Aims. This study aimed to describe practice variation in the use of total hip arthroplasty (THA) for older patients with
Aims. In this study, we aimed to explore surgical variations in the Femoral Neck System (FNS) used for stable fixation of Pauwels type III
Aims. Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a
Aims. Patients who sustain
Aims. Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal
Surgical interventions consisting of internal
fixation (IF) or total hip replacement (THR) are required to restore
patient mobility after hip fractures. Conventionally, this decision
was based solely upon the degree of fracture displacement. However,
in the last ten years, there has been a move to incorporate patient
characteristics into the decision making process. Research demonstrating
that joint replacement renders superior functional results when compared
with IF, in the treatment of displaced
Aims. The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. Methods. We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced
Aims. Dual-mobility acetabular components (DMCs) have improved total hip arthroplasty (THA) stability in
Aims. The aim of this study was to clarify the factors that predict the development of avascular necrosis (AVN) of the femoral head in children with a fracture of the femoral neck. Patients and Methods. We retrospectively reviewed 239 children with a mean age of 10.0 years (. sd. 3.9) who underwent surgical treatment for a
Aims. The aim of this study was to compare the functional and radiological
outcomes in patients with a displaced fracture of the hip who were
treated with a cemented or a cementless femoral stem. Patients and Methods. A four-year follow-up of a randomized controlled study included
141 patients who underwent surgery for a displaced femoral neck
fracture. Patients were randomized to receive either a cemented
(n = 67) or a cementless (n = 74) stem at hemiarthroplasty (HA;
n = 83) or total hip arthroplasty (THA; n = 58). Results. Early differences in functional outcome, assessed using the Harris
Hip Score, the Short Musculoskeletal Functional Assessment score
and EuroQol-5D, with better results in cemented group, deteriorated
over time and there were no statistically significant differences
at 48 months. Two (3%) patients in the cemented group and five (6.8%)
in the cementless group underwent further surgery for a periprosthetic
fracture. This difference was statistically significant (p = 0.4).
No patient underwent further surgery for instability or infection
between one and four years postoperatively. The mortality and the
radiological outcomes were similar in both groups. Conclusion. Patients with a displaced
Aims. The objective of this study was to investigate bone healing after
internal fixation of displaced
Aims. The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a
Aims. The aim of this investigation was to compare risk of infection in both cemented and uncemented hemiarthroplasty (HA) as well as in total hip arthroplasty (THA) following
Aims. Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced
The covid-19 pandemic had a great impact in the daily clinical and surgical practice. Concerning patients with a
Aims. The localization of necrotic areas has been reported to impact the prognosis and treatment strategy for osteonecrosis of the femoral head (ONFH). Anteroposterior localization of the necrotic area after a
Aims. Our primary aim was to assess reoperation-free survival at one year after the index injury in patients aged ≥ 75 years treated with internal fixation (IF) or arthroplasty for undisplaced
Aims. To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced
Aims. While interdisciplinary protocols and expedited surgical treatment improve the management of hip fractures in the elderly, the impact of such interventions on patients specifically undergoing arthroplasty for a
Aims. Within the UK, around 70,000 patients suffer
Object. The aim of this study was to investigate the impact of the COVID-19 pandemic on the management and outcome of patients with
Aims. Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed internal fixation for
Aim. The aim of this investigation was to compare risk of infection in both cemented and cementless hemiarthroplasty (HA) as well as total hip arthroplasty (THA) following
Aims. To develop prediction models using machine-learning (ML) algorithms for 90-day and one-year mortality prediction in
Aims. Evaluate if treating an unstable
The influence of rigid fixation and permanent compression on the results, the timing of fusion and rehabilitation after fractures of the femoral neck was investigated. A hip fracture is 60–80% of all fractures of the proximal femur. Despite recent advances in the treatment of this disease, the percentage of unsatisfactory outcomes as high as 25–35%. The choice of surgical treatment in
Abstract. Objectives. Hip instability following total hip arthroplasty in treatment of intracapsular
Intracapsular
Aims. The primary aim of this prognostic study was to identify baseline
factors associated with physical health-related quality of life
(HRQL) in patients after a
Abstract. Objectives. The use of cannulated screws for
Frail patients with
Introduction. In an ageing population the incidence of patients sustaining a
Introduction.
Introduction. While interdisciplinary protocols and expedited surgical treatment improve management of geriatric hip fractures, the impact of such interventions on patients undergoing specifically arthroplasty for
Although the number of displaced
We aimed to establish if radiological parameters, dual energy x-ray absorbtiometry (DEXA) and quantitative CT (qCT) could predict the risk of sustaining a
We aimed to establish if radiological parameters, dual energy x-ray absorbtiometry (DEXA) and quantitative CT (qCT) could predict the risk of sustaining a
Recent NICE guidelines suggest that Total Hip Arthroplasty (THA) be offered to all patients with a displaced intracapsular
Dislocation after hemiarthroplasty for
In this study 201 elderly patients with
Background: Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality of patients following hip fracture. It is not known preoperatively which patients are at greater risk of developing VTE complications following their surgery. This study reports the incidence of VTE following
Introduction: A unique failure mode of hip resurfacing is
Abstract. Introduction. Several studies have shown that patients over 65 years have a higher mortality with covid. Combine with inherently increased morbidity and mortality in
Three Cannulated Screws (3CS), Dynamic Hip Screw (DHS) with antirotation screw (DHS–Screw) or with a Blade (DHS–Blade) are the gold standards for fixation of unstable
Introduction: Hip resurfacing is a good conservative option for young patients with arthritis. Resurfacings risk two unique failure mechanisms that do not occur in THA, i.e.
Frail patients with
Aims. Our aim was to examine the Elixhauser and Charlson comorbidity indices, based on administrative data available before surgery, and to establish their predictive value for mortality for patients who underwent hip arthroplasty in the management of a
Delay in operative fixation of
We reviewed the records and radiographs from 10 hospitals to identify 50 patients with rheumatoid arthritis (RA) who had sustained 52
Aims. Dual SC Screw (DSCS) is a novel fixation device for the
Background: Confusion occurs in up to 60% of patients following
Introduction: Fractures of the femoral neck are common in elderly patients. Malignancy increases in incidence with increasing age. Therefore, it is inevitable that a proportion of patients with a history of malignancy will suffer a fracture of the femoral neck. Our aim was to quantify the proportion of patients admitted with a
In a prospective study, 170 impacted
Introduction: Arthroplasty is the most effective management of displaced intracapsular
In a series of over 1000 elderly patients with
Arthroplasty is the most effective management of displaced intracapsular
We describe a method of internal fixation for
Introduction & aims. Geriatric hip fractures are a challenging clinical problem throughout the world. Hip fracture services have been shown to shorten time to surgery, decrease the cost of admissions, and improve the outcomes. We instituted a geriatric hip fracture program for co management of these injuries by orthopedic and internal medicine teams at our hospital in India. Method. From January 2010 till December 2011, 119 patients with a
Aims: To calculate one-year survival after dislocated intracapsular
Introduction.
Femoral head collapse is a possible complication after surgical treatment of
Background: To highlight the higher incidence of sub-trochanteric fracture following cannulated screws fixation for the
Purpose: We conducted a prospective study among elderly women with a first hip fracture to document survival and functional outcome, and to determine whether outcomes differ by fracture type. Methods: The design was a one-year prospective cohort study in the context of standard day-to-day clinical practice. The main outcome measures were survival and functional outcome, both at hospital discharge and one year later. Functional outcome was assessed using the Rapid Disability Rating Scale version-2. Results: Of the 170 women originally enrolled, 86 (51%) had an intertrochanteric and 84 (49%) a
In 22 patients with
We measured the stability of fixation in
Aims: Research was preformed including evaluation of early functional and radiographic results, six months after operative treatment of
Aims: A retrospective study was done to examine the rate of failure. Methods: The most recent evaluation consisted of a medical papers and a radiographic examination. Between 1992 and 2000 in general orthopaedic unit 222 patients with an acute
Introduction. Osteosynthesis to conserve femoral head following
Twenty-six patients with
Bipolar hemiarthroplasty(BPHA) for displaced intracapsular neck of femur fractures(DICNOF) is a controversial topic as conflicting evidence exists. The most common reason for revision to total hip arthroplasty(THA) from BPHA is acetabular erosion. In our study, we sought to quantify the direction of migration of the bipolar head within the first 3 years post-operatively. A proportional index in the horizontal and vertical planes of the pelvis were used to quantify migration. This method removed the need to account for magnification and rotation of the radiographs.Abstract
Introduction
Methods
We report the outcome of 39 patients who underwent
a modified Pauwels’ intertrochanteric osteotomy for nonunion of
a
Radiographs of 100 randomly chosen
Introduction: Recently there has been increasing interest in postoperative pain treatment by use of wound infil-tration with local anaesthetics. The technique has been reported effective following hip and knee arthroplasty. We hypothesized that repeated installations of intraar-ticular local anaesthetic in patients with
Purpose: The purpose of this study was to evaluate clinical and radiological outcomes after cementless bipolar hemiar-throplasty in elderly patients with
Aims. The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells. Methods. HIPGEN is a multicentre, multinational, randomized, double-blind, placebo-controlled trial. A total of 240 patients aged 60 to 90 years with low-energy
To report the case of an asymptomatic simultaneous bilateral
Purpose of the study: This retrospective analysis compared surgical treatments of
Background. Systematic reviews disagree, but some recent studies have shown better function and less pain after operation with bipolar hemiarthroplasty compared to fixation by two screws in elderly patients operated for displaced
Purpose: Fracture-posterior dislocation of the femoral head is an exceptional hip injury. Emergency reduction is required. Relocation into the acetabular cavity of the displaced femoral head may not be feasible. Irreducibility, instability, and more rarely accidental fracture of the femoral neck may also occur. We encountered this latter complication in four patients and report here its frequency and mechanism and propose preventive therapeutic measures. Material and methods: Seventy dislocations and fracture-dislocations of the hip were treated in our unit from March 1997 to February 2003. Among these cases, fourteen hip dislocations were complicated by femoral head fractures. Fracture of the femoral neck occurred during reduction in four. All four cases occurred in men, mean age 49.7 years, who were traffic accident victims (drivers or passengers). There were two Pipkin IV fracture-dislocations and two Pipkin II. The first reduction, achieved under general anaesthesia in an emergency setting, was performed by an orthopaedic surgeon in one patient and a general surgeon in three patients. Arthroplasty was used to treat the
Aims. Patients with
Aims:We conducted a prospective study among elderly women with a
Aims. The aim of this randomized trial was to compare the functional outcome of two different surgical approaches to the hip in patients with a
Introduction: There is still controversy regarding which method of internal fixation of intraarticular hip fracture is ideal. The purpose of this study was to evaluate the outcome and complications following the fixation of such fractures with cannulated cancellous screws with two different types of triangular configurations of these screws: one superior and two inferior and vice versa. Methods: Between January 2006 and December 2008, one hundred and twelve
The objective of this study is to compare three dimensional (3D) postoperative motion between metal and ceramic bipolar hip hemiarthroplasty for
Background. A well conducted randomised study found similar functional results for patients with displaced
Aims: To evaluate a new treatment protocol for
Aims. This retrospective study aimed to determine the causes of in-hospital death after
Antibiotic-associated Clostridium difficile diarrhoea may complicate surgery for proximal femoral fracture. We undertook a 4 year case control study to evaluate the effects of a change in antibiotic prophylaxis in our department. In the period January 2003 to January 2005, patients received three doses of cefuroxime (1.5 g). The new regimen is a single dose of cefuroxime (1.5 g) with gentamicin (240 mg) at induction. Prior to the change in prophylaxis, 912 patients underwent surgery for
Introduction: Antibiotic-associated Clostridium difficile diarrhoea may complicate surgery for proximal femoral fracture. We sought to determine whether a change in antibiotic policy in our unit influenced rates of infection with C. difficile following hip fracture surgery. Methods: A 4 year case controlled study. A change in antibiotic prophylaxis was introduced during a 3 month period in 2005. Infection rates with C. difficile were compared for 2 years either side of this period. The initial regimen was one of three doses of cefuroxime (1.5 g). The new regimen is a single dose of cefuroxime (1.5 g) with gentamicin (240 mg) at induction. Infection was defined as diarrhoea with a positive isolate within 30 days of surgery. Results: Prior to the change in prophylaxis, 912 patients underwent surgery for
A total of 20 pairs of fresh-frozen cadaver femurs were assigned to four alignment groups consisting of relative varus (10° and 20°) and relative valgus (10° and 20°), 75 composite femurs of two neck geometries were also used. In both the cadaver and the composite femurs, placing the component in 20° of valgus resulted in a significant increase in load to failure. Placing the component in 10° of valgus had no appreciable effect on increasing the load to failure except in the composite femurs with varus native femoral necks. Specimens in 10° of varus were significantly weaker than the neutrally-aligned specimens. The results suggest that retention of the intact proximal femoral strength occurs at an implant angulation of ≥ 142°. However, the benefit of extreme valgus alignment may be outweighed in clinical practice by the risk of superior femoral neck notching, which was avoided in this study.
The processes linking long-term bisphosphonate treatment to atypical fracture remain elusive. To establish a means of exploring this link, we have examined how long-term bisphosphonate treatment with prior ovariectomy modifies femur fracture behaviour and tibia mass and shape in murine bones. Three groups (seven per group) of 12-week-old mice were: 1) ovariectomized and 20 weeks thereafter treated weekly for 24 weeks with 100 μm/kg subcutaneous ibandronate (OVX+IBN); 2) ovariectomized (OVX); or 3) sham-operated (SHAM). Quantitative fracture analysis generated biomechanical properties for the femoral neck. Tibiae were microCT scanned and trabecular (proximal metaphysis) and cortical parameters along almost its whole length measured.Aims
Methods
Introduction. There is conflicting evidence in the literature regarding outcome of patients living in their own home prior to a
Tranexamic Acid (TXA) is widely used to decrease bleeding by its antifibrinolytic mechanism. Its use is widespread within orthopaedic surgery, with level one evidence for its efficacy in total hip and knee replacement surgery; significantly reducing transfusion rates without increased thromboembolic disease. There is limited evidence for its use during hip fracture surgery, and we therefore sought to investigate its effects with a prospective cohort study. We recorded intra-operative blood loss, pre and post-operative haemoglobin and creatinine levels, post-operative complications and mortality in all hip fracture patients over a six month period. During this time, we introduced one gram of TXA into our standardised hip fracture theatre checklist. It was subsequently given to all patients unless contra-indicated. A total of 99 patients were included. 90-day mortality in the control group was 16%, there was no mortality in the TXA group (p<0.05). 14 patients required a transfusion in the control group and 3 in the TXA group (19% vs 11% transfusion rate, 0.36 units RCC vs 0.22 per patient respectively) Mean blood loss was 338 vs 235mls, Haemoglobin drop 23 vs 18g/dl control and TXA groups respectively. We have demonstrated a significantly lower mortality rate with TXA. We have also shown lower rates of transfusion, blood loss and recorded haemoglobin drop with the use of TXA. We intend to continue this study to demonstrate this significantly, and fully clarify the safety profile of TXA in this frail cohort of patients.
Introduction and aim. Avascular necrosis (AVN) of femoral head remains a major post-operative complication of the surgical fixation of
Over 70,000 hip fractures occur annually in the UK. Both SIGN (111) and NICE (124) give guidance on optimal management of these patients. Both suggest cemented hemiarthroplasty should be used in those without contra-indications, as cemented implants are associated with less thigh pain, subsidence and a better functional outcome. Cardiorespiratory compromise secondary to bone cement implantation syndrome (BCIS) is however a concern in those with pre-existing cardiorespiratory disease (NYHA grade 3–4, pulmonary hypertension) or pathological fracture [3]. The aim of our study was to audit the practice of a University of Glasgow hospital with regard to cemented hemiarthroplasty. We retrospectively reviewed data on all patients treated with hemiarthroplasty for hip fracture at the Southern General Hospital between 01/01/12-02/04/12. Patient demographics, pre-operative plan, procedure performed, ASA grade and pre-morbid mobility were recorded. Twenty-three hemiarthroplasties were performed. The median age was 82 (70–101). No patient aged over 90 underwent cemented hemiarthroplasty. Cemented implants (JRI, Furlong) were used in 26% (n=6) while 74% (n=17) underwent uncemented (Stryker, Austin-Moore) hemiarthroplasty. ASA grade was recorded in eight (35%). There were four ASA-2 patients (mild systemic disease not limiting activity) of which 75% underwent uncemented hemiarthroplasty. Pre-morbid mobility was recorded in eight (35%). All three independently mobile patients underwent uncemented hemiarthroplasty. Six (26%) had a documented pre-operative plan with regards to cement use. This study highlights the disparity between current recommendations and our Centres’ practice. Most notable were: poor recording of pre-operative mobility, poor documentation of a pre-operative surgical plan, the low use of cemented fixation even in fit mobile patients and the lack of ASA grade recording (stratification of risk) by our anaesthetic colleagues. We suggest a documented pre-operative discussion between the surgeon and anaesthetist to establish BCIS risk and decide on use of cemented arthroplasty taking into account age and mobility.Results
United Kingdom National Institute for Health
and Clinical Excellence guidelines recommend the use of total hip replacement
(THR) for displaced intracapsular fractures of the femoral neck
in cognitively intact patients, who were independently mobile prior
to the injury. This study aimed to analyse the risk factors associated
with revision of the implant and mortality following THR, and to
quantify risk. National Joint Registry data recording a THR performed
for acute fracture of the femoral neck between 2003 and 2010 were
analysed. Cox proportional hazards models were used to investigate
the extent to which risk of revision was related to specific covariates.
Multivariable logistic regression was used to analyse factors affecting
peri-operative mortality (<
90 days). A total of 4323 procedures
were studied. There were 80 patients who had undergone revision
surgery at the time of censoring (five-year revision rate 3.25%, 95%
confidence interval 2.44 to 4.07) and 137 patients (3.2%) patients
died within 90 days. After adjusting for patient and surgeon characteristics,
an increased risk of revision was associated with the use of cementless
prostheses compared with cemented (hazard ratio (HR) 1.33, p = 0.021).
Revision was independent of bearing surface and head size. The risk
of mortality within 90 days was significantly increased with higher
American Society of Anesthesiologists (ASA) grade (grade 3: odds
ratio (OR) 4.04, p <
0.001; grade 4/5: OR 20.26, p <
0.001;
both compared with grades 1/2) and older age (≥ 75 years: OR 1.65,
p = 0.025), but reduced over the study period (9% relative risk reduction
per year). THR is a good option in patients aged <
75 years and with
ASA 1/2. Cementation of the femoral component does not adversely
affect peri-operative mortality but improves survival of the implant
in the mid-term when compared with cementless femoral components.
There are no benefits of using head sizes >
28 mm or bearings other
than metal-on-polyethylene. More research is required to determine
the benefits of THR over hemiarthroplasty in older patients and
those with ASA grades >
2.