The aim of this study was to investigate the association between additional rehabilitation at the weekend, and in-hospital mortality and complications in patients with hip fracture who underwent surgery. A retrospective cohort study was conducted in Japan using a nationwide multicentre database from April 2010 to March 2018, including 572,181 patients who had received hip fracture surgery. Propensity score matching was performed to compare patients who received additional weekend rehabilitation at the weekend in addition to rehabilitation on weekdays after the surgery (plus-weekends group), as well as those who did not receive additional rehabilitation at the weekend but did receive weekday rehabilitation (weekdays-only group). After the propensity score matching of 259,168 cases, in-hospital mortality as the primary outcome and systemic and surgical complications as the secondary outcomes were compared between the two groups.Aims
Methods
Osteoporosis is common in total hip arthroplasty (THA) patients. It plays a substantial factor in the surgery’s outcome, and previous studies have revealed that pharmacological treatment for osteoporosis influences implant survival rate. The purpose of this study was to examine the prevalence of and treatment rates for osteoporosis prior to THA, and to explore differences in osteoporosis-related biomarkers between patients treated and untreated for osteoporosis. This single-centre retrospective study included 398 hip joints of patients who underwent THA. Using medical records, we examined preoperative bone mineral density measures of the hip and lumbar spine using dual energy X-ray absorptiometry (DXA) scans and the medications used to treat osteoporosis at the time of admission. We also assessed the following osteoporosis-related biomarkers: tartrate-resistant acid phosphatase 5b (TRACP-5b); total procollagen type 1 amino-terminal propeptide (total P1NP); intact parathyroid hormone; and homocysteine.Aims
Methods
We present a series of 30 uncemented total hip replacements performed between June 1985 and January 2002 with a mean follow-up of seven years (5 to 20) in 27 patients who had previously undergone a valgus intertrochanteric osteotomy. No further osteotomy was undertaken to enable hip replacement. We used a number of uncemented modular or monoblock femoral components, acetabular components and bearings. The patients were followed up clinically and radiologically. We report 100% survival of the femoral component. One acetabular component was revised at five years post-implantation for aseptic loosening. We noted cortical hypertrophy around the tip of the monoblock stems in six patients. We believe that modular femoral components should be used when undertaking total hip replacement in patients who have previously undergone valgus femoral osteotomy.
Titanium-alloy is a metal with excellent biocompatibility, but its osteoconduction is not as efficient as hydroxyapatite materials. Calcium-ion (Ca-ion) implantation is a surface modification technique that can improve osteoconduction of titanium without an additional layer of coating. We studied the effects of Ca-ion-implantation on osseointegration of a titanium-alloy stem in a bilateral canine THA model. The stem surface was grit-blasted and Ca-ion-implanted by the ion mixing technique. Fifteen mongrel dogs had bilateral single-stage THAs, with a Ca-ion-implanted stem used in one side and a non-Ca-ion-implanted stem in the contralateral side. They were sacrificed at 1, 6, and 12 months postoperatively, and microradiographs were taken. Undecalcified cross-sections were evaluated histologically. For quantitative evaluation, the length of new bone apposition to the implant surface was obtained using computer image analysis. Most implants were well integrated, and there was no apparent qualitative difference between the two types of stems radiographically and histologically. However, Ca-ion-implanted stems had significantly greater new bone apposition than non-Ca-ion-implanted stems at 1 month, although the overall effect of Ca-ion-implantation was not significant. The results showed enhanced osteoconduction with Ca-ion-implantation only in the early postoperative period. This could be related to the previous data of immersion tests that the dissolution rate of Ca-ion from Ca-ion-implanted titanium decreases with time. Clinically, early osteoconduction is desirable and could accelerate rehabilitation and outcome. Although further improvement of the Ca-ion-implantation technique for a sustained osteoconductive effect is necessary, Ca-ion-implantation will be beneficial for early fixation of titanium-alloy implants.
