Comparative study of radiological and functional outcomes following a direct anterior approach versus to a posterolateral approach to the hip

OBJECTIVE

To compare clinically and radiologically the results obtained using both a direct anterior approach (DAA) and posterolateral (PL) approach in total hip arthroplasty (THA).

MATERIAL AND METHODS

Multicentric longitudinal prospective study in 80 patients (80 THA). Forty patients underwent total hip arthroplasty through DAA and 40 through a PL approach. The following clinical parameters were collected: anaesthesia, length of surgical incision, duration of the procedure, lower limb discrepancy, pain, complications, hospitalization time, Harris Hip Score (HHS) and subjective patient satisfaction. Radiological measures collected were acetabular tilt angle, acetabular component version, osteointegration and lower limb length.

RESULTS

Postoperative pain: DAA 4points; PL 4.3points. Incision length: DAA 14cm, PL 15cm. Mean hospital stay: DAA 2.8days, PL 3.4days. HHS at 3weeks: DAA 87.5points and PL 84points; at 2months: DAA 92points and PL 91points. Femoral stem subsidence was noticed in 4 patients from DAA and 1 from PL. Malalignment was reported in 9 cases from the DAA group.

CONCLUSIONS

Our results show an initial advantage of the DAA group regarding functional recovery and pain that enabled shorter hospitalization time. This difference equalled out over 2months following the procedure. Likewise, we detected a greater complication rate in the DAA group using standard cementless stems.

Interimplant femoral fractures: risk factors, treatment and evolution

OBJECTIVE

The aim of this study is to determine the risk factors involved in the development of these fractures and analyze the treatments used as well as their influence on the clinical and functional prognosis of patients.

MATERIALS AND METHODS

We made an observational, retrospective case-control study, with a sample of 38 patients (40 femoral bones) operated in our hospital, who had two femoral ipsilateral implants, proximal and distal. We found 10 cases of interimplant fracture and 28 patients who had not suffered a fracture (2 of them had bilateral implants). We analyzed the influence of different variables, such as age, gender, comorbidities, radiological variables, type of treatments employed, clinical evolution, etc. RESULTS: the female sex was predominant in both groups, 80.7 was the average age. Osteoporosis was statistically significant (P=.007) for the development of these fractures. We did not find statistical significance in the radiological variables. Surgical treatment was the most frequent, and the plate of osteosynthesis the most employed option. We found a death rate of 40% at 4 years. Although all fractures healed, the survivors' ambulation ability was reduced.

CONCLUSIONS

interimplant fractures are predominant in elderly women. Osteoporosis is a statistically significant risk factor. Despite optimal treatment and fracture healing, functional outcomes were decreased. Specific classification systems and therapeutic algorithms are necessary to improve the management and prognosis of these patients.

Peri-prosthetic femoral fractures of hip or knee arthroplasty. Analysis of 34 cases and a review of Spanish series in the last 20 years

PURPOSE

To evaluate peri-prosthetic femoral fractures by analysing type of patient, treatment and outcomes, and to compare them with Spanish series published in the last 20 years.

MATERIAL AND METHODS

A retrospective review of the medical records of patients with peri-prosthetic femoral fractures treated in our hospital from 2010 to 2014, and telephone survey on the current status.

RESULTS

A total of 34 peri-prosthetic femoral fractures were analysed, 20 in hip arthroplasty and 14 in knee arthroplasty. The mean age of the patients was 79.9 years, and 91% had previous comorbidity, with up to 36% having at least 3 prior systemic diseases. Mean hospital stay was 8.7 days, and was higher in surgically-treated than in conservative-treated patients. The majority (60.6%) of patients had complications, and mortality was 18%. Functional status was not regained in 61.5% of patients, and pain was higher in hip than in knee arthroplasty.

DISCUSSION

Peri-prosthetic femoral fractures are increasing in frequency. This is due to the increasing number of arthroplasties performed and also to the increasing age of these patients. Treatment of these fractures is complex because of the presence of an arthroplasty component, low bone quality, and comorbidity of the patients.

CONCLUSION

Peri-prosthetic femoral fractures impair quality of life. They need individualised treatment, and have frequent complications and mortality.

Cam-type deformities: Concepts, criteria, and multidetector CT features

Interpreting imaging studies of a painful hip requires detailed knowledge of the regional anatomy. Some variants of the proximal femur, such as cam-type deformities, can course asymptomatically or cause femoroacetabular impingement. The principal numerical criterion for defining cam-type deformities, the alpha angle, has some limitations. In this article, we review the anatomic variants of the anterior aspect of the proximal femur, focusing on cam-type deformities. Using diagrams and multidetector CT images, we describe the parameters that are useful for characterizing these deformities in different imaging techniques. We also discuss the potential correspondence of imaging findings of cam-type deformities with the terms coined by anatomists and anthropologists to describe these phenomena.

Periprosthetic femoral fractures after hemiarthroplasty. An analysis of 17 cases

PURPOSE

To describe the characteristics of patients with periprosthetic femoral fractures after hemiarthroplasty and analyze their treatment.

MATERIAL AND METHOD

An observational, longitudinal, retrospective study was conducted on a series of 17 patients with periprosthetic femoral fractures after hip hemiarthroplasty. Fourteen fractures were treated surgically. The characteristics of patients, fractures and treatment outcomes in terms of complications, mortality and functionality were analyzed.

RESULTS

The large majority (82%) of patients were women, the mean age was 86 years and with an ASA index of 3 or 4 in 15 patients. Ten fractures were type B. There were 8 general complications, one deep infection, one mobilization of a non-exchanged hemiarthroplasty, and 2 non-unions. There were 85% consolidated fractures, and only 5 patients recovered the same function prior to the injury. At the time of the study 9 patients had died (53%).

DISCUSSION

Periprosthetic femoral fractures after hemiarthroplasty will increase in the coming years and their treatment is difficult.

CONCLUSION

Periprosthetic femoral fractures after hemiarthroplasty are more common in women around 90 years-old, and usually occur in patients with significant morbidity. Although the Vancouver classification is reliable, simple and reproducible, it is only a guide to decide on the best treatment in a patient often fragile. The preoperative planning is essential when deciding a surgical treatment.

[Effect of intramedullary reaming and nailing on the production of growth factors in the femur fracture callus in rats]

INTRODUCTION

Many studies have been conducted to determine the different effects that reaming or intramedullary nailing have on fracture healing, but there is no evidence in the literature of the effect of intramedullary reaming on osteogenesis. We performed a prospective study to analyse the effect of intramedullary reaming and nailing on the production of growth factors during the process of fracture healing in the femur of rats.

MATERIAL AND METHODS

A transverse mid-shaft non-comminuted femur fracture was produced in 64 rats; 34 rats did not receive any treatment, and a standardized surgical procedure was performed on 30 rats, by exposing the left knee, reaming the medullary canal from distal to proximal, and then fixing the fracture with a steel pin. The rats were sacrificed at the 24th hour, 4th, 7th and 15th days after the fracture. The amount of growth factors that appeared in the callus fracture was measured using histopathology studies. The primary categorical variables analysed were PDGFA, TGF2 and TGFβ-R2. These variables were analysed in each group at the different sacrifice times.

RESULTS

The results of the primary variables of the study, stratified by the time until sacrifice, showed no statistically significant differences.

DISCUSSION

Even if the presence of an intramedullary wire facilitates the fracture repair and the stabilising the bridge of bone between both edges of the fracture site, no evidence was found that reaming changes the expression of the growth factors studied (PDGFA, TGFβ-R2 and TGFβ2) during the callus formation in rats.