Purpose of study:

Total elbow replacement (TER) is one of the surgical options for treatment of severe haemophilic arthropathy of the elbow. There are only a few small series described in the literature. The goal of our study was to evaluate our cases and add these data to the known literature.

Purpose:

Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome.

Introduction: Since January 2008 a large set of parameters of each hip fracture patient admitted to the RdGG hospital, were documented prospectively. This documentation was repeated by a written survey 3 months and 1 year after the fracture.

Our research goal was to determine the percentage of patients returning to their living situation prior to their fracture.

Methods: From 1-1-2008 to 1-3-2009, 339 hip fracture patients were treated, 244 female, 95 male. Average age was 78.1 (21–101). ASA distribution showed 240 ASA I/ II patients and 99 ASA III/IV patients. Conservative treatment was chosen in 7 patients, 213 were treated with an osteosynthesis and 117 with a (hemi)-arthroplasty. All patients received a survey regarding their living situation 3 and 12 months after their hip fracture.

Results: 327 patients could be analyzed as the pre fracture living situation of 12 patients was unknown; 71% lived independently, 21% in a care home and 9% in a nursing home. The follow-up (FU) of the living situation of the first two groups was analyzed.

Patients living independently: 45% was discharged directly to their own home, 24% to a nursing home and 3% to a care home. A special rehabilitation unit within our hospital, the “Herstel Unit”, received 28% of patients for further recovery. Patients could rehabilitate here for a maximum of 4 weeks before going home. After 3 months 84% of the patients had returned to their independent living situation, 11% lived in a nursing home and 5% in a care home. This analysis is done in 184 patients as 12 had died and 35 were lost to FU. After 12 months 38 (84%) of 45 still lived independently, 4 went to a nursing home, 3 to a care home, 21 died and 4 were lost to FU.

Care home patients: 47% was discharged directly to their care home, 15% to the “Herstel Unit” and 37% to a nursing home. At 3 months 69% of the patients had returned to their care home, 31% lived in a nursing home. Analysis is done in 45 patients as 15 had died and 8 were lost to FU. 12 months FU is accomplished in 27 patients of whom 19 died, none lost to FU; 88% lived in a care home, 12% in a nursing home.

Conclusions: More than 80% of the pre operative independently living patients have returned to their own independent living situation within 3 months. At 1 year FU this percentage is steady. 52% of this population stayed briefly on an alternative location for further recovery. The patients living in a care home have stayed longer on an alternative location, but more than 90% of them have returned to their pre fracture living situation at 12 months FU.

Our results challenge the prejudice that hip fracture patients live or end up living in a nursing home. These data can be used to calculate the amount of specific discharge locations needed in the near future.