The primary objective of this study was to report the progression of functional status over time after hemiarthroplasty surgery for displaced femoral neck fractures in one hundred patients. One of the secondary outcomes was to determine factors predictive of bad outcome (age, co-morbidities, type of anesthesia, surgical approach, etc). Another secondary objective was to determine if early functional assessment correlates and/or predicts long term function. Finally, our group was compared to a normal control group database. A hundred patients treated with hemiarthroplasty for Garden-type III and IV femoral neck fractures were evaluated prospectively using validated functional outcome measures. Baseline data and preoperative functional level was determined for all patients. Functional recovery was evaluated using the Lower Extremity Measure (LEM) and the Time Up and Go (TUG). Clinical outcome was equally measured using the Harris Hip Score and SF-36 (Short-Form 36). Follow-up was done at one and a half, three, six, nine, twelve and twenty-four months. Preliminary results show that this study group is comparable to the group used in Jaglal et al.’s original study of the Lower Extremity Measurement score. LEM scores at one year follow-up are significantly lower than pre-operative scores. TUG scores at three months follow-up were significantly lower in the female sub-group in comparison to normal controls. This study of patients undergoing hemiarthroplasty for femoral neck fractures demonstrates the significant post operative functional repercussions as shown by the deterioration of scores of functional outcome measures used. Predicting functional outcomes based on pre-operative patient baseline data and function is relevant in that it could potentially impact decision to operate and determination of surgical procedure of choice.
This study is a prospective randomised clinical trial which primary objective was to demonstrate the safety and efficacy of a single posterior mini-incision approach compared to a standard posterior approach for hemiarthroplasty in acute femoral neck fractures. Fifty-five patients have been randomised: twenty-four patients in the mini-incision surgery group (MIS) and thirty-one patients in the standard incision group (STD). The mini-incision was defined as less than 8cm. Data were collected preoperatively and at four days, three and six weeks, three, six, twelve, and twenty-four months postoperatively. The Jaglal Lower Extremity Measurement (LEM) and the Time Up and Go (TUG) where evaluated. Secondary endpoints of pain, function, and quality of life where assessed by the components of the Harris hip Score and SF-36. Radiograghic outcomes where also evaluated. The demographic data where similar between the two groups for age, gender, weight, type of anaesthesia used, pre-operative haemoglobin and preoperative comorbidities. There was no significant difference for operative time, blood losses, 72h postoperative haemoglobin and the need for transfusion therapy between the two groups. Also, there was no difference between the groups for post-operative morphine use and pain evaluation with the Visual Analog Scale. The functional assessment using the LEM, TUG, Harris Hip score and SF-36 scores did not demonstrate any statistically significant difference between mini and standard incision. This study demonstrates that the clinical and functional outcomes measured are similar between the two groups, thus limiting the potential benefits of MIS in hip fracture patients.
To prospectively evaluate the accuracy as well as patient outcome of computer-assisted total knee replacement in a multi-centric randomised study. Two hundred and ninety-five patients in six European centers were randomised between two groups: One hundred and forty-seven in the conventional surgery group and one hundred and forty-eight in the computer assisted surgery. Radiological as well as clinical data (SF-36 and KSS scores) were collected preoperatively as well as six weeks and six months postoperatively. A multilevel mixed-effects linear regression for nested variable with random-effects was used to estimate the effect of the independent variable (type of surgery: conventional surgery vs computer assisted surgery) on each of the dependent variables at six weeks and six months post-operatively. Mechanical axis was statistically better in the navigation group at six weeks (p=0,01) and six months (p=0,04). Similar results are found for the femoral component at six months (p=0,001). At six months, there were statistically greater improvements in the following SF-36 scales for the computer assisted group: bodily pain (p=0,03), role emotional (p=0,03), mental health (p<
0,001), physical health dimension (p=0,01), mental health dimension (p=0,005) and global SF36 score (p=0,002). While a difference in operating time was noted (p<
10-5), the blood losses where similar for both groups (p=0.8). Computer assisted surgery improves the accuracy in total knee arthroplasty, especially for the mechanical axis and the femoral component orientation. These improvements result in better quality of life for the patient at six months postoperatively. Level of Evidence: I – High-quality randomised controlled trial with statistically significant difference.
In the recent years, the concept of minimally invasive surgery has invaded the orthopaedic field and literature on the subject is spawning. Mini-incision surgery for total hip arthroplasty has been studied without a clear consensus on the efficacy, safety and advantage of that innovative technique. To our knowledge, the efficacy and safety of mini-incisions in hip fracture surgery has not been studied. This study is a prospective clinical randomized trial which primary objective was to demonstrate the safety and efficacy of a single posterior mini-incision approach compared to a standard posterior approach for hemiarthroplasty in acute femoral neck fractures. The mini-incision was defined as less than 8 cm. To date, 45 patients have been randomized between the two surgery groups has follows: 22 patients in the mini-incision surgery group (MIS) and 23 patients in the standard incision group (STD). Data were collected preoperatively as well as 4 days, 3 and 6 weeks, 3, 6, 12, and 24 months postoperatively. The following validated disease-specific outcome instruments where used: the Jaglal Lower Extremity Measurement (LEM) and the Time Up and Go (TUG). Secondary endpoints of pain, function, and quality of life where assessed by the components of the Harris hip Score and SF-36. Radiograghic outcomes where also evaluated as well as the rates of all reported complications and adverse events during the two years follow-up. The demographic data where similar between the 2 groups for age, gender, weight, type of anaesthesia used, pre-operative haemoglobin and preoperative comorbidities. There was no significant difference for operative time, blood losses, 72h postoperative haemoglobin and the need for transfusion therapy between the 2 groups. Also, there was no difference between the groups for post-operative morphine use and pain evaluation with the Visual Analog Scale. The functional assessment using the LEM, TUG, Harris Hip score and SF-36 scores did not demonstrate any statistically significant difference between mini and standard incision. This study demonstrates that the clinical and functional outcomes measured are similar between the two groups, thus limiting the potential benefits of MIS in hip fracture patients.
