performed in three first 3A-grade hospitals in China. Participants A sequential sampling method was applied to select study participants. Medical records of 392 patients aged ≥65 years who had recovered from COVID-19 and underwent hip fracture surgery at three hospitals in China between 1 November, 2022, and 15 February, 2023, were reviewed. Interventions Patients were assigned to hypoxaemia or non-hypoxaemia groups, according to whether hypoxaemia occurred after surgery. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative hypoxaemia. Results The incidence of postoperative hypoxaemia was 38.01%. Statistically significant differences were found between the two groups in terms of age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, presence of expectoration symptoms, preoperative hypoxaemia, chronic obstructive pulmonary disease, pulmonary inflammation, time between recovery from COVID-19 and surgery, anaesthetic mode, surgical procedure, intraoperative blood loss, intraoperative infusion, duration of surgery, and length of hospital stay (p < 0.05). Furthermore, patients with BMI ≥28.0 kg/m2, expectoration symptoms, presence of preoperative hypoxaemia, ASA classification III, time between recovery from COVID-19 and surgery ≤2 weeks, and general anaesthesia were potential risk factors for postoperative hypoxaemia. Conclusion Obesity, expectoration symptoms, preoperative hypoxaemia, ASA classification III, time between recovery from COVID-19 and surgery ≤2 weeks, and general anaesthesia were potential risk factors for postoperative hypoxaemia in elderly patients who recovered from COVID-19 and underwent hip fracture surgery in the short term.
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Affiliation(s)
- Wen Chi
- Department of Operating Room, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Peng Pang
- Department of Anaesthesiology, Binzhou Medical College Affiliated Hospital, Binzhou, China
| | - Zhenguo Luo
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Xiaobing Liu
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Wenbo Cai
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
| | - Wangyang Li
- Department of Orthopedic, Linfen Hospital Affiliated to Shanxi Medical University, Linfen, China
| | - Jianhong Hao
- Department of Anaesthesiology, HongHui Hospital, Xi’an JiaoTong University, Xi’an, China
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16
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Levaillant M, Rony L, Hamel-Broza JF, Soula J, Vallet B, Lamer A. In France, distance from hospital and health care structure impact on outcome after arthroplasty of the hip for proximal fractures of the femur. J Orthop Surg Res 2023; 18:418. [PMID: 37296484 DOI: 10.1186/s13018-023-03893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Hip arthroplasty is a frequently performed procedure in orthopedic surgery, carried out in almost all health structures for two main issues: fracture and coxarthrosis. Even if volume-outcome relationship appeared associated in many surgeries recently, data provided are not sufficient to set surgical thresholds neither than closing down low-volumes centers. QUESTION With this study, we wanted to identify surgical, health care-related and territorial factors influencing patient' mortality and readmission after a HA for a femoral fracture in 2018 in France. PATIENTS AND METHODS Data were anonymously collected from French nationwide administrative databases. All patients who underwent a hip arthroplasty for a femoral fracture through 2018 were included. Patient outcome was 90-day mortality and 90-day readmission rate after surgery. RESULTS Of the 36,252 patients that underwent a HA for fracture in France in 2018, 0.7% died within 90-day year and 1.2% were readmitted. Male and Charlson comorbidity index were associated with a higher 90-day mortality and readmission rate in multivariate analysis. High volume was associated with a lower mortality rate. Neither time of travel nor distance upon health facility were associated with mortality nor with readmission rate in the analysis. CONCLUSION Even if volume appears to be associated with lower mortality rate even for longer distance and time of travel, the persistence of exogenous factors not documented in the French databases suggests that regionalization of hip arthroplasty should be organized with caution. CLINICAL RELEVANCE As volume-outcome relationship must be interpreted with caution, policy makers should not regionalize such surgery without further investigation.
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Affiliation(s)
- Mathieu Levaillant
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.
- Centre Hospitalier Universitaire d'Angers, Angers, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | - Julien Soula
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
| | - Benoît Vallet
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
| | - Antoine Lamer
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000, Lille, France
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Pangaud C, Pioger C, Pauly V, Orleans V, Boyer L, Argenson JN, Ollivier M. Total hip arthroplasty reduces the risk of dislocation after femoral neck fracture. Orthop Traumatol Surg Res 2023; 109:103575. [PMID: 36754167 DOI: 10.1016/j.otsr.2023.103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/28/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Femoral neck fracture in the elderly patient can either be managed using hemi-arthroplasty (HA) or total hip arthroplasty (THA). The aim of this study was to explore the rate of three selected complications in each procedure: is the dislocation rate higher with HA compared to THA? Is the blood transfusion rate higher with THA compared to HA? Do the patients who underwent THA require more ICU transfer than the patients who underwent HA? Is the ICU transfer correlated to the use of cement for stem fixation? METHOD Based on a national health-care database, a comparative and retrospective study was conducted. 96,184 patients were included after having a surgery for femoral neck fracture between 2014 and 2017. The mean follow up was 3.5 years (Min. 2 years-Max. 5 years). The population was divided into two groups: hemiarthroplasty (HA) and total hip arthroplasty (THA). The primary outcome was the dislocation rate and the secondary outcomes were the blood transfusion rate and the need for ICU after surgery. RESULTS At two years of follow up in the Hemiarthroplasty group, 3647 patients had a dislocation episode over 64,106 patients: 5.69%. In the Total Hip Arthroplasty group: 1904 patients had a dislocation episode over 32,078 patients: 5.94% (p=0.26711). The percentage of deceased patient without dislocation was 17.76% in the HA group and 11.56% in the THA group (p<0.001). The univariate hazard ratio for dislocation was higher in the THA group: HR 1.063 IC 95% (0.993-1.138) p=0.077. The multivariate analysis calculating competitive risk with death and dislocation found THA to be a protective factor of dislocation HR 0.926 IC 95% (0.866-0.991) p=0.0266. The rate of blood transfusion was 5.59% in the THA group and 7.03% in the HA group (p<0.001), The multivariate analysis found HR=1.062 IC 95% (0.99-1.139) p=0.0955. The need for ICU transfer after the surgery was 7.04% in the HA group and 8.08% in the THA group (p<0.001). The multivariate analysis found HR 0.995 IC 95% (0.921-1.076) p=0.9094. Finally, only cement was found as an independent risk factor of ICU transfer after surgery: HR 1.254 IC 95% (1.164-1.35) p<0.0001. CONCLUSION THA for femoral neck fracture allows to reduce the risk of dislocation compared to hemiarthroplasty. The multivariate analysis failed to prove the superiority of one procedure over the other regarding blood transfusion risk and the need for ICU transfer. The use of cemented stem appears to be a risk factor of ICU transfer after hip arthroplasty. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Corentin Pangaud
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France.
| | - Charles Pioger
- Public Teaching Hospital of Paris, Ambroise-Paré Hospital, Paris, France
| | - Vanessa Pauly
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Veronica Orleans
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Jean Noël Argenson
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
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18
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Hoggett L, Alexander D, Helm A. Post-operative complications following total hip arthroplasty for trauma: A multicentre cohort study comparing dual mobility with conventional acetabular bearings. J Orthop 2023; 40:34-37. [PMID: 37159824 PMCID: PMC10163605 DOI: 10.1016/j.jor.2023.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/16/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
Aims Dislocation of a total hip replacement is a serious complication after total hip arthroplasty (THA). Dislocation rates are higher when surgery is performed following trauma. Our study compares post-operative dislocation rates between conventional acetabular bearing (CAB) and dual mobility acetabular bearing (DMB) THA performed for neck of femur fracture alongside post-operative periprosthetic fracture, revision and mortality. Methods A retrospective multicentre cohort study at 9 hospital trusts in the United Kingdom of all THA performed for neck of femur fracture between March 2018 and February 2019. Results A total of 295 operations were performed. 64% (189) were CAB and 36% (106) were DMB. Average age was 75 years (38-98). 223 Female: 72 Male. The follow-up period was an average of 42 months (36-48). Overall revision rate was 1.6%,8 peri-prosthetic fracture rate was 6 (2%) and overall mortality was 9.8% (29) with no significant difference between cohorts for any outcome. The posterior approach (PA) was favoured 82% (242) vs the lateral approach (LA) 18% (53) with the PA used more often in patients undergoing DMB 96% (102) vs CAB 74% (140) p = 0.001. Patients approached posteriorly at the time of their index procedure were significantly less likely to sustain a simple dislocation following a DMB 0 (0%) vs. CAB 8 (5.7%) p = 0.015. Conclusion Our study demonstrates that the risk of dislocation following THA for trauma is more than four times higher than when conventional bearings are used compared to dual mobility acetabular components. This effect is most pronounced when the PA is utilised for the index procedure. The use of these bearings does not impact mortality, peri-prosthetic fracture or revision rate. We would encourage the use of dual mobility acetabular bearings in patients undergoing THA for fracture via a PA.
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Affiliation(s)
- Lee Hoggett
- Health Education North West, Trauma and Orthopaedic Surgery, UK
- Corresponding author.
| | | | - Anthony Helm
- Lancashire Teaching Hospitals NHS Foundation Trust, Trauma and Orthopaedic Surgery, UK
| | - NWORC CollaborativeBarclayJennifercDamarajuSandeepcWilkinsonHannahdSoufiMazeneCullenClareeElsorafyKareemeMustafaSyedeYahiaZoubaidaeNaderiSadafeGreenhalghMikefKnowlesDavidfSharrockMartingHerlekarDeepakgCollinsThomashMaceJameshRogersSophiehTalhaSamiriJohnsonDavidiChikateAlbertjKulkarniKrishanjUnsworthRichardkDivechaHirenkNaylorThomaslLancashire Teaching Hospitals, UKBlackpool Teaching Hospitals, UKEast Lancashire Teaching Hospitals NHS Foundation Trust, UKMorcambe Bay Hospitals (Barrow), UKMorcambe Bay Hospitals (Lancaster), UKBolton NHS Foundation Trust, UKStockport NHS Foundation Trust, UKNorthern Care Alliance NHS Foundation Trust (Salford), UKWrightington Wigan and Leigh NHS Foundation Trust, UKManchester University NHS Foundation Trust (North Manchester General), UK
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19
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Laggner R, Taner B, Straub J, Tiefenböck TM, Binder H, Sator T, Hajdu S, Windhager R, Böhler C. Do Elevated Serum C-Reactive-Protein Levels Excuse Delayed Surgery for Femoral Neck Fractures? Antibiotics (Basel) 2023; 12:antibiotics12040738. [PMID: 37107100 PMCID: PMC10135175 DOI: 10.3390/antibiotics12040738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
In elderly patients with femoral neck fractures, preoperative serum C-reactive protein (CRP) values might be elevated due to active infections. Although there are limited data on CRP as a predictor of periprosthetic joint infection (PJI), out of concern, this could lead to delayed surgery. Therefore, we aim to investigate whether elevated serum-CRP levels justify delayed surgery for femoral neck fractures. A retrospective analysis was performed of the records of patients undergoing arthroplasty who were found to have an elevated CRP level of 5 mg/dL or more between January 2011 to December 2020. The patients were stratified to three groups, according to initial serum CRP levels at a cut off of 5 mg/dL and the time between admission and surgery (<48 vs. ≥48 h after admission). This study revealed that the patients with elevated serum CRP levels and delayed surgery showed a worse survival rate and significantly more postoperative complications than the patients on whom surgery was performed immediately. There were no significant differences in terms of PJI and prolonged wound healing in the inter-group comparison. Therefore, delays to surgery on the basis of elevated CRP values offer no benefits to patients with femoral neck fractures.
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Affiliation(s)
- Roberta Laggner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Benan Taner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Jennifer Straub
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Harlad Binder
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Sator
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Böhler
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
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20
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Hu W, Xu WB, Li H, Jiang WH, Shao YC, Shan JC, Yang D, Wan DE, Shuang F. Outcomes of direct superior approach and posterolateral approach for hemiarthroplasty in the treatment of elderly patients with displaced femoral neck fractures: A comparative study. Front Surg 2023; 10:1087338. [PMID: 36998599 PMCID: PMC10043180 DOI: 10.3389/fsurg.2023.1087338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/16/2023] [Indexed: 03/16/2023] Open
Abstract
Hemiarthroplasty is a surgical choice for super-aged patients with a high surgical risk and a sedentary lifestyle. The direct superior approach (DSA), a minimally invasive modification of the posterior approach, is rarely studied in hemiarthroplasty. The aim of the present study was to compare the clinical outcomes in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty via DSA with the conventional posterolateral approach (PLA). A total of 48 elderly patients with displaced femoral neck fractures who underwent hemiarthroplasty between February 2020 and March 2021 were retrospectively included in the study. Of them, 24 patients (mean age 84.54 ± 2.11 years) were treated with hemiarthroplasty via DSA (DSA group), while the other 24 patients (mean age 84.92 ± 2.15 years) were treated with hemiarthroplasty via PLA (PLA group). Clinical outcomes, perioperative data, and complications were recorded. There were no obvious differences in the baseline characteristics between the DSA and PLA groups, including age, gender, body mass index, Garden type, American Society of Anesthesiologists score, and hematocrit. Perioperative data showed that the length of the incision in the DSA group was smaller than that in the PLA group (p < 0.001). However, the duration of the operation and blood loss in the DSA group were longer and higher than those in the PLA group, respectively (p < 0.001). In addition, the DSA group had a shorter hospitalization time than the PLA group (p < 0.001). The visual analog scale score and Harris score 1 month postoperatively in the DSA group were better than those in the PLA group (p < 0.001). Moreover, there were no significant differences between the two groups in Harris score (for assessment dysfunction) 6 months postoperatively (p > 0.05). DSA is less invasive and has better clinical outcomes, which can allow an early return to daily living activities in elderly patients with displaced femoral neck fractures undergoing hemiarthroplasty.
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21
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Rougereau G, Naline C, Boisrenoult P, Langlais T, Pujol N. Proximal femoral fracture and female gender are risk factors for recurrent fracture: Cohort study of 292 patients over 75 years-old with iterative osteoporotic fractures. Injury 2023:S0020-1383(23)00187-0. [PMID: 36931968 DOI: 10.1016/j.injury.2023.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The purpose of this study was to: 1/ describe the characteristics of a cohort of patients over 75 years of age hospitalized in perioperative geriatric units (UPOG) for iterative fractures; 2/ investigate the risks of institutionalization related to the first fracture; and 3/ search for potential risk factors for iterative fracture. METHODS This is a retrospective single-center study analyzing patients over 75 years old, hospitalized in UPOG. RESULTS Of the 3207 patients hospitalized, 292 patients had a refracture (9.1%), with a mean age of 85.4+/-5.8 years. Initial fractures were mainly intertrochanteric (43.2%) and the femoral neck (32.9%). Refractures occurred mainly in the first year (55.5%), with a median delay of 9.6 months. Refractures were mainly intertrochanteric (29.5%), peri‑implant (prosthesis, osteosynthesis) (28.8%), and femoral neck (26.7%). Dementia was the only factor for institutionalization after the first fracture episode (p = 0.0002). Proximal femoral fracture (PFF) and female gender were risk factors for iterative fracture (10.2% vs. 6.8%, p = 0.003; 10.7% vs. 6.8%, p = 0.005 respectively), but not age (85.4 vs. 85.8 years, p = 0.24). PFF were more likely to result in the same fracture type in the second episode (58.1% vs 7.1%, p<0.0001). The time to refracture was shorter in case of peri‑implant fracture (p = 0.0002), or discharge directly to home (p = 0.04). CONCLUSION PFF and female gender are risk factors for recurrent fracture, which is even more likely to occur early in case of home discharge or peri‑implant fracture.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France.
| | - Charlotte Naline
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France; Department of Geriatrics, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Philippe Boisrenoult
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Tristan Langlais
- Department of Orthopaedic paediatric Surgery, Hôpital des enfants, Purpan, Université de Toulouse, Toulouse, France; Department of Orthopaedic paediatric Surgery, Sorbonne Université, A. Trousseau, APHP, Paris, France
| | - Nicolas Pujol
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
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22
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Chulsomlee K, Prukviwat S, Tuntiyatorn P, Vasaruchapong S, Kulachote N, Sirisreetreerux N, Tanphiriyakun T, Chanplakorn P, Sa-Ngasoongsong P. Correlation between shape-closed femoral stem design and bone cement implantation syndrome in osteoporotic elderly femoral neck fracture undergoing cemented hip arthroplasty: A retrospective case-control study in 128 patients. Orthop Traumatol Surg Res 2023; 109:103450. [PMID: 36273503 DOI: 10.1016/j.otsr.2022.103450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is a serious and potentially fatal complication especially in patients with osteoporotic femoral neck fracture (OFNF) undergoing cemented hip arthroplasty (CHA). Recent studies showed that the shape-closed femoral stem profile could lead to a significant increase of the intramedullary pressure during cementation and prosthesis insertion. This study aimed to (1) correlate the use of shaped-closed femoral stem and other perioperative risk factors with severe grade of BCIS grade 2 or 3: BCIS gr2/3, and (2) identify the prevalence of BCIS in the elderly patients with OFNF and treated with CHA. HYPOTHESIS Large wedge-shaped (or "shape-closed") femoral stem design would significantly associate with BCIS gr2/3 in the elderly patients who sustained OFNF and underwent CHA. PATIENTS AND METHODS A total of 128 OFNF patients, who aged over 75years and underwent CHA were retrospectively reviewed and then allocated into 2 groups: SC Group (use shape-closed femoral stem, n=40) and FC Group (use force-closed femoral stem, n=88). BCIS was grading in all patients according to Donaldson classification. Perioperative data between the patients with BCIS-gr2/3 and those with BCIS grade 0 or 1 (BCIS-gr0/1) were compared. Multiple logistic regression analysis was used to identify predictive factors for BCIS-gr2/3. RESULTS The prevalence of overall BCIS and BCIS-gr2/3 was 32.8% (n=42) and 6.2% (n=8), respectively. The total in-hospital and 1-year mortality rates were 2.3% and 4.7%, respectively. The major perioperative complication in patients with BCIS-gr2/3 was significantly higher compared to those in patients with BCIS-gr0/1 (62.5% vs. 10.0%, p=0.001). Multivariate analysis showed that age>90years (OR=9.4, 95% CI: 1.4-62.9, p=0.02), preinjury Parker mobility score<4 (OR=48.8; 95% CI: 2.7-897.2, p=0.008) and shape-closed femoral stem used (OR=19.1; 95% CI: 1.8-204.5, p=0.01) were the significant independent predictors for BCIS-gr2/3 in these patients. CONCLUSION BCIS in OFNF patients undergoing CHA is common and associates with a high major perioperative complication rate. Our initial hypothesis is validated as the patients at risk for BCIS-gr2/3 are those whose CHA procedures use a shape-closed femoral stem design and with extreme age, and having poor preinjury ambulatory status. Therefore, we recommended using cementless stem as the first option in OFNF. However, if CHA is needed, strict guideline for cement insertion should be followed with force-closed stem application to avoid the risk of BCIS-gr2/3. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Kulapat Chulsomlee
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasichol Prukviwat
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panithan Tuntiyatorn
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Satetha Vasaruchapong
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Noratep Kulachote
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Norachart Sirisreetreerux
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thiraphat Tanphiriyakun
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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23
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Wilharm A, Wutschke I, Schenk P, Hofmann GO. Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis of Perioperative Outcome. Geriatr Orthop Surg Rehabil 2023; 14:21514593221147817. [PMID: 36654888 PMCID: PMC9841876 DOI: 10.1177/21514593221147817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/24/2022] [Accepted: 11/21/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction: Implantation of a dual-head hip prosthesis to treat medial femoral neck fractures is often associated with significant blood loss. In elective endoprosthetics procedures, it has already been demonstrated that administration of tranexamic acid (TXA) reduces blood loss and need for postoperative transfusions, as well as reducing the frequency of postoperative complications. The aim of this study is to show whether the administration of TXA also leads to a reduction in perioperative blood loss and haemorrhage-associated complications when applied as part of treatment of femoral neck fractures using a dual-head prosthesis. Methods: In a single-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 93 patients who had suffered from femoral neck fractures. This group was compared to a comparison group of 65 patients who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, frequency of transfusion, and frequency of specific complications occurring. Results: The transfusion rate in the TXA group was 6% lower, whereby the volume of blood transfused was 26.7% lower than in the nonTXA group. However, neither result was significant. The calculated perioperative blood loss remained the same. Similarly, the incidence of postoperative renal failure was not significantly lower in the TXA group, at 6.5%, as compared to the nonTXA group (7.7%). A higher rate of complications or deaths as a result of TXA administration was not observed. The tranexamic acid effect seems to be related to the dose. Conclusion: Preoperative administration of TXA during implantation of a dual-head prosthesis for treatment of a femoral neck fracture does not lead to an increased complication rate. The study revealed a trend towards fewer transfusions required, but a significant reduction in blood loss could not be demonstrated. There should be further investigation of other factors influencing blood loss, in particular the dosing regimen followed for perioperative administration of TXA. Level of Evidence: Level 4: retrospective case-control study.
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Affiliation(s)
- Arne Wilharm
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Jena, Germany,Arne Wilharm, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, Jena 07747, Germany.
| | - Isabell Wutschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Philipp Schenk
- Department of Research Executive, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Gunther Olaf Hofmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Jena, Germany
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Longo UG, Viganò M, de Girolamo L, Banfi G, Salvatore G, Denaro V. Epidemiology and Management of Proximal Femoral Fractures in Italy between 2001 and 2016 in Older Adults: Analysis of the National Discharge Registry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16985. [PMID: 36554865 PMCID: PMC9778915 DOI: 10.3390/ijerph192416985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
This study aims to determine the annual incidence of proximal femoral fractures in Italy in the period between 2001 and 2016 among older adults, and to describe the trends in the clinical management of these cases. Data were retrieved from the National Hospital Discharge records issued by the Italian Ministry of Health and from the Italian Institute for Statistics. The number of hospitalizations increased between 2001 and 2016, while the age-adjusted yearly incidence decreased from 832.2 per 100,000 individuals to 706.2. The median age was 83 years (IQR 78-88) with a large majority of females (76.6%). The type of fracture varied with age in female subjects, with older women more frequently reporting pertrochanteric fractures. Therapeutic strategies for the different types of fracture depended on patients' age. During the study years, improvements in fracture classification and management strategies were observed, with a clear decreasing trend for non-operative solutions. In conclusion, the number of proximal femur fractures in older adults is growing, even if at a lower rate compared to population aging. The Italian surgical practice changed during the study period towards the implementation of the most recent guidelines.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Giuseppe Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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25
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Thejeel B, Endo Y. Imaging of total hip arthroplasty: Part I – Implant design, imaging techniques, and imaging of component wear and fracture. Clin Imaging 2022; 98:74-85. [PMID: 36229386 DOI: 10.1016/j.clinimag.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
Despite being one of the most reliable procedures in orthopedic surgery, complications can occur after total hip arthroplasty, and radiology plays an essential role in their evaluation. This article will review the various types of hip arthroplasty and their normal appearances on imaging, followed by mechanisms and imaging appearances of component wear and fracture.
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Affiliation(s)
- Bashiar Thejeel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA
| | - Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
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Bhagwat AP, Ambade DR. Virtual and Augmented Surgical Skills in Total Hip Arthroplasty. Cureus 2022; 14:e28895. [PMID: 36237780 PMCID: PMC9543854 DOI: 10.7759/cureus.28895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022] Open
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Orth M, Osche D, Mörsdorf P, Holstein JH, Rollmann MF, Fritz T, Pohlemann T, Pizanis A. Minimal-invasive anterior approach to the hip provides a better surgery-related and early postoperative functional outcome than conventional lateral approach after hip hemiarthroplasty following femoral neck fractures. Arch Orthop Trauma Surg 2022; 143:3173-3181. [PMID: 36053291 DOI: 10.1007/s00402-022-04602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Femoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases. MATERIAL AND METHODS In the present retrospective study geriatric patients with FNF (n = 100) treated either by anterior minimal-invasive surgery (AMIS; n = 50) or lateral conventional surgery (LCS; n = 50) were characterized (age at the time of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and 12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed. RESULTS Patients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and complication rates did not differ between the two groups. Further, more patients in the AMIS group achieved full weight-bearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often than patients of the LCS group. No significant differences in functional and surgery-related performance could be observed between AMIS and LCS group at 12 months postoperatively. CONCLUSIONS In conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in these vulnerable patients.
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Affiliation(s)
- M Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.
| | - D Osche
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - P Mörsdorf
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - J H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.,Ethianum Clinic, Heidelberg, Germany
| | - M F Rollmann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.,BG Klinik Tuebingen on behalf of the Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - T Fritz
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - T Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
| | - A Pizanis
- Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany
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Maccagnano G, Maruccia F, Rauseo M, Noia G, Coviello M, Laneve A, Quitadamo AP, Trivellin G, Malavolta M, Pesce V. Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease. J Clin Med 2022; 11:jcm11164785. [PMID: 36013024 PMCID: PMC9410486 DOI: 10.3390/jcm11164785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange.
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Affiliation(s)
- Giuseppe Maccagnano
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Francesco Maruccia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michela Rauseo
- Department of Anesthesia and Intensive Care, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giovanni Noia
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Michele Coviello
- Orthopaedic & Trauma Unit, AOU Consorziale Policlinico. Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico. Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3938165088
| | - Andrea Laneve
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Alessandro Pio Quitadamo
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
| | - Giacomo Trivellin
- Hip and Trauma Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Michele Malavolta
- Knee Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Vito Pesce
- Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy
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Zhang X, Liu S. The role of internal fixation in the treatment of femoral head necrosis with ipsilateral hip fracture. Medicine (Baltimore) 2022; 101:e29921. [PMID: 35960040 PMCID: PMC9371497 DOI: 10.1097/md.0000000000029921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Whether internal fixation or hip arthroplasty is the most appropriate initial treatment for patients with ipsilateral hip fracture and osteonecrosis of the femoral head remains unknown. In this study, the prognoses of patients who underwent internal fixation or hip arthroplasty were analyzed and compared to explore the role of internal fixation in treating such patients. We retrospectively reviewed 69 patients diagnosed with osteonecrosis of the femoral head and ipsilateral hip fracture from 1999 to 2018. They were divided into the hip arthroplasty or internal fixation group. The visual analog scale and Harris score were used. The incidence of complications and the conversion to arthroplasty were also investigated to further explore the role of internal fixation. Male patients (male/female: 25/31 vs 20/38, P = .015), younger patients (average age: 46.80 ± 13.14 vs 61.07 ± 15.61, P < .001), and patients with femoral neck fractures (fracture type, femoral neck/trochanter: 21/31 vs 12/38, P = .003) were more likely to receive 1-stage hip arthroplasty. Of 38 patients undergoing internal fixation, fracture nonunion was identified in 9, and progression of osteonecrosis was identified in 16. Meanwhile, conversion to secondary hip arthroplasty occurred in 13 patients. Four independent risk factors for conversion to secondary hip arthroplasty were identified: age of ≤60 years (odds ratio [OR] = 9.786, 95% confidence interval [CI] = 2.735-35.015), male sex (OR = 6.790, 95% CI = 1.718-26.831), collapse of the femoral head before injury (OR = 7.170, 95% CI = 2.004-25.651), and femoral neck fracture (OR = 8.072, 95% CI = 2.153-30.261). A new scoring system was constructed for predicting conversion to hip arthroplasty in patients undergoing internal fixation treatment. A cutoff of ≤2 points indicated low risk for conversion, 3 to 4 points indicated moderate risk, and ≥5 points indicated high risk. Patients who underwent internal fixation had worse prognoses than those who underwent 1-stage hip arthroplasty. However, in this study, hip arthroplasty conversion did not occur in most patients who received internal fixation. Using the new scoring system to identify patients who may require conversion to replacement may help make appropriate patient management and clinical decisions.
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Affiliation(s)
- Xinguo Zhang
- Department of orthopedic, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, People’s Republic of China
| | - Sikai Liu
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- *Correspondence: Sikai Liu, Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei Province, People’s Republic of China (e-mail: )
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Sano K, Homma Y, Shirogane Y, Ishii S, Ito T, Baba T, Kaneko K, Ishijima M. Acetabular morphological variation in Asian patients with femoral neck fracture: A three-dimensional CT-based study. Injury 2022; 53:2823-2831. [PMID: 35768326 DOI: 10.1016/j.injury.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/26/2022] [Accepted: 06/19/2022] [Indexed: 02/02/2023]
Abstract
AIMS The acetabular morphology varies greatly among individuals, and hypoplasia is more common in Asia than in Europe. Dislocation after bipolar hip arthroplasty (BHA) for femoral neck fracture occurs at a constant rate, and is affected by the acetabular morphology. This study aimed to clarify individual differences in the acetabula of Asian patients with displaced femoral neck fractures. PATIENTS AND METHODS Fifty patients with displaced femoral neck fractures were assessed (50 fractured hips, 50 non-fractured hips). On CT corrected by the anterior pelvic plane, the 100 hips were assessed regarding acetabular coverage (six parameters), acetabular depth (two parameters), and acetabular opening angle (four parameters). Additional parameters related to the fracture and sex were examined. The percentile of each parameter was shown for all hips. RESULTS There was no patient with hip dysplasia defined as superior acetabular sector angle (SASA) less than 110° Compared with men, women had a significantly smaller anterior acetabular sector angle (AASA) (p = 0.016), and significantly larger acetabular inclination angle (p = 0.006) and acetabular index angle (p = 0.034). In the group with a normal SASA, seven hips (7.3%) had an anterior wall defect (AASA<50°) and five hips (5.2%) had a posterior wall defect (posterior acetabular sector angle<90°). CONCLUSION Older adults with femoral neck fractures can have anterior wall and posterior wall defects, even if their SASA is normal. Hidden acetabular dysplasia may be related to post-BHA dislocation. So, our results suggest that is important to accurately evaluate the acetabulum of patients with femoral neck fracture before surgery.
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Affiliation(s)
- Kei Sano
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Yuichi Shirogane
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Seiya Ishii
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomoyuki Ito
- Division of Orthopedic Surgery, Tominaga Kusano Hospital, Niigata, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Martin MP, Cole MW, Patel AH, Sherman WF. Gunshot Wound to the Hip Resulting in a Femoral Head and Acetabulum Fracture Treated With Open Reduction and Internal Fixation and Bipolar Hemiarthroplasty. Arthroplast Today 2022; 16:229-236. [PMID: 35880228 PMCID: PMC9307496 DOI: 10.1016/j.artd.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 11/05/2022] Open
Abstract
Combined fractures of the femoral head and acetabulum due to ballistic injuries are rare injuries, especially in the elderly. We present a case of a 70-year-old female who sustained a gunshot wound to the left hip, resulting in a comminuted femoral head fracture and posterior wall acetabular fracture. She was treated with open reduction and internal fixation of the acetabulum, as well as bipolar hemiarthroplasty for treatment of her femoral head fracture. At her 18-month follow-up visit, the patient was doing well and had no complaints.
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The Feasibility of Using the Direct Anterior Approach for Total Hip Arthroplasty or Bipolar Hemiarthroplasty to Treat Femoral Neck Fractures among the Elderly. Adv Orthop 2022; 2022:2115586. [PMID: 35910812 PMCID: PMC9328964 DOI: 10.1155/2022/2115586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Femoral neck fractures (FNFs) are a significant cause of mortality and disability among the elderly. Total hip arthroplasty (THA) is the preferred treatment method in active, cognitively intact patients. In less active or cognitively impaired patients, bipolar hemiarthroplasty (BHA) is the practical option in Japan. Even with the direct anterior approach (DAA), clinical concerns about conducting THA in elderly patients include possible dislocations, critical complications, and medical cost-effectiveness. This study is aimed at rethinking the practical surgical indications for FNFs. Methods Between April 2019 and March 2021, BHA patients with displaced FNF (n = 21) performed through the DAA were compared with THA patients with displaced FNF (n = 19). The perioperative complications, clinical and radiologic outcomes, and mortality were compared between groups retrospectively at six months. Results THA patients had an increased average operation time (103.3 min vs. 89.1 min, P < 0.05) and similar amounts of bleeding (183.16 ml. vs. 121.1 ml.). The percentages of patients who received biological transfusion showed no difference, with low rates of perioperative complications (4% vs. 0%) and similar mortality rates compared to BHA patients. One THA patient experienced posterior dislocation during a state of postoperative delirium. Conclusion THA through the DAA might be a credible and safe option for FNF patients, with excellent functional outcomes and fewer surgery-related complications. Early posterior dislocation might be related to optimized offset distance and not related to leg discrepancy or other radiographic items. Hence, orthopedic surgeons should reconsider their options before conducting BPH for elderly and cognitively intact FNF patients.
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Ochi H, Kobayashi H, Baba T, Nakajima R, Kurita Y, Kato S, Sasaki K, Nozawa M, Kim SG, Sakamoto Y, Homma Y, Kaneko K, Ishijima M. Acetabular cartilage abnormalities in elderly patients with femoral neck fractures. SICOT J 2022; 8:24. [PMID: 35699460 PMCID: PMC9196023 DOI: 10.1051/sicotj/2022022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Both hemiarthroplasty (HA) and total hip arthroplasty (THA) are widely accepted surgical procedures for hip replacement following displaced femoral neck fractures. However, in cases involving an intact joint line before surgery, the choice between HA and THA remains debatable. This study investigated the prevalence of acetabular cartilage and labral abnormalities in elderly patients with femoral neck fractures. METHODS Thirty-seven patients underwent hip arthroplasty for femoral neck fractures between April 2020 and February 2021. After excluding 4 patients, 33 patients (6 men and 27 women; mean age = 82.2 [range = 67-98] years) with fractures in 12 left and 21 right hips were included. After femoral head removal during arthroplasty, the acetabulum was macroscopically examined for the presence of cartilage and labral lesions. Acetabular cartilage abnormalities were classified as either overall degeneration or partial damage according to the cartilage damage classification system. RESULTS Acetabular cartilage abnormalities, including overall degeneration or partial damage, were found in all hips (100%). Out of the 33 hips, overall degeneration, partial damage, and labral abnormalities were detected in 32 (96.9%), 16 (48.4%), and 9 (27.2%) hips, respectively. DISCUSSION In this study, most elderly patients with femoral neck fractures exhibited acetabular cartilage and labral abnormalities, which were already present at the time of surgery. Therefore, surgeons should carefully examine these abnormalities as they may impact postoperative outcomes such as pain and function.
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Affiliation(s)
- Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, San-ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo 130-0012, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Riko Nakajima
- Department of Orthopaedic Surgery, San-ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo 130-0012, Japan
| | - Yasuha Kurita
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Suguru Kato
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Kyoko Sasaki
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masahiko Nozawa
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Sung-Gon Kim
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Yuko Sakamoto
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Peng P, Xiao F, He X, Fang W, Huang J, Wang B, Luo Y, Zhang Q, Zhang Y, He W, Wei Q, He M. Global Research Status and Trends of Femoral Neck Fracture Over the Past 27 Years: A Historical Review and Bibliometric Analysis. Front Surg 2022; 9:875040. [PMID: 35784942 PMCID: PMC9241583 DOI: 10.3389/fsurg.2022.875040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Femoral neck fracture (FNF) is a commonly encountered injury in orthopedic practice, and many studies have been conducted in this field. However, no bibliometric studies regarding the global research trend concerning FNF have been performed. This study aims to analyze the knowledge framework, research hotspots, and theme trends in the field of FNF research. Methods The scientific outputs related to FNF from 1994 to 2021 were retrieved from the Web of Science Core Collection. Three bibliometric tools were used for this study. The main analyses include publication and citation counts, contributions of countries, institutions, authors, funding agencies and journals, and clustering of keywords. Results In total, 3,553 articles were identified. The annual publication counts of FNF showed an ascending tendency as a whole. The United States has the most prominent contributions, with the most number of publications and the highest H-index. Karolinska Institutet devoted the most in this domain. Professors Bhandari M, Schemitsch EH, Frihagen F, Parker MJ, and Rogmark C were the core authors in this field. The most productive journal was Injury International Journal of the Care of the Injured. Keywords were divided into four clusters: epidemiology and mortality, fracture prevention, internal-fixation and risk factors, and hip replacement. A trend of balanced and diversified development existed in these clusters. Keywords with the ongoing bursts, including “outcome,” “reoperation,” “complication,” “revision,” “displaced intracapsular,” “fracture,” and “adult,” are considered as the research hotspots in the future and deserve more attention. Conclusions The management of FNF in young patients is drawing more attention from orthopedic surgeons, and it is expected that these research topics may continue to be the research hotspots and focus in the near future.
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Affiliation(s)
- Peng Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangjun Xiao
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoming He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weihua Fang
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiewen Huang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bin Wang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiwen Luo
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qinwen Zhang
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital (Orthopedics Hospital of Henan), China
| | - Wei He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiushi Wei
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
| | - Mincong He
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Correspondence: Mincong He Qiushi Wei
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Stołtny T, Pasek J, Rokicka D, Wróbel M, Dobrakowski M, Kamiński P, Domagalski R, Czech S, Strojek K, Koczy B. Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement. J Int Med Res 2022; 50:3000605221095225. [PMID: 35726568 PMCID: PMC9218464 DOI: 10.1177/03000605221095225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.
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Affiliation(s)
- Tomasz Stołtny
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Jarosław Pasek
- Department of Physiotherapy, Faculty of Health Sciences, University of Jan Długosz, Częstochowa, Poland
| | - Dominika Rokicka
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Marta Wróbel
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Michał Dobrakowski
- Department of Medical Radiology and Radiodiagnostics, Independent Public Clinical Hospital No. 1, Zabrze, Poland.,Department of Biochemistry, Faculty of Medical Sciences, Medical University of Silesia, Zabrze, Poland
| | - Paweł Kamiński
- Department of Medical Radiology and Radiodiagnostics, Independent Public Clinical Hospital No. 1, Zabrze, Poland
| | - Rafał Domagalski
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Szymon Czech
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Krzysztof Strojek
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Bogdan Koczy
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
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Fixation vs Arthroplasty for Femoral Neck Fracture in Patients Aged 40-59 Years: A Propensity-Score-Matched Analysis. Arthroplast Today 2022; 14:175-182. [PMID: 35342781 PMCID: PMC8943217 DOI: 10.1016/j.artd.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/26/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusions
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Li Q, Wang Y, Shen X. Effect of Psychological Support Therapy on Psychological State, Pain, and Quality of Life of Elderly Patients With Femoral Neck Fracture. Front Surg 2022; 9:865238. [PMID: 35402487 PMCID: PMC8987194 DOI: 10.3389/fsurg.2022.865238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore the intervention effect of psychological support therapy (PST) on elderly patients with femoral neck fracture. Methods A total of 82 elderly patients with femoral neck fractures admitted to our hospital from July 2020 to June 2021 were selected. Patients were randomly divided into conventional group (n = 41) and intervention group (n = 41). The conventional group received routine nursing care. The intervention group was given PST on the basis of the conventional group. The joint function, psychological state, pain, quality of life, and nursing satisfaction of both groups were observed. Results Compared with before intervention, the Harris hip joint score and the General Quality-of-Life Inventory-74 scores of both groups increased after the intervention, and the increase was more obvious in the intervention group (p < 0.05). Compared with before intervention, the self-rating anxiety scale, the self-rating depression scale scores, and the visual analog scales score in both groups decreased after the intervention, and the decrease was more obvious in the intervention group (p < 0.05). The total satisfaction of the intervention group (92.68%) was higher than that of the conventional group (75.61%) (p < 0.05). Conclusion Psychological support therapy has a certain intervention effect on elderly patients with femoral neck fracture, which can improve psychological state, reduce pain, improve quality of life, and improve nursing satisfaction.
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Zhao F, Xue Y, Wang X, Zhan Y. Efficacy of Supercapsular Percutaneously-Assisted Total Hip Arthroplasty in the Elderly With Femoral Neck Fractures: A Meta-analysis. Geriatr Orthop Surg Rehabil 2022; 13:21514593221074176. [PMID: 35186423 PMCID: PMC8855386 DOI: 10.1177/21514593221074176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach is a
novel minimally invasive surgical technique for total hip arthroplasty
(THA). This meta-analysis was conducted to evaluate the outcomes following
THA via the SuperPATH approach in elderly patients with femoral neck
fractures (FNFs), compared with those via traditional surgical
approaches. Methods Eligible studies were retrieved through searching 7 electronic databases and
manually screening related references. Objectives were surgical-related
parameters, functional outcomes, and incidence of postoperative
complications. Results 9 comparative studies were included. Pooled results suggested that at the
cost of longer operative time (WMD: 14.25, 95% CI: 3.25 to 25.25), the
SuperPATH technique was superior to traditional approaches regarding
incision length (WMD: −4.51, 95% CI: −6.46 to −2.56), intraoperative blood
loss (WMD: −80.47, 95% CI: −122.36 to −38.57), and hospital stays (WMD:
−3.35, 95% CI: −5.05 to −1.65). SuperPATH groups exhibited significantly
increased Harris Hip Scores within 1 month after surgery (7d, WMD: 9.85, 95%
CI: 6.40 to 13.30; 14d, WMD: 10.68, 95% CI: 8.29 to 13.08; 1 month, WMD:
6.17, 95% CI: 3.56 to 8.78) and had a reduced incidence of overall
complications (OR: .19, 95% CI: .09 to .41). No significant differences were
found between the 2 groups regarding postoperative pain relief. Conclusion Elderly patients with FNFs are potential candidates for THA treatment via the
SuperPATH technique, which is associated with improved surgical outcomes,
better short-term functional recovery, and lower risk of total complications
as compared to traditional approaches. Additional studies are needed to
further confirm our conclusions and validate the long-term efficacy of
SuperPATH.
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Affiliation(s)
- Fulong Zhao
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yang Xue
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xuefei Wang
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yunjia Zhan
- Department of Trauma Orthopedics, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
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Bertault-Le Gourrierec J, Cavaignac E, Berard E, Moretti F, Marot V, Chiron P, Reina N. Comparative study of total hip arthroplasties with dual mobility cups versus hemiarthroplasties in management of femoral neck fractures: Survival and dislocation rate at 5 years of follow-up? Orthop Traumatol Surg Res 2022; 108:103098. [PMID: 34624538 DOI: 10.1016/j.otsr.2021.103098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/02/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instability after hip arthroplasty, whether it is a total (THA) or intermediate (HA), poses a major risk, however arthroplasty is the standard treatment for displaced intracapsular fractures of the femoral neck of the elderly. Three types of arthroplasties can be proposed: total prostheses with or without a dual mobility cup (DM THA) reducing the risk of dislocation, and hemiarthroplasties. In the absence of clear recommendations regarding the type of implant to be used and the scarcity of studies comparing HA and DM THA, we conducted a monocentric comparative retrospective study using the propensity score method to compare DM THA versus HA on recently displaced femoral neck fractures: (1) survival and risk of dislocation, (2) functional results, (3) mortality. HYPOTHESIS The rate of dislocation of THA fitted with a DM cup is lower than that of HA. PATIENTS AND METHODS We retrospectively identified 112 patients in the HA group and 153 patients in the DM THA group who underwent an emergency arthroplasty for a displaced cervical fracture between 2010 and 2013. The minimum follow-up was 5 years (range, 5-9 years). The mean age at surgery was 81 years (range, 55-101 years). Elective surgery patients (n=2), hardware fractures (n=10), pathological fractures of the femoral neck (n=6), associated fractures (n=3), and revision surgeries (n=5) were excluded. The primary outcome measure was instability. Clinical follow-up was performed by the WOMAC score and the risk of mortality was determined after adjusting for confounding factors using the propensity score method. RESULTS After adjustment by the propensity score, the dislocation rate at 2-years was 2.2% (n=3/153) in the dual mobility THA group and 6.3% (n=7/112) in the HA group (OR=0.34 [95% CI: 0.06-1.96] (p=0.23)). After adjustment by the propensity score, the mean WOMAC score was 8.20 (±6.56) in the THA group, compared to 10.78±3.92 on average in the HA group (p=0.031). After adjustment by the propensity score, we did not find any significant difference in the reoperation rate without changing implants and revisions, and postoperative complications. After adjustment by the propensity score, mortality was significantly higher in the HA group 45.5% (n=69/152) versus 91.5% (n=102/112) in the HA group (OR=0.50 [95% CI: 0.25-0.98] (p=0.042)). DISCUSSION Few studies have compared these two types of implant in the context of trauma. Although the results of our study are not significant regarding the risk of dislocation, the use of a dual mobility cup seems to be a very satisfactory solution in this trauma context. LEVEL OF EVIDENCE III; comparative retrospective cohort.
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Affiliation(s)
- Juliette Bertault-Le Gourrierec
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Etienne Cavaignac
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Emilie Berard
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France; CERPOP, Inserm, UPS, Purpan faculty of medicine, university of Toulouse, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Federico Moretti
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Vincent Marot
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Philippe Chiron
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Nicolas Reina
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France.
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Cecere AB, De Cicco A, Bruno G, Toro G, Errico G, Braile A, Schiavone Panni A. SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case-control study. Arch Orthop Trauma Surg 2022; 142:3265-3270. [PMID: 34482424 PMCID: PMC9522763 DOI: 10.1007/s00402-021-04153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches. MATERIALS AND METHODS We retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients. RESULTS Thirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072). CONCLUSIONS The SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes.
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Affiliation(s)
- Antonio Benedetto Cecere
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Gaetano Bruno
- Unit of Orthopaedics and Traumatology, AORN Sant'Anna E San Sebastiano, Caserta, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy.
| | - Giacomo Errico
- Unit of Orthopaedics and Traumatology, AORN Sant'Anna E San Sebastiano, Caserta, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
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Bhan K, Hasan K, Khan BG, Shafiq H, Pimplé M. Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity? Cureus 2021; 13:e19049. [PMID: 34858741 PMCID: PMC8613712 DOI: 10.7759/cureus.19049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Femoral neck fractures are one of the most common fractures treated by an Orthopaedic surgeon. Arthroplasty is the recommended management for intracapsular neck of femur fractures in the elderly population owing to the high risk of avascular necrosis of the femoral head following an internal fixation. Elderly patients with intracapsular fractures deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2) are recommended a hip hemiarthroplasty. Routine practice throughout the United Kingdom is to obtain a postoperative check radiograph for all hip hemiarthroplasty patients prior to their discharge from the hospital. This may be done for various reasons like checking the presence of any peri-prosthetic fracture, the position of the components along with the presence of any dislocation. However, it is unclear whether a radiograph is the sole identifier of such complications. Through this study, we aim to analyse whether routine recommendation of post-operative radiographs following hip hemiarthroplasty affects the clinical outcome, and whether it is effective in identifying potential complications before the patients report any signs or symptoms.
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Affiliation(s)
- Kavyansh Bhan
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
| | - Kamrul Hasan
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
| | | | - Hassan Shafiq
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
| | - Mahesh Pimplé
- Trauma and Orthopaedics, Barts Health NHS Trust, London, GBR
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Bschorer K, Zeckey C. [72/f-Pain in hips and groin after falling : Preparation for the medical specialist examination: part 56]. Unfallchirurg 2021; 124:152-158. [PMID: 33420519 DOI: 10.1007/s00113-020-00945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kathrin Bschorer
- Klinik für Unfallchirurgie und Orthopädie, RoMed Klinikum Rosenheim, Pettenkoferstr. 10, 83022, Rosenheim, Deutschland
| | - Christian Zeckey
- Klinik für Unfallchirurgie und Orthopädie, RoMed Klinikum Rosenheim, Pettenkoferstr. 10, 83022, Rosenheim, Deutschland.
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Yoo JI, Jang SY, Cha Y, Choy WS, Koo KH. Comparison of Mortality, Length of Hospital Stay and Transfusion between Hemiarthroplasty and Total Hip Arthroplasty in Octo- and Nonagenarian Patients with Femoral Neck Fracture: a Nationwide Study in Korea. J Korean Med Sci 2021; 36:e300. [PMID: 34811975 PMCID: PMC8608921 DOI: 10.3346/jkms.2021.36.e300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the mortality rate between patients undergoing hemiarthroplasty (HA) and those undergoing total hip arthroplasty (THA) in two age groups: patients aged 65-79 years (non-octogenerian) and patients aged ≥ 80 years (octogenarian). METHODS We identified elderly (aged ≥ 65 years) femoral neck fracture patients who underwent primary THA or HA from January 1, 2005 to December 31, 2015 in South Korea using the Health Insurance and Review and Assessment database; the nationwide medical claim system of South Korea. We separately compared the mortality rate between the HA group and THA group in two age groups. A generalized estimating equation model with Poisson distribution and logarithmic link function was used to calculate the adjusted risk ratio (aRR) of death according to the type of surgery. RESULTS The 3,015 HA patients and 213 THA patients in younger elderly group, and 2,989 HA patients and 96 THA patients in older elderly group were included. In the younger elderly group, the mortality rates were similar between the two groups. In older elderly group, the aRR of death in the THA group compared to the HA group was 2.16 (95% confidence interval [CI], 1.20-3.87; P = 0.010) within the in-hospital period, 3.57 (95% CI, 2.00-6.40; P < 0.001) within 30-days, and 1.96 (95% CI, 1.21-3.18; P = 0.006) within 60-days. CONCLUSIONS In patients older than 80 years, THA was associated with higher postoperative mortality compared to HA. We recommend the use of HA rather than THA in these patients.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Won-Sik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Zhuang TF, Huan SW, Luo SM, She GR, Wu WR, Chen JY, Liu N, Zha ZG. The role of routine postoperative laboratory tests following hip hemiarthroplasty for an elderly femoral neck fracture. BMC Musculoskelet Disord 2021; 22:806. [PMID: 34537036 PMCID: PMC8449897 DOI: 10.1186/s12891-021-04698-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 09/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background Performing postoperative laboratory tests following joint arthroplasty is a regular practice. However, the role of routine postoperative laboratory tests in primary hip arthroplasty is currently in doubt. This study aimed to assess the role of routine postoperative laboratory tests for femoral neck fractures in elderly patients who underwent hip hemiarthroplasty and to evaluate the risk factors for postoperative laboratory testing abnormalities and related interventions. Methods This retrospective study reviewed 735 consecutive patients with femoral neck fractures (FNFs) who underwent hip hemiarthroplasty at a single tertiary academic organization. Patient characteristic features and laboratory testing values were recorded. Logistic regression models were calculated to identify risk factors. Results A total of 321 elderly patients (> 75 years of age) were ultimately enrolled for analysis. Abnormal postoperative laboratory tests were found in 265 patients (82.6%). Only a minority of the included patients (7.5%) needed medical intervention to treat postoperative laboratory testing abnormalities. Multivariate logistic regression analysis reported that a higher Charlson comorbidity index (CCI) (P = 0.03), abnormal preoperative haemoglobin level (P < 0.01), higher intraoperative blood loss (P < 0.01) and less frequent tranexamic acid use (P = 0.05) were risk factors for abnormal postoperative laboratory tests. Furthermore, a higher CCI has been identified as a risk factor for patients needing clinical interventions related to laboratory abnormalities. Conclusions Because 92.5% of laboratory tests did not influence postoperative management, the authors suggest that routine laboratory tests after hip hemiarthroplasty for FNFs are less instructive for the majority of elderly patients. Nevertheless, for patients with identified risk factors, postoperative laboratory tests are still required to identify the abnormalities that need to be managed.
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Affiliation(s)
- Teng-Feng Zhuang
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Song-Wei Huan
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Si-Min Luo
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Guo-Rong She
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Wen-Rui Wu
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Jun-Yuan Chen
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Ning Liu
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China.
| | - Zhen-Gang Zha
- The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China.
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Raj JJ, Kow RY, Ramalingam S, Low CL. Neck of Femur Fracture in Young Patients With End-Stage Renal Disease and Hyperparathyroidism: A Report of Three Cases and Proposed Treatment Algorithm. Cureus 2021; 13:e16155. [PMID: 34367767 PMCID: PMC8338123 DOI: 10.7759/cureus.16155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 11/05/2022] Open
Abstract
Secondary hyperparathyroidism is a complication arising from untreated end-stage renal disease (ESRD). It can invariably lead to osteoporosis and subsequently cause pathological neck of femur (NOF) fracture. Despite being young, osteosynthesis in neck of femur fractures of these patients often leads to nonunion and implant failure due to severely osteoporotic bone. We present our experience in managing three young patients with ESRD and secondary hyperthyroidism who sustained NOF fractures. All three patients were successfully treated and showed no complication at one year post-operation. Based on our experience and literature review, we propose a simple algorithm to guide the management of these patients.
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Affiliation(s)
- Jeffrey J Raj
- Department of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | - Ren Yi Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS.,Department of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | | | - Chooi Leng Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
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Spina M, Luppi V, Chiappi J, Bagnis F, Balsano M. Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study. Aging Clin Exp Res 2021; 33:1635-1644. [PMID: 32910422 DOI: 10.1007/s40520-020-01696-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND In the current literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs). AIM The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs. MATERIALS AND METHODS Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6 months and mortality at 1, 3 and 12 months. RESULTS Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8 min vs. 97.7 min), a lower mean number of blood units transfused perioperatively (1.4 U vs. 1.9 U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12 months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant. CONCLUSIONS The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Mauro Spina
- Department of Orthopedics and Traumatology A, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia.
| | - Valentina Luppi
- Department of Orthopedics and Traumatology B, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
| | - Jacopo Chiappi
- Department of Orthopedics and Traumatology B, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
| | - Francesco Bagnis
- Department of Orthopedics and Traumatology B, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
| | - Massimo Balsano
- Department of Orthopedics and Traumatology A, Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italia
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Hubert J, Beil FT, Ries C. [Hemiarthroplasty for geriatric femoral neck fractures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:245-261. [PMID: 34043028 DOI: 10.1007/s00064-021-00714-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/13/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Restoration of pain-free joint function by implantation of a bipolar hemiarthroplasty via anterolateral approach. INDICATIONS Elderly multimorbid patients >70 years, age >80 years, low functional demand. CONTRAINDICATIONS Infection. Relative contraindications: dysplastic hip joint. SURGICAL TECHNIQUE Supine position. Anterolateral approach. Incision of the iliotibial tract and entering the interval between tensor fasciae latae muscle/gluteus medius muscle. Capsulotomy. Femoral neck osteotomy. Removal of the femoral head and determination of the size of the bipolar prosthetic head. Inspection of the acetabulum. Adduction, external rotation ("figure 4" position) of the leg. Medullary preparation of the femur with rasps up to the correct level and size of the planed stem. Ensure the correct rotation of anteversion (10-15°). Trial reduction and examination of hip stability. Verification with image intensifier. Cement restrictor, jet lavage, drying the medullary canal, injection of bone cement and insertion of the prosthetic stem. Assembly/attachment of the definitive bipolar head to the stem. Reduction of the joint. Wound closure. POSTOPERATIVE MANAGEMENT Early mobilization and full weight bearing. Limitation of hip flexion >90°, rotation and adduction for 6 weeks. Venous thromboembolism prophylaxis. Osteoporosis evaluation and management. Clinical-radiological control (after 6 weeks, 1/3/5 years). RESULTS The implantation of a cemented hemiarthroplasty using the anterolateral approach is a muscle-sparing and dislocation-safe surgical procedure with a low risk of revision, which enables early patient mobilization and a good hip joint function.
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Affiliation(s)
- J Hubert
- Fachbereich Orthopädie, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, Gebäude Ost 10, 20246, Hamburg, Deutschland.
| | - F T Beil
- Fachbereich Orthopädie, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, Gebäude Ost 10, 20246, Hamburg, Deutschland
| | - C Ries
- Fachbereich Orthopädie, Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, Gebäude Ost 10, 20246, Hamburg, Deutschland
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Sarpong NO, Grosso MJ, Lakra A, Herndon CL, Jennings E, Shah RP, Geller JA, Cooper HJ. Outcomes and survivorship after conversion of failed hip hemiarthroplasty to total hip arthroplasty. Hip Int 2021; 31:388-392. [PMID: 31822131 DOI: 10.1177/1120700019891427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthroplasty is the treatment of choice for elderly patients with displaced femoral neck fractures. When compared to total hip arthroplasty (THA), higher revision rates have been reported for hemiarthroplasty (HA). Conversion of failed HA to THA can be complex, especially in the elderly population at risk for revision surgery complications. We report a single institution's experience with conversion of failed HA to THA at mid-term follow-up. METHODS We identified patients converted from failed HA to THA from 2006 to 2016. Clinical data including indication for index and conversion surgery, maintenance or revision of femoral component during conversion, operative time, estimated blood loss, postoperative complications, and need for revision surgery were collected. Descriptive statistics were analysed in SPSS. RESULTS The cohort included 21 men and 39 women (mean age of 74.5 years). The mean follow-up after conversion HA to THA was 2.8 years. During conversion surgery, the femoral component was revised in 75.0% and retained in 25.0% of cases. After conversion HA to THA, the rate of major complications and re-revision at 2 years was 11.7% and 10.0%, respectively. Femoral revision versus retention did not affect complication rates (11.1% vs. 6.7%; p = 0.31) or re-revision rates (8.9% vs. 13.3%; p = 1.0). CONCLUSIONS In this high-risk population, mid-term follow-up demonstrated tolerable complication and re-revision rates, the majority of which were for instability. We observed high rates of femoral component revision during conversion THA, although this did not increase the likelihood of postoperative complications or need for future surgery.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Akshay Lakra
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Carl L Herndon
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Emma Jennings
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P Shah
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey A Geller
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Larrañaga I, Etxebarria-Foronda I, Ibarrondo O, Gorostiza A, Ojeda-Thies C, Martínez-Llorente JM. Stratified cost-utility analysis of total hip arthroplasty in displaced femoral neck fracture. GACETA SANITARIA 2021; 36:12-18. [PMID: 33888335 DOI: 10.1016/j.gaceta.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/20/2021] [Accepted: 02/11/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To conduct a stratified cost-utility analysis of total versus partial hip arthroplasty as a function of clinical subtype. METHOD All cases of this type of intervention were analysed between 2010 and 2016 in the Basque Health Service, gathering data on clinical outcomes and resource use to calculate the cost and utility in quality-adjusted life years (QALYs) at individual level. The statistical analysis included applying the propensity score to balance the groups, and seemingly unrelated regression models to calculate the incremental cost-utility ratio and plot the cost-effectiveness plane. The interaction between age group and American Society of Anesthesiologists (ASA) risk class was assessed in the multivariate analysis. RESULTS The study identified 5867 patients diagnosed with femoral neck fracture, of whom 1307 and 4560 were treated with total and partial hip arthroplasty, respectively. In the cost-utility analysis based on the seemingly unrelated regression, total hip arthroplasty was found to have a higher cost and higher utility (2465€ and 0.42 QALYs). Considering a willingness-to-pay threshold of €22,000 per QALY, total hip arthroplasty was cost-effective in the under-80-year-old subgroup. Among patients above this age, hemiarthroplasty was cost-effective in ASA class I-II patients and dominant in ASA class III-IV patients. CONCLUSIONS Subgroup analysis supports current daily clinical practice in displaced femoral neck fractures, namely, using partial replacement in most patients and reserving total replacement for younger patients.
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Affiliation(s)
- Igor Larrañaga
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Gipuzkoa, Spain; Kronikgune Institute for Health Service Research, Barakaldo, Bizkaia, Spain.
| | - Iñigo Etxebarria-Foronda
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Department of Orthopaedic and Trauma Surgery, Arrasate-Mondragón, Gipuzkoa, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Oliver Ibarrondo
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Gipuzkoa, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Ania Gorostiza
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Gipuzkoa, Spain; Kronikgune Institute for Health Service Research, Barakaldo, Bizkaia, Spain
| | - Cristina Ojeda-Thies
- 12 de Octubre University Hospital, Department of Orthopaedic and Trauma Surgery, Madrid, Spain
| | - Jose Miguel Martínez-Llorente
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Department of Accounting, Arrasate-Mondragón, Gipuzkoa, Spain
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Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures. Arthroplast Today 2021; 8:92-95. [PMID: 33732832 PMCID: PMC7943958 DOI: 10.1016/j.artd.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background Total hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral). Methods A retrospective review identified 52 patients who underwent primary THA for FNF between 2009 and 2018, including 20 via the DA approach and 32 by alternative approaches. All procedures were exclusively performed by high-volume arthroplasty surgeons. Perioperative results, complications, and clinical outcomes were compared with those of routine statistical methods. Mean follow-up duration was 3 years (range, 1-8). Results The average age was 74 years (range, 57-92) with similar baseline characteristics between the 2 groups (P = .09). The DA cohort demonstrated significantly shorter length of stay (3 days vs 5 days, P < .01) and discharge to home vs skilled nursing facility (40.0% vs 9.4% P = .014). There was a trend toward decreased complications (0% vs 16%, P = .08). There were no dislocations or fractures in either cohort. Final Harris Hip Scores (94 vs 81, P = .07) and return to community ambulation (96%) were similar between DA and alternative approach groups. Conclusion The DA approach to THA performed for FNF appears safe with improved outcomes compared with alternative approaches. Larger studies are needed to verify these results.
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