Aims. The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods. We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). Results. A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. Conclusion. Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA. Cite this article: Bone Joint J 2022;104-B(1):134–141

Introduction. The purpose of the present study was to identify risk factors for lag-screw cut-out following osteosynthesis of intertrochanteric fractures. Materials and methods. The study was a case-control study using a sex and age matched control group. The fractures were classified according to Evans and OTA/AO classifications. Operative treatment was performed using dynamic hip-screw or cephalomedullary nailing systems. All patients were followed for at least 3–4 months postoperatively. The following risk factors were assessed: fracture type, quality of reduction by blinded assessment using a visual analogue scale, tip-apex distance (TAD) according to Baumgaertner, lag-screw positioning and other relevant additional risk factors in terms of walking ability, osteoporosis, cardio-vascular disease, neurological disease, diabetes, obesity, alcohol consumption and smoking. Results. 35 cases with lag-screw cut-out and 122 controls without cut-out, 124 women with a mean age of 84.9 (range: 51–95) years and 33 men with a mean age of 82.3 (range: 67–94) years were identified. Cut-out were significantly more frequent in OTA/AO type 31-A3 fractures (odds ratio (OR) 4.13; 95% CI: 1.50–11.36). The quality of reduction was significantly related to the risk of cut-out. The mean TAD was 26.5 mm in the case group and 21 mm in the control group. This difference was significant (chi square test p=0.046). Assessment of the lag-screw positioning showed that a central/central (OR 0.18; 95 % CI: 0.11–0.30) or central/inferior (OR 0.14; 95 % CI: 0.03–0.63) position was associated with a reduced risk for cut-out. None of the additional risk factors included in this study seemed to have any influence on the results. Conclusion. This study showed that fracture type, quality of reduction, TAD and lag-screw positioning were the most important risk factors for cut-out

Aims

We aimed to determine the effect of dementia and Parkinson’s disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population.

Heterotopic ossification (HO) of the hip after injury to the central nervous system can lead to joint ankylosis. Surgery is usually delayed to avoid recurrence, even if the functional status is affected. We report a consecutive series of patients with HO of the hip after injury to the central nervous system who required surgery in a single, specialised tertiary referral unit. As was usual practice, they all underwent CT to determine the location of the HO and to evaluate the density of the femoral head and articular surface. The outcome of surgery was correlated with the pre-, peri- and post-operative findings.

In all, 183 hips (143 patients) were included of which 70 were ankylosed. A total of 25 peri-operative fractures of the femoral neck occurred, all of which arose in patients with ankylosed hips and were associated with intra-articular lesions in 18 and severe osteopenia of the femoral head in seven. All the intra-articular lesions were predicted by CT and strongly associated with post-operative complications.

The loss of the range of movement before ankylosis is a more important factor than the maturity of the HO in deciding the timing of surgery. Early surgical intervention minimises the development of intra-articular pathology, osteoporosis and the resultant complications without increasing the risk of recurrence of HO.