Worldwide, it is expected that 6.3 million patients will sustain a hip fracture in 2050. Hemiarthroplasty is commonly practiced for displaced femoral neck fractures. The choice between unipolar (UH) or bipolar (BH) hemiarthroplasty is still controversial. The objective of this study was to assess the effect on hip function of BH compared to UH for a displaced femoral neck fracture in elderly patients.

We conducted a systematic review and meta-analysis of randomized controlled trials comparing BH to UH. Data sources were Medline, Embase, Cochrane Library and Web of Science. All data was pooled in Review Manager (RevMan) version 5.3 software. Selection of the studies included, data abstraction, data synthesis, risk of biais and quality of evidence evaluation was done independently by two authors. Our primary outcome was postoperative hip function. Secondary outcomes were health-related quality of life (HRQoL), acetabular erosion and postoperative complications.

13 randomized controlled trials (n=2256) were eligible for the meta-analysis. There was no difference in hip function scores (standardized mean difference of 0.33 [−0.09–0.75, n=864, I²= 87%,]). Patients with bipolar heads had higher Health-Related Quality of Life scores than patients with unipolar heads (mean difference in EQ-5D scores of 0.12 [0.04–0.19, n=550, I²= 44%]). The use of BH decreased the incidence of acetabular erosion (relative risk of 0.37 [0.17–0.83, n=525, I²= 0%]). There was no relative risk difference for mortality, dislocation, revision and infection.

Due to the high heterogeneity between the studies included, it is still unclear whether patients undergoing BH have better hip function than patients undergoing UH. Although, health-related quality of life (HRQoL) may be improved. Future research could be conducted to determine whether a BH offers a better quality of life than UH to geriatric patients undergoing surgery. More precise assessment scores could be developed to better evaluate postoperative outcomes.

Modularity in femoral revision stems was developed to reduce subsidence, leg length discrepancy and dislocation experienced in revision surgery. The Wagner SL Revision Stem (Zimmer, Warsaw, IN) has been known for excellent bony fixation and proximal bony regeneration, but the third-generation proportional neck offset and 135° neck-shaft angle has an unknown track record. Our aim is to study the effect of these design modifications on stem subsidence, dislocation rate and stem survival.

We reviewed 76 consecutive femoral revisions (70 patients; 50 M: 20 W; 67.7 yo [range; 37.7 – 86.6 yo]) with the Wagner SL implanted at our institution (2004–2012). No patient was lost to follow-up, but nine had died, and one patient was excluded for a Paprosky type I femoral bone defect. This leaves us 66 hips (60 patients) at 2 to 9.5 years of follow-up (mean 55 months; range, 24–114 months). Indications for revisions included aseptic stem loosening (62.1%), infection (13.6%), acetabular loosening (12.1%), recurrent dislocation (4.5%), periprosthetic (4.5%) and stem fracture (1.5%), and chondrolysis (1.5%). Patients were actively followed up at regular intervals to ascertain revision status and outcome measures including the Merle d'Aubigné (n=53), WOMAC questionnaires (n=59) and radiographs (n=66). Radiographs were evaluated for stem subsidence (mm).

One of the surviving 66 stems was revised for recurrent deep infection (1.5%). No patient underwent revision of the femoral stem for aseptic loosening or subsidence. The mean preoperative WOMAC scores (P: 12.8; S: 5.6; F: 51.8) had improved significantly at follow-up (P: 9.7;, S: 4.3; F: 37.6) (p<0.05). The mean Merle D'Aubigné score went from a pre-op of 8.2 (SD: 2.8; range 1 to 14) to a mean of 15.3 (SD: 2.6; range 7 to 18) (p<0,05) at the latest follow-up. During the follow-up period, 3 hips dislocated (4.5%). Each event happened prior to six months after surgery. Only one of these cases dislocated twice. Closed reduction was performed in all cases. None required revision surgery subsequently, and they all remained stable. The stem survivorship is 98.4% at 5 years (0.95 CI: 93–100) and 97.4% at 7.5 years (0.95 CI: 88.9–100). Stem subsidence of 0 to 5 mm was considered as not clinically significant (n=20; 30%). Stem subsidence of 5 to 10 mm occurred in 5 hips (7.6%)and stem subsidence greater than 10 mm only occurred in one hips (1.5%).

The third generation Wagner SL conical revision femoral stem has a lower rate of complication than its preceding generations, and is comparable to modular stems performance reported in current literature. These results motivate the authors to continue using monoblock conical revision femoral stems.

Background:

Total knee replacement (TKR) is a frequent and effective surgery for knee osteoarthritis. Postoperative pain is under concern and can be relieved by different methods, including femoral nerve block (FNB). The efficacy of FNB on pain relief was associated with the absence of clinical impact when measured with the range of motion (ROM). Recent studies suggest that the quadriceps strength is the best indicator of functional recovery after TKR. The goal of this study is to compare the quadriceps strength recovery after TKR according to the kind of analgesia (patient control analgesia (PCA) with or without FNB) Hypothesis: the FNB delays the QSR at short and mid-term follow-up.

Purpose: Bone stress transmission by an implant has been demonstrated to be inversely proportional to its rigidity. Since trabecular metal has a high elasticity modulus, it is hypothesised that it should have a preservative impact on bone mineral density (BMD) loss. No current studies prospectively compare BMD variations using such implants.

Method: A randomized study recruiting 65 patients with osteoarthritis of the knee, were assigned to a cemented titanium or a non-cemented trabecular metal tibial base plate. Each patient had a DXA scan of the proximal tibia on the TKA side at two weeks, six months, one and two years follow-up. Analytic methods for DXA scans were standardized (Variation coefficient=0,59–0,84%), and BMD variation compared between groups using the Student t-Test.

Results: Versus early post operative evaluation, BMD loss was found in the two groups. Fixed effects on BMD, such as patient’s height (p< 0.001) and tibial implant size (p=0.04) were demonstrated. Patella resurfacing and polyethylene thickness had no effect on BMD. BMD loss was more important under titanium implants (−30.9%) than trabecular metal implants (−6.3%). The most affected area was the metaphysis (p=0.002) compared to the diaphysis (p=0.054).

Conclusion: Trabecular metal tibial base plate seems to diminish BMD loss under tibial implant compared to traditional titanium base plate. A long-term study will be necessary to determine the tibial trabecular metal component survival rate.