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Al-Essah Z, Curlewis K, Chan G, Tokeisham K, Ghosh K, Stott P, Rogers BA. Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians. BMC Musculoskelet Disord 2024; 25:324. [PMID: 38658870 PMCID: PMC11040911 DOI: 10.1186/s12891-024-07340-1] [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: 06/15/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Hip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians. METHODS A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 - 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination. RESULTS There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015). CONCLUSION There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds. TRIAL REGISTRATION Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.
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Affiliation(s)
| | | | - Gareth Chan
- Brighton and Sussex Medical School, Brighton, UK.
- University Hospitals NHS Foundation Trust, Sussex, UK.
| | | | - Koushik Ghosh
- University Hospitals NHS Foundation Trust, Sussex, UK
| | - Philip Stott
- University Hospitals NHS Foundation Trust, Sussex, UK
| | - Benedict A Rogers
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals NHS Foundation Trust, Sussex, UK
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Araiza-Nava B, Méndez-Sánchez L, Clark P, Peralta-Pedrero ML, Javaid MK, Calo M, Martínez-Hernández BM, Guzmán-Jiménez F. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review. Osteoporos Int 2022; 33:1429-1444. [PMID: 35247062 DOI: 10.1007/s00198-022-06346-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 01/17/2023]
Abstract
UNLABELLED This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after discharge. We identified 43 studies reporting 74 associated factors to functional recovery; most of them were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. PURPOSE This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after hospital discharge. We assessed the use of the hip fracture core-set and key-performance indicators for secondary fracture reduction. METHODS A search was performed in seven electronic databases. Observational studies reporting predictors after usual care of elderly patients with hip fracture diagnoses receiving surgical or conservative treatment were included. Primary outcomes considered were part of the domains corresponding to functional capacity. RESULTS Of 3873 references identified, and after the screening and selection process, 43 studies were included. Sixty-one functional measures were identified for ten functional outcomes, including BADLs, IADLs, ambulation, and mobility. Biological characteristics such as age, sex, comorbidities, cognitive status, nutritional state, and biochemical parameters are significantly associated. Determinants such as contact and size of social network and those related to institutional care quality are relevant for functional recovery at six and 12 months. Age, pre-fracture function, cognitive status, and complications continue to be associated five years after discharge. We found 74 associated factors to functional recovery of elderly hip fracture patients. Ten of the studies reported rehabilitation programs as suggested in KPI 9; none used the complete hip fracture core-set. CONCLUSION Most of the associated factors for functional recovery of elderly hip fracture were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. For the core-set and KPI's, we found an insufficient use and report. This study reports 61 different instruments to measure functional capacity. REGISTRATION NUMBER PROSPERO (CRD42020149563).
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Affiliation(s)
- Berenice Araiza-Nava
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | - Lucia Méndez-Sánchez
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico.
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | | | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mónica Calo
- Regional Manager of IOF Latin America, Buenos Aires, Argentina
| | - Brenda María Martínez-Hernández
- Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | - Fabiola Guzmán-Jiménez
- Medical Unit of High Specialty Traumatology and Orthopaedics Hospital "Lomas Verdes", Mexican Institute of Social Security (UMAE Hospital de Traumatología Y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social), Naucalpan de Juárez, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
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Naovarat BS, Lyons MA, Dau JD, Nguyen BY, Salazar GA, Williams FM, Reveille JD. Factors Associated With Knee Osteoarthritis in an Outpatient HIV-1 Clinic Setting: Management and Follow-up. J Clin Rheumatol 2022; 28:e308-e311. [PMID: 34117189 DOI: 10.1097/rhu.0000000000001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin S Naovarat
- From the Division of Rheumatology, The University of Texas-McGovern Medical School, Houston, TX
| | - Marka A Lyons
- From the Division of Rheumatology, The University of Texas-McGovern Medical School, Houston, TX
| | - Jonathan D Dau
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Binh Y Nguyen
- From the Division of Rheumatology, The University of Texas-McGovern Medical School, Houston, TX
| | - Gloria A Salazar
- From the Division of Rheumatology, The University of Texas-McGovern Medical School, Houston, TX
| | - Francis M Williams
- From the Division of Rheumatology, The University of Texas-McGovern Medical School, Houston, TX
| | - John D Reveille
- From the Division of Rheumatology, The University of Texas-McGovern Medical School, Houston, TX
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Wu HH, Liu M, Challa ST, Morshed S, Eliezer EN, Haonga BT, Zirkle L, Shearer DW. Development of Squat-and-Smile Test as Proxy for Femoral Shaft Fracture-Healing in Patients in Dar es Salaam, Tanzania. J Bone Joint Surg Am 2019; 101:353-359. [PMID: 30801374 DOI: 10.2106/jbjs.18.00387] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are few validated instruments that serve as a proxy for fracture-healing after lower-extremity trauma in low-resource settings. The squat-and-smile test (S&S) has been under development by SIGN (Surgical Implant Generation Network) Fracture Care International to monitor outcomes of lower-extremity long-bone fractures after intramedullary nailing in resource-limited settings. The goals of this study were to develop and identify domains of the S&S test. METHODS The S&S domains were developed through an iterative process, and consensus was achieved regarding 3: squat depth, support needed to squat, and facial expression. Adult patients with an OTA/AO type-32 femoral shaft fracture were included in this retrospective study and had the S&S administered at 6 weeks and 3, 6, and 12 months postoperatively. Two authors independently assessed photographs of the patients performing the S&S. S&S domains were correlated with the EuroQol 5-Dimensions (EQ-5D) index score, and comparisons were made between S&S domains and reoperation status. Interrater and test-retest reliability was assessed using the kappa statistic. Sensitivity and specificity analyses were performed. RESULTS Six hundred and nine S&S images were evaluated for 231 patients. Each domain improved over time and correlated positively with EQ-5D scores (p < 0.05). Squat depth and support needed to squat correlated with the need for a reoperation (p ≤ 0.01), and both had high specificity (0.95 and 0.97, respectively) for ruling out the need for a reoperation at 1 year. All 3 domains had high test-retest reliability (κ = 0.95, 0.92, and 0.96). Squat depth and need for support also had strong interrater reliability (κ = 0.75 and 0.78). CONCLUSIONS The S&S is a potential tool for monitoring clinical and functional outcome of femoral shaft fractures in low-resource settings. Our data support the binary assessment of squat depth and need for support, but not facial expression, as a proxy for fracture-healing. Future prospective studies in external populations are warranted to evaluate the validity, reliability, and responsiveness of the S&S. CLINICAL RELEVANCE The S&S provides a valuable proxy for femoral shaft fracture assessment for middle to low-income countries because it is locally relevant (based on squatting), it is easy to administer, and assessment can be performed remotely via mobile telephone or text messaging.
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Affiliation(s)
- Hao-Hua Wu
- University of California San Francisco, San Francisco, California
| | - Max Liu
- Stanford University, Stanford, California
| | - Sravya T Challa
- University of California San Francisco, San Francisco, California
| | - Saam Morshed
- University of California San Francisco, San Francisco, California
| | - E N Eliezer
- Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Billy T Haonga
- Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Lewis Zirkle
- SIGN Fracture Care International, Richland, Washington
| | - David W Shearer
- University of California San Francisco, San Francisco, California
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Uozumi Y, Nagamune K, Oe K. Automated Femoral Stem Canal Fill Ratio Evaluation for Bipolar Hip Arthroplasty in 2D X-Ray Image. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2018. [DOI: 10.20965/jaciii.2018.p0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A stem loosening is one of the significant problem in the bipolar hip arthroplasty (BHA), causes a pain and instability of a patient’s hip, and requires a further surgery of BHA. A stem canal fill ratio (SCFR), a general evaluation of the stem loosening, have been clinically studied many; however, a determination of the optimal SCFR evaluation has not been still understood well. A purpose of this study is to propose an automatic and quantitative evaluation of SCFR from BHA hip X-ray image. A proposed method segmented the femoral canal and stem, and evaluated SCFR. In experiments, a proposed method’s accuracy was validated, and six BHA patients’ SCFRs were clinically evaluated (age 88±7 (74–93), one male / five females). In result of the proposed method’s accuracy, the femur canal was 90.60±3.65%, and the stem was 97.83±0.46%; therefore, the proposed method had the accuracy to well evaluate SCFR. Result of six BHA patients’ SCFRs was 63.70±5.62%. In conclusion, the proposed method was able to automatically evaluate SCFR from the hip X-ray image with BHA.
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Döring R, Jentzsch T, Scheyerer MJ, Pfäffli W, Werner CML. The value of modular hemiarthroplasty for unstable femoral neck fractures in elderly patients with coxarthrosis. BMC Musculoskelet Disord 2016; 17:223. [PMID: 27215472 PMCID: PMC4877940 DOI: 10.1186/s12891-016-1068-x] [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: 10/15/2015] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Displaced femoral neck fractures are common in the elderly patient. The surgical treatment options consist of a hemiarthroplasty (HA) or total hip arthroplasty (THA). However, the best surgical choice is still under debate. Bipolar HAs do not address preexisting arthritic changes of the acetabulum, which may lead to an unfavorable clinical outcome. The purpose of the present study was to conduct a long term follow-up analysis of the bipolar hemiarthroplasty with particular focus on the influence of preoperative acetabular osteoarthritis on the functional outcome. Methods In a retrospective observational study, the medical charts of consecutive patients treated with a bipolar hemiarthroplasty at a level one trauma center between 2004 and 2008 were reviewed before a final radiographic and clinical follow-up was performed. The outcome variables consisted of arthritic findings on the pre- and postoperative x-rays with particular focus on double fond osteophyte (DFO) and posterior wall sign (PWS) as well as the revision rate and functional scores. Results This study included 102 patients with a mean age of 77.2 years. Most patients (75 %) had a Kellgren-Lawrence grading scale (KLGS) of 2 or 3. While only 30 % of patients had a DFO, most patients (73 %) had a PWS. The DFO correlated significantly with the KLGS, but no correlation was seen with the clinical outcome. Most patients showed a decreased offset by a mean of −7.8 mm. The mean modified Harris Hip Score (HHS) of 90.3 and the mean Merle d'Aubigné score of 10.8 correlated significantly. Despite a significant correlation of the HSS subcategory of pain and the preoperative KLGS, there was no statistical relationship between the arthritic x-ray measurements and the clinical outcome. Conclusions In the presented study population, the presence of radiographic acetabular osteoarthritis did not influence the clinical outcome after bipolar hemiarthroplasty for displaced femoral neck fractures.
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Affiliation(s)
- Robert Döring
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Thorsten Jentzsch
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Max J Scheyerer
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - William Pfäffli
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Clément M L Werner
- Department of Trauma Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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