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
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. 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. 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. 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. 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
We aimed to examine outcomes between displaced
Aims. To develop prediction models using machine-learning (ML) algorithms for 90-day and one-year mortality prediction in
Debate continues about the best treatment for patients over 65 years with non-displaced subcapital hip fractures: internal fixation (IF) or hemiarthroplasty (HA). Surgical aggression, mortality, complications and recovery of walking ability after 1year have been compared between both treatments. Match-paired comparison of 2 retrospective cohorts. 220 patients with IF vs 220 receiving a cemented bipolar HA. Matching by age (82.6±7.16 years (65–99)), sex (74.5% women), year of intervention (2013–2021) and ASA scale (24.2% ASA II, 55.8% III, 20.0% IV). Age (p=0.172), sex (p=0.912), year of intervention (p=0.638) and ASA scale (p=0.726) showed no differences. Surgical aggression smaller in IF: Surgical time (p< 0,00001), haemoglobin/haematocrit loss (p <0,00001), need for transfusion (p<0,00008), in-hospital stay (p<0,00001). Mortality: higher in-hospital for hemiarthroplasties (12 deaths (5.5%) vs 1 (0.5%) (p=0.004) (RR=12, 1.5–91.5)). But no significant differences in 1-month (13 hemiarthroplasties, 6%, vs 9 osteosynthesis, 4.1%) and 1-year mortality (33 hemiarthroplasties, 15%, vs 35, 16%). Medical complications: no differences in urinary/respiratory infections, heart failure, ictus, myocardial infarction, digestive bleeding, pressure sores or pulmonary embolus (p=0.055). Surgical complications: no significant differences. HA: 6 intraoperative (2,7%) and 5 postoperative periprosthetic fractures (2,3%), 5 infections (2,3%), 10 dislocations (4,5%), 3 neurovascular injuries. IF: 10 acute fixation failures (4,5%), 2 infections (0,9%), 9 non-unions (4,1%), 16 ischemic necrosis (7,3%). Functional results: no significant differences; 12 patients in each group (5,5%) never walked again (p=1), 110 HA (50%) and 100 IF (45.5%) suffered worsening of previous walking ability (p=0.575), 98 HA (44%) and 108 IF patients (49%) returned to pre-fracture walking ability (p=0.339). Fixation with cannulated screws may be a better option for non-displaced
Osteonecrosis of the femoral head after
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
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
Aims. The objective of this study was to investigate bone healing after
internal fixation of displaced
We report the outcome of 39 patients who underwent
a modified Pauwels’ intertrochanteric osteotomy for nonunion of
a
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
Patients with FNF may be treated by either total hip arthroplasty (THA) or hemiarthroplasty (HA). Utilizing American Joint Replacement Registry (AJRR) data, we aimed to evaluate outcomes in FNF treatment. Medicare patients with FNF treated with HA or THA reported to the AJRR database from 2012–2019 and CMS claims data from 2012–2017 were analyzed in this retrospective cohort study. “Early” was defined as less than 90 days from index procedure. A logistic regression model, including index arthroplasty, age, sex, stem fixation method, hospital size1, hospital teaching affiliation1, and Charlson comorbidity index (CCI), was utilized to determine associations between index procedure and revision rates.Introduction
Methods
Between April 1999 and April 2004, 3497 Birmingham hips were inserted by 89 surgeons. Fracture of the neck of the femur occurred in 50 patients, an incidence of 1.46%. Complete data were available for 45 patients in whom the incidence was 1.91% for women and 0.98% for men. The relative risk of fracture for women The mean time to fracture was 15.4 weeks. In women the fractures occurred at a mean of 18.5 weeks and were more likely to have been preceded by a pro-dromal phase of pain and limping. In men the mean time to fracture was 13.5 weeks. Significant varus placement of the femoral component, intra-operative notching of the femoral neck and technical problems were common factors in 85% of cases.
We performed a case–control study to compare
the rates of further surgery, revision and complications, operating time
and survival in patients who were treated with either an uncemented
hydroxyapatite-coated Corail bipolar femoral stem or a cemented
Exeter stem for a displaced intracapsular fracture of the hip. The
mean age of the patients in the uncemented group was 82.5 years
(53 to 97) and in the cemented group was 82.7 years (51 to 99) We used
propensity score matching, adjusting for age, gender and the presence
or absence of dementia and comorbidities, to produce a matched cohort
receiving an Exeter stem (n = 69) with which to compare the outcome of
patients receiving a Corail stem (n = 69). The Corail had a significantly
lower all-cause rate of further surgery (p = 0.016; odds ratio (OR)
0.18, 95% CI 0.04 to 0.84) and number of hips undergoing major further
surgery (p = 0.029; OR 0.13, 95% CI 0.01 to 1.09). The mean operating
time was significantly less for the Corail group than for the cemented Exeter
group (59 min [12 to 136] Cite this article:
The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery. We have studied 102 patients of mean age 80 years, with an acute displaced fracture of the femoral neck. They were randomly placed into two groups, treated either by internal fixation (IF) with two cannulated screws or total hip replacement (THR). None showed severe cognitive dysfunction, all were able to walk independently, and all lived in their own home. They were reviewed at four, 12 and 24 months after surgery. Outcome measurements included hip complications, revision surgery, hip function according to Charnley and the health-related quality of life (HRQoL) according to EuroQol (EQ-5D). The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications (36% and 4%, respectively; p <
0.001), and the number of revision procedures (42% and 4%, p <
0.001). Hip function was significantly better in the THR group at all follow-up reviews regarding pain (p <
0.005), movement (p <
0.05 except at 4 months) and walking (p <
0.05). The reduction in HRQoL (EQ-5D index score) was also significantly lower in the THR group than in the IF group, comparing the pre-fracture situation with that at all follow-up reviews (p <
0.05). The results of our study strongly suggest that THR provides a better outcome than IF for elderly, relatively healthy, lucid patients with a displaced fracture of the femoral neck.