Aims. Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses. Methods. A total of 400 patients with a displaced intracapsular fracture of the hip were randomized to receive either a cemented polished tapered stem hemiarthroplasty or an uncemented Furlong hydroxyapatite-coated hemiarthroplasty. Follow-up was conducted by a nurse blinded to the implant at set intervals for up to one year from surgery. Results. A total of 115 patients died in the year after surgery. There was a tendency towards a slightly higher mortality in those treated with the uncemented prosthesis after one year (64 vs 51; p = 0.18). For the survivors, there was no significant difference in pain score at any of the time intervals. Patients treated using the cemented hemiarthroplasty recovered mobility better than those treated with the uncemented hemiarthroplasty (mean decrease in mobility score at one year: 1.7 vs 1.1, SD 1.9; p = 0.008). There was a tendency to more periprosthetic fractures in the uncemented group (five vs two cases; p = 0.45), but overall the need for further surgery was similar in both groups (nine vs seven cases). There were four perioperative deaths in the cemented group. Conclusion. These results indicate that a contemporary cemented hemiarthroplasty gives better results than an uncemented hemiarthroplasty for patients with a displaced intracapsular fracture of the hip. When the condition of the patient permits, a cemented hemiarthroplasty should be used. Cite this article: Bone Joint J. 2020;102-B(1):11–16

Aim of this study was to identify reoperation rates in patients with short oblique and transverse fractures around a well fixed cemented polished taper slip stem and to determine any associations with treatment failure. Retrospective cohort study of 31 patients with AO transverse or short oblique Vancouver B1 PFFs around THA (total hip arthroplasty) cemented taper slip stems: 12 male (39%); mean age 74±11.9 (range 44–91); mean BMI 28.5±1.4 (range 16–48); and median ASA 3. Patient journeys were assessed, re-interventions reviewed. The primary outcome measure was reoperation. Time from primary THA to fracture was 11.3±7.8yrs (0.5–26yrs). Primary surgical management was fixation in 27/31 and rTHA (revision total hip arthroplasty) in 4/31. 10 of 31 (32%) patients required reoperation, 9 within 2 years of fracture: 1 following rTHA and 8 following ORIF. The commonest mode of failure was non-union (n=6). No significant associations with reoperation requirement were identified. Kaplan-Meier free from reoperation was 67.4% (49.8–85.0 95% CI) at 2 years and this was unaffected by initial management with ORIF or rTHA (Log rank 0.898). Of those reoperated, 6/10 required multiple reoperations to obtain either bony union or a stable revision construct and 13% ultimately required proximal femoral endoprostheses. The relative risk of 1 year mortality was 1.6 (0.25 to 10.1 95%CI) among patients who required reoperation compared to those who did not. These are difficult fractures to manage, should not be underestimated and patients should be counselled that there is a 30% risk of reoperation and 20% of requiring multiple reoperations

Vancouver B fractures around a cemented polished tapered stem (CTPS) are often treated with revision arthroplasty. Results of osteosynthesis in these fractures are poor as per current literature. However, the available literature does not distinguish between fractures around CTPS from those around other stems. The aim of our study was to assess the clinical and radiological outcome of open reduction and internal fixation in Vancouver B fractures around CTPS using a broad non-locking plate. Patients treated with osteosynthesis between January 1997 and July 2011 were retrospectively reviewed. All underwent direct reduction and stabilisation using cerclage wires before definitive fixation with a broad DCP. Bicortical screw fixation was obtained in the proximal and distal fragments. We defined failure of treatment as revision for any cause. 101 patients (42 men and 59 women, mean age 79) were included. 70 had minimum follow-up of 6 months. 63 of these went on to clinical and radiological union. Three developed infected non-union. 7 had failure of fixation. Lack of anatomical reduction was the commonest predictor of failure followed by inadequate proximal fragment fixation and infection. 14 patients dropped at least 1 mobility grade from their preoperative status. This is the largest series of a very specific group of periprosthetic fractures treated with osteosynthesis. Patients who develop these fractures are often frail and “high risk” for major revision surgery. We recommend osteosynthesis for patients with Vancouver B periprosthetic fractures around CTPS provided these fractures can be anatomically reduced and adequately fixed

Aims

The aim of this study was to report the three-year follow-up for a series of 400 patients with a displaced intracapsular fracture of the hip, who were randomized to be treated with either a cemented polished tapered hemiarthroplasty or an uncemented hydroxyapatite-coated hemiarthroplasty.

To investigate predictors of periprosthetic fracture level (around stem (Vancouver B) or distal to stem (Vancouver C/D) in cemented polished tapered femoral stems. Retrospective cohort study of 188 patients (mean age 79 (range 30–91); 99 (53%) male) with unilateral periprosthetic femoral fractures associated with CPT stems. Medical notes were reviewed and the following recorded: patient demographics, past medical history, drug history, date of prosthesis insertion, and date of injury. Radiographs analysis included Vancouver classification, cement restrictor type, cement mantle to implant tip distance, cortical thickness, femoral diameter and DORR classification. Univariate, multivariate and ROC curve analysis was performed. Fractures occurred at mean 7.5 years following primary procedure: 152 (83%) were B fractures; and 36 (19%) C/D. On univariate analysis female gender, lower BMI, osteoporosis, NSAID use, Bisphosphonate therapy, cortical thickness, distal cement mantle length and distal cement mantle length:femoral diameter ratio were significantly associated with C level fractures (p<0.05). Distal cement mantle lengths of >19.6mm (AUC 0.688, p<0.001) were associate with C level fractures. Multivariate analysis demonstrated female gender and distal cement mantle length:femoral diameter ratio to be independent predictors of C level periprosthetic fractures. Though female sex is the largest independent predictor of periprosthetic fractures distal to a CPT femoral stem, the relationship between cortical thickness and distal cement mantle length appears significant. As fractures distal to the stem are invariably managed by ORIF, whereas fractures around the stem frequently require revision arthroplasty, this has relevance at primary surgery in osteoporotic females to reduce the need for complex revisions

Aims

The aim of this study was to describe the demographic details of patients who sustain a femoral periprosthetic fracture (PPF), the epidemiology of PPFs, PPF characteristics, and the predictors of PPF types in the UK population.

Aims

The aim of this study was to describe services available to patients with periprosthetic femoral fracture (PPFF) in England and Wales, with focus on variation between centres and areas for care improvement.

Aims

Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment.

Aims

This study aimed to compare the change in health-related quality of life of patients receiving a traditional cemented monoblock Thompson hemiarthroplasty compared with a modern cemented modular polished-taper stemmed hemiarthroplasty for displaced intracapsular hip fractures.

Background

Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes.