Comparison of Mid-term Survivorship and Clinical Outcomes between Bipolar Hemiarthroplasty and Total Hip Arthroplasty with Cementless Stem: A Multicenter Retrospective Study

Early Postoperative Outcomes of Periprosthetic Femoral Fracture in Patients Over 90 Years of Age

The number of total hip arthroplasty and bipolar hemiarthroplasty is increasing because of their good clinical outcomes and the aging population. Consequently, the incidence of periprosthetic femoral fractures (PFFs) is expected to increase in older patients with osteoporosis. Surgery is the first choice of treatment for PFF, except in Vancouver Type A fractures. However, surgical treatment of PFF, including open reduction and internal fixation (ORIF) and revision arthroplasty, is highly invasive, and high mortality rates have been reported. The indication for ORIF for PFF in very elderly patients at a high risk of complications remains controversial, and postoperative outcomes are uncertain. This study aimed to evaluate the postoperative outcomes of ORIF for PFF in elderly patients. We retrospectively analyzed four females with a mean age of 90.7 years (91-92 years) who underwent ORIF for PFF at our institution from September 2014 to January 2023. No cases of American Society of Anesthesiologists (ASA) grade 3 or higher were found. Three patients were classified as Vancouver Type B1, and one was classified as Vancouver Type C. Cementless stems were used in primary surgeries in all cases. To measure clinical outcomes, we investigated the patient's walking ability at 30 days, three months postoperatively, and the final follow-up. Mortality was assessed during the follow-up period. One patient could walk without walking aids preoperatively, two used a walking stick, and one used a walker. All patients remained hospitalized and underwent gait training with a walker at 30 days follow-up; however, at three months postoperatively and the final follow-up, no patient was unable to walk. No deaths occurred within one month of surgery. Three deaths occurred during follow-up: one within six months, one within one year, and one within five years of surgery. The postoperative ORIF results for PFF in patients aged > 90 years showed no fatal perioperative complications and low mortality within 30 days postoperatively. These results suggest that ORIF for PFF can be considered for elderly patients if the preoperative ASA grade is relatively low.

Histological evaluation of the acetabular labrum after bipolar hip hemiarthroplasty: a case report

We report herein the microstructure of the acetabular labrum obtained from a patient with stem loosening but without bipolar cup migration who had undergone hemiarthroplasty for femoral neck fracture 18 years ago. We used light and scanning electron microscopy to investigate the influence of bipolar cup on acetabular labrum in vivo. Deparaffinized blocks were treated with 2 N NaOH to digest the cell matrix, allowing the collagen fibers, constituting the acetabular labrum, to be observed under scanning electron microscopy. Although chondrocyte atrophy was seen, the basic structure was not different from the normal tissue images of the elderly. However, in the deep part of the acetabular labrum, there was an area that was not stained with Alcian blue observed with light microscopy, and there was an amorphous tissue without type II collagen fibrils observed with scanning electron microscopy. These findings proved that the acetabular labrum has partially degenerated over the long term after bipolar hemiarthroplasty, and that the acetabular labrum can survive in vivo in such a condition. Given that hemiarthroplasty has a possibility to preserve the face-to-face tissue in the long term in vivo, it may be one of the valuable options for modern or future joint reconstruction surgery.