1
|
Teeuw G, Brokelman R, Heuvel JO, Fransen B. Excellent Long-Term Results of an Austin Moore Hemiarthroplasty After Half a Century: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00054. [PMID: 37319272 DOI: 10.2106/jbjs.cc.23.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
CASE We present the unique case of a 73-year-old man who was treated 50 years ago with a hemiarthroplasty (HA) for avascular necrosis after a femoral neck fracture (FNF) of his left hip and who has developed only mild osteoarthritis since and has reported satisfactory clinical and functional outcomes with no acetabular erosion. CONCLUSION HA for FNFs can provide durable long-term results and can, therefore, be considered as an option in the treatment of FNFs in younger patients. We describe a case with good results after 50 years, which, to our knowledge, is the longest reported follow-up of HA.
Collapse
Affiliation(s)
- Gideon Teeuw
- Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands
| | | | | | | |
Collapse
|
2
|
Probert N, Andersson ÅG, Magnuson A, Kjellberg E, Wretenberg P. Surgical-site infection after hip fracture surgery: preoperative full-body disinfection compared to local disinfection of the surgical site-a population-based observational cohort study. Eur Geriatr Med 2022; 13:1089-1097. [PMID: 35391660 PMCID: PMC9553784 DOI: 10.1007/s41999-022-00640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 11/20/2022]
Abstract
Aim To compare preoperative full-body disinfection (FBD) prior to hip fracture surgery with local disinfection (LD) of the surgical site regarding incidence of postoperative surgical-site infection (SSI), both procedures performed with 4% chlorhexidine. Findings There were 16 (6.8%) cases of SSI in 2018 when FBD was performed and 8 (3.1%) cases in 2019 when LD was performed. FBD (2018) compared to LD (2019) presented an adjusted OR of 2.0 (95% CI 0.8–5.1) in the logistic regression analysis. Message Results suggest that LD is not inferior to FBD regarding SSI prevention, meaning patients could potentially be spared significant levels of pain caused by FBD. Purpose Swedish national guidelines recommend full-body disinfection (FBD) with 4% chlorhexidine before hip fracture surgery to prevent surgical-site infection (SSI) despite little evidence. Our objective was to compare preoperative FBD with local disinfection (LD) of the surgical site regarding SSI incidence. Methods All patients with hip fracture, operated at a hospital in Sweden, January 1, 2018 to December 31, 2019 were included. Patients in 2018 (n = 237) were prepared with FBD and patients in 2019 (n = 259) with LD. Primary outcome was SSI and secondary outcome was SSI and/or death. We adjusted for potential confounders with logistic regression. The adjusted analysis was performed in two models to enable assessment of variables that lacked either outcome; in the first model, these variables were not adjusted, and the second model was restricted to a sub-population not affected by respective variables. Results There were 16 (6.8%) cases of SSI in 2018 and 8 (3.1%) cases in 2019. FBD (2018) compared to LD (2019) presented an adjusted OR of 1.9 (95%CI 0.8–4.9, P = 0.16) respectively 2.0 (95%CI 0.8–5.1, P = 0.14) in the two models of the logistic regression. In addition, 40 (16.9%) patients in 2018 and 29 (11.2%) patients in 2019 had the combined outcome of SSI and/or death, adjusted OR 1.6 (95% CI 0.9–2.8, P = 0.08) respectively 1.7 (95% CI 0.9–2.9, P = 0.06). Conclusion We found a non-significant increased risk of SSI 2018 compared to 2019 after adjustment. Randomized control trials are needed. Nonetheless, results suggest that LD is not inferior to FBD regarding SSI prevention, meaning patients could potentially be spared substantial pain.
Collapse
Affiliation(s)
- Noelle Probert
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Centre of Clinical Research, Region Värmland, Karlstad, Sweden.
| | - Åsa G Andersson
- Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Elin Kjellberg
- Department of Infectious Diseases, Central Hospital of Kristianstad, Kristianstad, Sweden
| | - Per Wretenberg
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
3
|
Zelle BA, Salazar LM, Howard SL, Parikh K, Pape HC. Surgical treatment options for femoral neck fractures in the elderly. INTERNATIONAL ORTHOPAEDICS 2022; 46:1111-1122. [DOI: 10.1007/s00264-022-05314-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
|
4
|
Austin MS, Ashley BS, Bedard NA, Bezwada HP, Hannon CP, Fillingham YA, Kolwadkar YV, Rees HW, Grosso MJ, Zeegen EN. What is the Level of Evidence Substantiating Commercial Payers' Coverage Policies for Total Joint Arthroplasty? J Arthroplasty 2021; 36:2665-2673.e8. [PMID: 33867209 DOI: 10.1016/j.arth.2021.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.
Collapse
Affiliation(s)
- Matthew S Austin
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Blair S Ashley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Nicholas A Bedard
- Department of Orthopaedic Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA
| | | | - Charles P Hannon
- Department of Orthopaedic Surgery, The Mayo Clinic, Ochester, MN
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Yogesh V Kolwadkar
- Department of Orthopaedic Surgery, VA Central California Health Care System, Fresno, CA
| | - Harold W Rees
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Connecticut Joint Replacement Institute, Hartford, CT
| | - Erik N Zeegen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA
| |
Collapse
|
5
|
Davanzo D, Previtali D, Tamborini S, Filardo G, Fusco A, Bordoni V, Gaffurini P, Candrian C. Comparison of the survivorship between arthroplasty and ORIF for basi-cervical femoral neck fractures in the overall population and in polymorbid patients. Orthop Traumatol Surg Res 2021; 107:102789. [PMID: 33333272 DOI: 10.1016/j.otsr.2020.102789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Femoral neck fractures (FNFs) are associated with high mortality and can be treated with arthroplasty or open reduction and internal fixation (ORIF). For basi-cervical FNFs, there is no agreement on which procedure is better. Do arthroplasty and open reduction with internal fixation (ORIF) have different rates of survival? Do age and comorbidities influence survivorship? HYPOTHESIS Patients who underwent arthroplasty and patients who underwent ORIF have different rates of survival. PATIENTS AND METHODS Survivorship curves, complications, and hospitalisation length were analysed in 154 patients who received hip arthroplasty, and in 72 patients who received ORIF. Age and ASA score were used to divide the patients into sub-groups and perform secondary analyses. RESULTS At 4.9±2.4 years after surgery, 74 patients in the arthroplasty group (48%) and 33 in the ORIF group (45%) had died. The survivorship curves of the two groups showed a non-significant difference. The hospitalisation length was 13.5±8.9 days, with a non-significant difference between groups. There were 130 complications in total: 97 in the arthroplasty patients (19 patients had multiple complications, 52 had only one), 33 in the ORIF patients (4 patients had multiple complications, 29 had only one); the odds ratio was therefore 2.1 (p=0.02). Age, ASA score, Sernbo score, Charlson comorbidity index, and sex (male) were the best predictors of mortality. In the ASA 3-4 sub-group, the survivorship curves showed a lower mortality in the arthroplasty group (p=0.02). DISCUSSION Arthroplasty and ORIF are both valid procedures for the treatment of basi-cervical FNFs, but a high mortality rate is associated with either procedures. There is no difference in terms of survivorship between arthroplasty and ORIF in the overall population, but the presence of comorbidities may favour arthroplasty, which should be considered when managing patients with basi-cervical FNFs. LEVEL OF EVIDENCE III; retrospective, observational study.
Collapse
Affiliation(s)
- Diego Davanzo
- Orthopaedic and traumatology unit, Ospedale regionale di Lugano, EOC, Via Tesserete 46, 6900 Lugano, Switzerland (CH)
| | - Davide Previtali
- Orthopaedic and traumatology unit, Ospedale regionale di Lugano, EOC, Via Tesserete 46, 6900 Lugano, Switzerland (CH)
| | - Simone Tamborini
- Orthopaedic and traumatology unit, Ospedale regionale di Lugano, EOC, Via Tesserete 46, 6900 Lugano, Switzerland (CH)
| | - Giuseppe Filardo
- Orthopaedic and traumatology unit, Ospedale regionale di Lugano, EOC, Via Tesserete 46, 6900 Lugano, Switzerland (CH); ATRC, IRCCS Istituto ortopedico Rizzoli, Bologna, Italy
| | | | - Vittorio Bordoni
- Orthopaedic and traumatology unit, Ospedale regionale di Lugano, EOC, Via Tesserete 46, 6900 Lugano, Switzerland (CH).
| | - Paolo Gaffurini
- Orthopaedic and traumatology unit, Ospedale regionale di Lugano, EOC, Via Tesserete 46, 6900 Lugano, Switzerland (CH)
| | - Christian Candrian
- Orthopaedic and traumatology unit, Ospedale regionale di Lugano, EOC, Via Tesserete 46, 6900 Lugano, Switzerland (CH)
| |
Collapse
|
6
|
Abstract
BACKGROUND Hip fractures are recognized as one of the most devastating injuries impacting older adults because of the complications that follow. Mortality rates postsurgery can range from 14% to 58% within one year of fracture. We aimed to identify factors associated with increased risk of mortality within 24 months of a femoral neck fracture in patients aged ≥50 years enrolled in the FAITH and HEALTH trials. METHODS Two multivariable Cox proportional hazards regressions were used to investigate potential prognostic factors that may be associated with mortality within 90 days and 24 months of hip fracture. RESULTS Ninety-one (4.1%) and 304 (13.5%) of 2247 participants died within 90 days and 24 months of suffering a femoral neck fracture, respectively. Older age (P < 0.001), lower body mass index (P = 0.002), American Society of Anesthesiologists (ASA) class III/IV/V (P = 0.004), use of an ambulatory aid before femoral neck fracture (P < 0.001), and kidney disease (P < 0.001) were associated with a higher risk of mortality within 24 months of femoral neck fracture. Older age (P = 0.03), lower body mass index (P = 0.02), use of an ambulatory aid before femoral neck fracture (P < 0.001), and having a comorbidity (P = 0.04) were associated with a higher risk of mortality within 90 days of femoral neck fracture. CONCLUSIONS Our analysis found that factors that are indicative of a poorer health status were associated with a higher risk of mortality within 24 months of femoral neck fracture. We did not find a difference in treatment methods (internal fixation vs. joint arthroplasty) on the risk of mortality. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
7
|
Cui S, Wang D, Wang X, Li Z, Guo W. The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis. J Orthop Surg Res 2020; 15:433. [PMID: 32958029 PMCID: PMC7507610 DOI: 10.1186/s13018-020-01958-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/10/2020] [Indexed: 01/28/2023] Open
Abstract
Background Femoral neck fractures are common fractures in the elderly. Common treatment options include internal fixation (IF) and hemiarthroplasty (HA). However, the clinical application of these two options is always controversial due to the potential clinical trauma, postoperative function, early complications, and other factors. Materials and methods Randomized controlled trials and cohort studies comparing screw fixation and hemiarthroplasty in elderly patients with displaced femoral neck fractures were extracted from databases such as PubMed, Web of Science, EMBASE, and Cochrane. The revised Jadad scale or NOS treatment evaluation form was used to evaluate the quality of the included studies. After extracting the data, the standard deviation of continuous data and the relative risk of binary data were used. The operation time, blood loss during operation, EQ-5D (EuroQol-5 Dimension) score, mortality rate, reoperation rate, and postoperative common complications were reviewed using Review Manager software (RevMan 5.3) were compared. Results There were 7 randomized controlled trials and 5 cohort studies. The results showed that the operation time, intraoperative blood loss, and short-term EQ-5D score of the internal fixation group were lower than those of the hemi-hip replacement group, but the reoperation rate was higher. There was no statistically significant difference in mortality and common complications such as deep vein thrombosis, pulmonary embolism, infection, and pressure sores during short-term follow-up. Conclusions In the treatment of elderly femoral neck fractures, the screw internal fixation group has shorter operation time and less intraoperative bleeding, and the perioperative advantage is more obvious. However, the hemi-hip replacement group had more advantages in postoperative functional scoring and reoperation.
Collapse
Affiliation(s)
- Shuai Cui
- School of Mathematics, Jilin University, Changchun, Jilin Province, China
| | - Dehui Wang
- School of Mathematics, Jilin University, Changchun, Jilin Province, China
| | - Xuejie Wang
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zehui Li
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
| |
Collapse
|
8
|
Hsu KH, Tsai SW, Chen CF, Chang MC, Chen WM. The risk factors of early acetabular failure after bipolar hemiarthroplasty because of fracture of the femoral neck. J Chin Med Assoc 2019; 82:419-423. [PMID: 30893260 DOI: 10.1097/jcma.0000000000000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the influence of leg length discrepancy in geriatric patients with early failure of bipolar hemiarthroplasty and to identify related failure patterns and risk factors. METHODS In this retrospective study, the risk factors of early acetabulum failure within 5 years of hemiarthroplasty for displaced femoral neck fracture were compared with a control group of patients who had implant survival for at least 5 years after hemiarthroplasty. The basic data, leg length discrepancy, femoral offset, and the shell size were evaluated. RESULTS Of all risk factors, there was a significant difference in increased leg length between the two groups. The mean difference in leg length was 7.8 ± 5.9 mm in the early acetabular failure group and -1.7 ± 6.2 mm in the control group. For an increase in leg length of >6 mm, the odds ratio of early acetabular failure was 25-fold greater when compared with the control group. CONCLUSION Increased leg length was significantly associated with early acetabular failure after bipolar hemiarthroplasty for femoral neck fracture among geriatric patients. It is critical to avoid increase in leg length after bipolar hemiarthroplasty.
Collapse
Affiliation(s)
- Kuei-Hsiang Hsu
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shang-Wen Tsai
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| |
Collapse
|
9
|
Mullins B, Akehurst H, Slattery D, Chesser T. Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre. BMJ Open 2018; 8:e020625. [PMID: 29705761 PMCID: PMC5931299 DOI: 10.1136/bmjopen-2017-020625] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine whether not waiting for the elimination of direct oral anticoagulants (DOACs) has an effect on the amount of perioperative bleeding in patients who undergo operative treatment of a hip fracture. DESIGN Observation, retrospective case-control study. SETTING A single UK major trauma centre. PARTICIPANTS Patients who sustained a hip fracture were identified using the National Hip Fracture Database (NHFD). All those found to be taking a DOAC at the time of fracture were identified (n=63). A matched group not taking a DOAC was also identified from the NHFD (n=62). MAIN OUTCOME Perioperative drop in haemoglobin concentration. RESULTS There was no relationship between admission to operation interval and perioperative change in haemoglobin concentration in patients taking DOACs (regression coefficient=-0.06 g/L/hour; 95% CI -0.32-0.20; p=0.64). No relationship was found between the time from admission to operation interval and the probability of transfusion (OR=0.94; 95% CI 0.85 to 1.90; p=0.16) or reoperation (OR=1.04; 95% CI 0.93 to 1.16; p=0.49). One mortality was recorded in the DOAC group within 30 days of admission, and this compared with five in the matched group of patients (p=0.2). CONCLUSIONS Delaying surgery in patients who sustain a hip fracture who are taking a DOAC drug has not been shown to reduce perioperative bleeding or affect their mortality in this study.
Collapse
Affiliation(s)
- Barry Mullins
- Trauma and Orthopaedics, Southmead Hospital, Bristol, UK
| | | | - David Slattery
- Trauma and Orthopaedics, Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Tim Chesser
- Trauma and Orthopaedics, Southmead Hospital, Bristol, UK
| |
Collapse
|
10
|
Effect of tranexamic acid use on blood loss and thromboembolic risk in hip fracture surgery: systematic review and meta-analysis. Hip Int 2018; 28:3-10. [PMID: 28983887 DOI: 10.5301/hipint.5000556] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to minimise blood loss and allogenic blood transfusion. However, the use of IV TXA in hip fracture surgery remains inconclusive. We conducted a meta-analysis to investigate the role of TXA in operative hip fracture management on operative and total blood loss, allogenic blood transfusion requirements and impact on venous thromboembolic (VTE) event incidence. METHODS A systematic computerised literature search of PubMed, Medline, Embase, Ovid, The Cochrane Controlled Trials Register, Trip and Google was conducted. We reviewed the efficacy of IV TXA on perioperative blood loss, total blood loss, pre- and postoperative haemoglobin differences, duration of surgery, allogenic blood transfusion requirements and VTE events. RESULTS 8 studies were eligible including 6 randomised control trials and 2 cohort studies. Patients receiving IV TXA had reduced mean total blood loss of 442.9 mls (95% CI, 426.5-459.3; p<0.00001), reduced operative blood loss of 88.5 mls (95% CI, 59.9-117.2; p<0.00001), a decrease in the need for allogenic blood transfusion (OR 0.37; 95% CI, 0.26-0.53; p<0.00001) and a reduction in pre- and postoperative haemoglobin difference (p = 0.013.) There was no significant increase in VTE risk (OR 1.59; 95% CI 0.67-3.75; p>0.29) or significant difference on duration of surgery seen with IV TXA usage (p>0.06). CONCLUSIONS Our review demonstrated the efficacy of IV TXA in minimising perioperative, reducing total blood loss and lowering the necessity for allogenic blood transfusions with no significant increased risk in VTE events.
Collapse
|
11
|
Wejjakul W, Chatmaitri S, Wattanarojanaporn T, Pongkunakorn A, Ittiwut C, Shotelersuk V. Bilateral Femoral Neck Fractures in Cerebrotendinous Xanthomatosis Treated by Hip Arthroplasties: The First Case Report and Literature Review. J Orthop Case Rep 2017. [PMID: 29242796 DOI: 10.13107/jocr.2250‐0685.894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disease caused by mutations of the CYP27A1 gene and deficiency of the sterol-27-hydroxylase enzyme in bile acid biosynthesis. It is characterized by the accumulation of cholestanol and bile alcohols in plasma, the formation of xanthomatous lesions in various tissues, and organ degeneration. This disorder is also associated with osteoporosis and increased risk of fracture. To date, only two CTX patients with femoral neck fractures have been reported. Neither was treated by arthroplasties, and the operative outcomes are lacking. Case Report We report the case of a 46-year-old Thai female who presented with consecutive bilateral femoral neck fractures following minor trauma within a 3-year period and received cementless bipolar hemiarthroplasties. Her phenotypic expression included Achilles tendon masses, childhood-onset cataracts, intellectual disability, and cerebellar ataxia. A brain computed tomography showed non-enhancing hypodense lesions in the bilateral cerebellar hemispheres with mild brain atrophy. Histopathology from an Achilles tendon biopsy revealed tendinous xanthoma and molecular analysis confirmed a homozygous nonsense mutation, c.1072C>T (p.Gln358Ter), in exon 6 of the CYP27A1 gene. The intra-operative crack of a calcar femorale was a major complication during both prosthetic insertion surgeries and warranted cerclage wiring. At the 7-month follow-up of the right hip and the 41-month follow-up of the left hip, postoperative radiographs showed well-fixed and well-aligned prostheses. Independent household ambulation could be resumed with Harris hip scores of 81 points equally. Conclusion CTX is associated with osteoporosis, and middle-aged patients could present with femoral neck fracture following minor trauma. Cementless bipolar hemiarthroplasty for a totally displaced fracture is justified for a patient who has cognitive impairment. Intra-operative fracture is a major complication during prosthetic insertion and warrants cerclage wiring to achieve predictable bone healing and a satisfactory result.
Collapse
Affiliation(s)
- Witchuree Wejjakul
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Swist Chatmaitri
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | | | - Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Chupong Ittiwut
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
12
|
Wejjakul W, Chatmaitri S, Wattanarojanaporn T, Pongkunakorn A, Ittiwut C, Shotelersuk V. Bilateral Femoral Neck Fractures in Cerebrotendinous Xanthomatosis Treated by Hip Arthroplasties: The First Case Report and Literature Review. J Orthop Case Rep 2017; 7:54-58. [PMID: 29242796 PMCID: PMC5728000 DOI: 10.13107/jocr.2250-0685.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage disease caused by mutations of the CYP27A1 gene and deficiency of the sterol-27-hydroxylase enzyme in bile acid biosynthesis. It is characterized by the accumulation of cholestanol and bile alcohols in plasma, the formation of xanthomatous lesions in various tissues, and organ degeneration. This disorder is also associated with osteoporosis and increased risk of fracture. To date, only two CTX patients with femoral neck fractures have been reported. Neither was treated by arthroplasties, and the operative outcomes are lacking. Case Report: We report the case of a 46-year-old Thai female who presented with consecutive bilateral femoral neck fractures following minor trauma within a 3-year period and received cementless bipolar hemiarthroplasties. Her phenotypic expression included Achilles tendon masses, childhood-onset cataracts, intellectual disability, and cerebellar ataxia. A brain computed tomography showed non-enhancing hypodense lesions in the bilateral cerebellar hemispheres with mild brain atrophy. Histopathology from an Achilles tendon biopsy revealed tendinous xanthoma and molecular analysis confirmed a homozygous nonsense mutation, c.1072C>T (p.Gln358Ter), in exon 6 of the CYP27A1 gene. The intra-operative crack of a calcar femorale was a major complication during both prosthetic insertion surgeries and warranted cerclage wiring. At the 7-month follow-up of the right hip and the 41-month follow-up of the left hip, postoperative radiographs showed well-fixed and well-aligned prostheses. Independent household ambulation could be resumed with Harris hip scores of 81 points equally. Conclusion: CTX is associated with osteoporosis, and middle-aged patients could present with femoral neck fracture following minor trauma. Cementless bipolar hemiarthroplasty for a totally displaced fracture is justified for a patient who has cognitive impairment. Intra-operative fracture is a major complication during prosthetic insertion and warrants cerclage wiring to achieve predictable bone healing and a satisfactory result.
Collapse
Affiliation(s)
- Witchuree Wejjakul
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Swist Chatmaitri
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | | | - Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Chupong Ittiwut
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
13
|
Abstract
Neck of femur fractures are occurring at an increased incidence. Functionally independent patients without cognitive impairment can expect reasonable life expectancy. This indicates the need for a durable surgical option that optimises the chance to return to pre-injury functional status, with minimal risk of complications and reoperation. Most fractures are displaced. Surgical options include internal fixation, hemiarthroplasty or total hip arthroplasty (THA). Evidence is conclusive that arthroplasty options outperform internal fixation in terms of function, quality of life and reoperation rates. In anyone other than young patients where head preserving surgery is required, arthroplasty is the standard of care. Hemiarthroplasty is the heavily favoured arthroplasty option for surgeons. However, in patients other than the extreme elderly, medically infirm, neurologically impaired, or with little or no ambulatory capacity, the evidence to support hemiarthroplasty is lacking. In functionally independent patients without cognitive impairment, THA should be considered the gold standard, producing better functional and quality of life outcomes, lower reoperation rates and better cost effectiveness, with no difference in complications or mortality. An increased risk of dislocation does exist. This may be reduced with modern surgical technique and implant options. Low amounts of research have been afforded to undisplaced fractures. For this fracture type, surgery is the standard of care. Despite a higher risk of reoperation, internal fixation is the preferred option for all age groups. Further study is required to identify the difference between internal fixation and THA, in particular, for unstable fracture patterns in elderly patients.
Collapse
|
14
|
Luthra JS, Al Riyami A, Allami MK. Dual mobility total hip replacement in a high risk population. SICOT J 2016; 2:43. [PMID: 27924742 PMCID: PMC5142081 DOI: 10.1051/sicotj/2016037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/08/2016] [Indexed: 12/14/2022] Open
Abstract
Objective: The purpose of the study was to evaluate results of dual mobility total replacement in a high risk population who take hip into hyperflexed position while sitting and praying on the floor. Method: The study included 65 (35 primary total replacement and 30 complex total hip replacement) cases of total hip replacement using avantage privilege dual mobility cup system from biomet. A cemented acetabular component and on femoral side a bimetric stem, either cemented or uncemented used depending on the canal type. Ten cases were examined fluoroscopically in follow up. Result: There was dislocation in one patient undergoing complex hip replacement. Fluoroscopy study showed no impingement between the neck of prosthesis and acetabular shell at extremes of all movements. Conclusion: The prevalence of dislocation is low in our high risk population and we consider it preferred concept for patients undergoing complex total hip replacement.
Collapse
|
15
|
Neck of Femur Fracture in a Patient with a Chronic Osteomyelitis of the Ipsilateral Foot. Case Rep Orthop 2016; 2016:2108537. [PMID: 27843662 PMCID: PMC5098071 DOI: 10.1155/2016/2108537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
This case report describes a successful two-stage treatment in a 75-year-old male with a displaced neck of femur fracture, also suffering from an active chronic osteomyelitis of the ipsilateral calcaneus. In our case, a below-knee amputation was performed first, followed by total hip arthroplasty two weeks later. At 15-month follow-up, full recovery of the prefracture level of activities of daily living without significant impairment was obtained. Only a few cases of total hip arthroplasty in amputees have been published, but the indication for surgery was mainly traumatic or advanced osteoarthritis. Treating patients with this type of comorbidities is challenging; therapeutic dilemmas can be major. The management in cases like these requires a thorough evaluation and a clear surgical and medical treatment plan, preferably conducted by a multidisciplinary orthogeriatric team.
Collapse
|
16
|
The Outcomes of Treating Femoral Neck Fractures Using Bipolar Hemiarthroplasty. Trauma Mon 2016. [DOI: 10.5812/traumamon.26831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
17
|
Griffin J, Anthony TL, Murphy DK, Brennan KL, Brennan ML. What is the impact of age on reoperation rates for femoral neck fractures treated with internal fixation and hemiarthroplasty? A comparison of hip fracture outcomes in the very elderly population. J Orthop 2016; 13:33-9. [PMID: 26951944 DOI: 10.1016/j.jor.2015.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/24/2015] [Indexed: 01/28/2023] Open
Abstract
METHODS A retrospective comparative study was performed at a level 1 trauma center at which electronic medical records and digital radiographs were reviewed for 949 femoral neck fractures. For the primary outcome of reoperation based on age, Kaplan-Meier models were built and analysis applied. RESULTS A total of 334 fractures were nondisplaced treated with closed reduction and percutaneous pinning (CRPP), and 615 were displaced managed with hemiarthroplasty (HA). Overall, 98 patients (10.33%) required reoperation. Increasing reoperation rates for CRPP was seen with each subsequent age group. The opposite was seen with HA in which increasing age groups showed lower reoperation rates.
Collapse
Affiliation(s)
- Joshua Griffin
- Baylor Scott & White Health, Temple, TX 76508, United States
| | | | | | | | | |
Collapse
|
18
|
Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Mid- and Long-term Followup? A Meta-analysis. Clin Orthop Relat Res 2015; 473:2672-9. [PMID: 25981713 PMCID: PMC4488202 DOI: 10.1007/s11999-015-4345-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 04/30/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroplasty has been shown to be superior regarding low risk of reoperation and better function score to internal fixation for treatment of displaced femoral neck fractures at short-term followup. However, there are unanswered questions regarding the efficacy of arthroplasty in the longer term compared with internal fixation. QUESTIONS/PURPOSES We performed a meta-analysis comparing arthroplasty (hemiarthroplasty or THA) with internal fixation in patients with displaced femoral neck fractures with respect to (1) mortality, (2) reoperation, (3) functional recovery, and (4) complications, including only randomized trials with a minimum of 4 years followup. METHODS Computerized databases, including PubMed (MEDLINE), EMBASE, Cochrane Register of Controlled Trials databases, and Web of Science™ were searched for studies published from the inception date for each database to March 2014. Eleven randomized controlled trials that compared arthroplasty (either hemiarthroplasty or THA) with internal fixation for treatment of patients with a femoral neck fracture were included in our analysis. The quality of the trials was assessed according to the Cochrane Handbook and meta-analyses were conducted using RevMan 5.2 software from the Cochrane Collaboration. The heterogeneity among studies was evaluated by the I-squared index (I2) and publication bias was assessed using forest plots. RESULTS There were no differences between the internal fixation and arthroplasty groups for patient mortality at mid-term (48.4% vs 46.8%) or long-term followup (83.2% vs 81.5%). Arthroplasty was associated with a lower risk of reoperation at mid-term (7.2% vs 39.8%; relative risk [RR]=0.10; 95% CI, 0.06-0.07) and at long-term followup (14.3% vs 43.8%; RR=0.10; 95% CI, 0.06-0.07). Arthroplasty was associated with better functional recovery at mid-term followup (standard mean difference [SMD]=0.55; 95% CI, 0.02-1.09), whereas function at long-term followup (SMD=0.14; 95% CI, -0.35 to 0.62) was not different between the arthroplasty and internal fixation groups. There were no significant differences in subsequent ipsilateral fractures (1.5% vs 1.2%; RR=2.18; 95% CI, 0.32-14.67; p=0.42) and deep infections (2.7% vs 2.9%; RR=0.89; 95% CI, 0.40-2.01; p=0.78) between patients treated with arthroplasty and internal fixation. CONCLUSIONS Based on our results, we found that compared with internal fixation, arthroplasty may result in a lower rate of subsequent reoperation at mid- and long-term followup, and better mid-term functional recovery. Future studies should investigate the mid- and long-term results of THAs compared with hemiarthroplasty.
Collapse
|
19
|
Desai SJ, Wood KS, Marsh J, Bryant D, Abdo H, Lawendy AR, Sanders DW. Factors affecting transfusion requirement after hip fracture: can we reduce the need for blood? Can J Surg 2015; 57:342-8. [PMID: 25265109 DOI: 10.1503/cjs.030413] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fractures are common injuries that result in blood loss and frequently require the transfusion of blood products. We sought to identify risk factors leading to increased blood transfusion in patients presenting with hip fractures, especially those factors that are modifiable. METHODS We retrospectively reviewed the cases of all patients who had fixation of their hip fractures between October 2005 and February 2010. The need for transfusion was correlated with potential risk factors, including age, sex, preoperative hemoglobin, fracture type, fixation method and more. RESULTS A total of 835 patients had fixation of their hip fractures during the study period; 631 met the inclusion criteria and 249 of them (39.5%) were transfused. We found an association between need for blood transfusion and female sex (p = 0.018), lower preoperative hemoglobin (p < 0.001), fracture type (p < 0.001) and fixation method (p < 0.001). Compared with femoral neck fractures, there was a 2.37 times greater risk of blood transfusion in patients with intertrochanteric fractures (p < 0.001) and a 4.03 times greater risk in those with subtrochanteric fractures (p < 0.001). Dynamic hip screw (DHS) fixation decreased the risk of transfusion by about half compared with intramedullary nail or hemiarthroplasty. We found no association with age, delay to operation (p = 0.17) or duration of surgery (p = 0.30). CONCLUSION The only modifiable risk factor identified was fixation method. When considering blood transfusion requirements in isolation, we suggest a potential benefit in using a DHS for intertrochanteric and femoral neck fractures amenable to DHS fixation.
Collapse
|
20
|
Lin JCF, Wu CC, Lo C, Liang WM, Cheng CF, Wang CB, Chang YJ, Wu HC, Leu TH. Mortality and complications of hip fracture in young adults: a nationwide population-based cohort study. BMC Musculoskelet Disord 2014; 15:362. [PMID: 25361701 PMCID: PMC4289162 DOI: 10.1186/1471-2474-15-362] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/20/2014] [Indexed: 11/20/2022] Open
Abstract
Background This study assessed the mortality and complications of hip fractures using in-patients aged 20–40 years from a nationwide population database in Taiwan. Methods Subjects were selected from Taiwan’s National Health Insurance Research Database for the period 2000–2008, and these subjects were followed up until the end of 2010. A total of 5,079 (3,879 male and 1,200 female) subjects were admitted for the first time with primary diagnosis of hip fracture and treated with operation. We calculated the long-term overall survival rate and complication-free rate. We also assessed the risk factors for mortality and complications. Results The 1-month, 3-month, 6-month, 1-year, 2-year, 5-year, and 10-year complication-free rates were 98.3%, 96.2%, 94.5%, 86.8%, 80.4%, 75.3%, and 73.5% for the entire cohort, respectively. The 10-year survival rates were 93.3%, 91.8%, and 94.5% for total cases, trochanteric fracture, and cervical fracture, respectively. The 10-year complication-free rates were 73.5%, 80.5%, and 67.3% for total cases, trochanteric fracture, and cervical fracture, respectively. The risk factors for overall death were male, older age, and greater number of Charlson comorbidity index (CCI) comorbidities. The risk factors for complication were cervical fracture, and greater number of CCI comorbidities. Complications resulted in 42.83% of patients receiving internal fixation implants or prothesis removal and 2.01% underwent conversion to revision arthroplasty during follow-up. Conclusions The overall 10-year survival rate in hip fracture patients aged 20–40 years in Taiwan was over 90%. The 10-year complication-free rates were around 70%. Preventing the occurrence of severe complications after hip fracture among young adults is an important public health issue that warrants greater attention. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-362) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, Taipei 10478, Taiwan.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP. Dual mobility cups in total hip arthroplasty. World J Orthop 2014; 5:180-187. [PMID: 25035820 PMCID: PMC4095010 DOI: 10.5312/wjo.v5.i3.180] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/21/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature.
Collapse
|
22
|
Strike SA, Sieber FE, Gottschalk A, Mears SC. Role of fracture and repair type on pain and opioid use after hip fracture in the elderly. Geriatr Orthop Surg Rehabil 2014; 4:103-8. [PMID: 24600530 DOI: 10.1177/2151458513518343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Pain after hip fracture repair is related to worse functional outcomes and higher fracture care costs than that for patients with no or less pain. However, to our knowledge, few studies have examined the roles of hip fracture type or surgical procedure as factors influencing postoperative pain or opioid analgesic requirements. Our goal was to determine whether the type of hip fracture or hip fracture repair affects postoperative pain or opioid analgesic requirements in the elderly patient. METHODS We conducted a retrospective review of 231 patients ≥65 years old admitted to a hip fracture center for surgical repair. Fracture patterns were classified into femoral neck (FN) versus intertrochanteric (IT), stable versus unstable, and type of surgical repair. Demographic and intraoperative variables, postoperative pain scores, and opioid analgesic use data were collected and analyzed according to the type of hip fracture and type of surgical repair. RESULTS There were no differences in postoperative pain when comparing FN versus IT fractures, stable versus unstable fractures, or type of surgical repair. Patients with FN fractures had higher analgesic requirements on postoperative days 1, 2, and 3. There was no difference in postoperative analgesic requirements among patients with stable versus unstable fractures or type of surgical repair. Otherwise, there were no differences in postoperative pain or opioid analgesic use based on the surgical repair or fracture type. Overall, patients with hip fracture experienced low levels of pain.
Collapse
Affiliation(s)
- Sophia A Strike
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Frederick E Sieber
- Department of Anesthesiology, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Allan Gottschalk
- Department of Anesthesiology, The Johns Hopkins University, Baltimore, MD, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| |
Collapse
|
23
|
Solarino G, Abate A, Morizio A, Vicenti G, Moretti B. Should we use ceramic-on-ceramic coupling with large head in total hip arthroplasty done for displaced femoral neck fracture? ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2014.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
24
|
Viberg B, Overgaard S, Lauritsen J, Ovesen O. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture: 12- to 19-year follow-up of patients aged 75 years or more. Acta Orthop 2013; 84:254-9. [PMID: 23594248 PMCID: PMC3715822 DOI: 10.3109/17453674.2013.792033] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Elderly patients with displaced femoral neck fractures are commonly treated with a hemiarthroplasty (HA), but little is known about the long-term failure of this treatment. We compared reoperation rates for patients aged at least 75 years with displaced femoral neck fractures treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up. METHODS 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1 (1991-1993) with 180 patients had undergone IF; cohort 2 (1991-1995) with 203 patients had received an uncemented bipolar Ultima HA stem (Austin-Moore); cohort 3 (1991-1995) with 209 patients had received a cemented Charnley-Hastings HA; and cohort 4 (1991-1998) with 158 patients had received an uncemented hydroxyapatite-coated Furlong HA. Data were retrieved from patient files, from the region-based patient administrative system, and from the National Registry of Patients at the end of 2010. We performed survival analysis with adjustment for comorbidity, age, and sex. RESULTS Cemented HA had a reoperation rate (RR) of 5% and was used as reference in the Cox regression analysis, which showed significantly higher hazard ratios (HRs) for IF (HR = 3.8, 95% CI: 1.9-7.5; RR = 18%), uncemented HA (HR = 2.2, CI: 1.1-4.5; RR = 11%) and uncemented hydroxyapatite-coated HA (HR = 3.6, CI: 1.8-7.4; RR = 16%). INTERPRETATION Cemented HA has a superior long-term hip survival rate compared to IF and uncemented HA (with and without hydroxyapatite coating) in patients aged 75 years or more with displaced femoral neck fractures.
Collapse
Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,Institute of Clinical Research, University of Southern Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,Institute of Clinical Research, University of Southern Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,Institute of Public Health, Department of Biostatistics, University of Southern Denmark, Denmark
| | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,Institute of Clinical Research, University of Southern Denmark
| |
Collapse
|
25
|
Open reduction internal fixation versus hemiarthroplasty versus total hip arthroplasty in the elderly: a review of the National Surgical Quality Improvement Program database. J Surg Res 2013; 181:193-8. [DOI: 10.1016/j.jss.2012.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 06/13/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
|
26
|
Gao H, Liu Z, Xing D, Gong M. Which is the best alternative for displaced femoral neck fractures in the elderly?: A meta-analysis. Clin Orthop Relat Res 2012; 470:1782-91. [PMID: 22278852 PMCID: PMC3348330 DOI: 10.1007/s11999-012-2250-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 01/10/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of displaced femoral neck fractures includes internal fixation and arthroplasty. However, whether arthroplasty or internal fixation is the primary treatment for displaced femoral neck fractures in elderly patients remains a subject for debate. The literature contains conflicting evidence regarding rates of mortality, revision surgery, major postoperative complications, and function in elderly patients with displaced femoral neck fractures treated either by internal fixation or arthroplasty (either hemiarthroplasty or THA). QUESTIONS/PURPOSE We determined mortality, revision surgery rates, major surgical complications (which include infection, nonunion or early redisplacement, avascular necrosis, dislocation, loosening of the prosthesis, acetabular erosion, fracture below or around the implant, and other severe general complications such as deep vein thrombosis and pulmonary embolism), and function in patients treated with either internal fixation or arthroplasty for displaced femoral neck fractures in the elderly. METHODS We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing internal fixation and arthroplasty. We identified 20 RCTs with 4508 patients meeting all the criteria for eligibility. We performed a meta-analysis of the major complications, reoperations, function, pain, and mortality. RESULTS Compared with internal fixation, arthroplasty reduced the risk of the major complications (95% CI, 0.21-0.54 for 1 year; 95% CI, 0.16-0.31 for 5 years) and the incidence of reoperation 1 to 5 years after surgery (95% CI, 0.15-0.34 for 1 year; 95% CI, 0.08-0.24 for 5 years), and provided better pain relief (95% CI, 0.34-0.72). Function was superior (RR = 0.59; 95% CI, 0.44-0.79) for patients treated with arthroplasty than for patients treated by internal fixation. However, mortality 1 to 3 years after surgery was similar (95% CI, 0.96-1.23, p = 0.20 for 1 year; 95% CI, 0.91-1.17, p = 0.63 for 3 years). CONCLUSIONS Arthroplasty can reduce the risk of major complications and the incidence of reoperation compared with internal fixation, and provide better pain relief and function, but it does not reduce mortality. LEVEL OF EVIDENCE Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hongwei Gao
- Department of Orthopaedics, The Second Hospital of Shandong University, 247 Beiyuan Street, Shandong, 250033 Jinan People’s Republic of China
| | - Zhonghao Liu
- Department of Orthopaedics, The Second Hospital of Shandong University, 247 Beiyuan Street, Shandong, 250033 Jinan People’s Republic of China
| | - Deguo Xing
- Department of Emergency, The Second Hospital of Shandong University, 247 Beiyuan Street, Shandong, 250033 Jinan People’s Republic of China
| | - Mingzhi Gong
- Department of Orthopaedics, The Second Hospital of Shandong University, 247 Beiyuan Street, Shandong, 250033 Jinan People’s Republic of China
| |
Collapse
|
27
|
Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Molé D, Fessy MH. Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthop Traumatol Surg Res 2012; 98:296-300. [PMID: 22463868 DOI: 10.1016/j.otsr.2012.01.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 12/10/2011] [Accepted: 01/05/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Displaced fractures of the femoral neck in the elderly are best treated with arthroplasty. The type of arthroplasty to be used, either hemi- or total hip arthroplasty, remains controversial as total hip replacements potentially have a higher rate of dislocation. HYPOTHESIS Dual mobility cups have a low dislocation rate when used to manage acute fractures of the femoral neck. PATIENTS AND METHODS In a multicenter prospective study conducted in France over an inclusion time of 3 months, all displaced fractures of the femoral neck treated with arthroplasty were operated on with insertion of a dual mobility cup. Patients had clinical and radiological assessment at 3, 6, and 9 months postoperative. RESULTS Two hundred and fourteen hips in 214 patients with a mean age of 83 years (range, 70-103 years) were included. None of the patients was lost to follow-up. The mortality rate after 9 months was 19%. Two patients (1%) had early postoperative infection successfully treated with lavage and antibiotics. Three patients (1.4%), operated through a posterior approach, presented one postoperative dislocation, all of which were posterior. Reduction was performed through closed external manipulation under general anesthesia. There was no recurrence of dislocation. DISCUSSION This low rate of dislocation after acute total hip replacement using dual mobility design cups favorably compares with hemiarthroplasties. Dual mobility cups might therefore be considered a valuable option to prevent postoperative dislocation when treating displaced intracapsular fractures of the proximal femur in elderly patients if a total hip replacement is recommended. Further study is needed before extending the indications for total hip arthroplasty following a fracture of the femoral neck, to assess the potential cost and complications of a longer procedure with its potential acetabular complication, and weigh them against the potential benefits.
Collapse
Affiliation(s)
- P Adam
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Musculo-skeletal division, Strasbourg Regional Academic Hospital Center, 1, avenue Molière, 67098 Strasbourg, France.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Souder CD, Brennan ML, Brennan KL, Song J, Williams J, Chaput C. The rate of contralateral proximal femoral fracture following closed reduction and percutaneous pinning compared with arthroplasty for the treatment of femoral neck fractures. J Bone Joint Surg Am 2012; 94:418-25. [PMID: 22398735 DOI: 10.2106/jbjs.j.01134] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As the population ages, the number of proximal femoral fractures seen each year is expected to increase. Subsequent contralateral hip fractures have been reported to occur in as many as 11.8% of patients after surgical fixation of the initial fracture, but it is unknown if this rate is similar among patients managed with different surgical procedures. METHODS A retrospective comparative study was performed at a single institution at which electronic medical records and digital radiographs were reviewed for 1177 patients who underwent closed reduction and percutaneous pinning or arthroplasty for the treatment of a proximal femoral fracture. For the primary outcome of subsequent fracture, logistic regression analysis was applied. RESULTS Four hundred and ninety-five patients were managed with closed reduction and percutaneous pinning, and 682 were managed with arthroplasty. Patients who underwent closed reduction and percutaneous pinning were two times more likely to have a subsequent contralateral femoral fracture in comparison with those who underwent arthroplasty, with contralateral fracture rates of 10.10% for the closed reduction and percutaneous pinning group and 5.57% for the arthroplasty group (p = 0.0035). CONCLUSIONS Patients undergoing closed reduction and percutaneous pinning as the initial treatment for a hip fracture had an increased risk of a subsequent contralateral hip fracture in comparison with those undergoing arthroplasty, after controlling for patient characteristics.
Collapse
Affiliation(s)
- Christopher D Souder
- Department of Orthopaedics, Scott & White Healthcare, 2401 South 31st Street, Temple, TX 76508, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Sheth U, Simunovic N, Tornetta P, Einhorn TA, Bhandari M. Poor citation of prior evidence in hip fracture trials. J Bone Joint Surg Am 2011; 93:2079-86. [PMID: 22262379 DOI: 10.2106/jbjs.j.01274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Failure to cite prior evidence in the medical literature may result in publication redundancy and inefficient use of research funding. We evaluated trials in which internal fixation was compared with arthroplasty for the treatment of hip fractures in order to determine the extent to which these randomized trials cited all relevant previous trials. METHODS We searched MEDLINE and Embase for all relevant articles on four topics: internal fixation compared with arthroplasty, total hip arthroplasty compared with hemiarthroplasty, sliding hip screws compared with other fixation devices, and surgical delay of hip fracture treatment. We determined the proportion of previous studies that were cited in comparison with the total number of previous studies that were citable (i.e., the citation rate) as well as the proportion of times that a study was cited in comparison with the total number of times that it could have been cited (i.e., the hit rate). A cumulative meta-analysis was performed for the "internal fixation compared with arthroplasty" topic to determine whether compelling evidence favoring one intervention existed at an earlier time. RESULTS In total, sixty studies were assessed and yielded an overall citation rate of 48%. All "highly cited" studies reported a positive result (favoring arthroplasty), and 60% were published in The Journal of Bone and Joint Surgery (American or British volume). The results of a study and the journal of publication significantly affected the hit rate (p < 0.05). CONCLUSIONS Our review of studies of hip fracture treatment suggests poor citation of the previous literature. Studies in higher-impact journals with positive results are more likely to be cited in subsequent studies. Therefore, redundancy in publication and unnecessary surgical trials often occur.
Collapse
Affiliation(s)
- Ujash Sheth
- Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7, Canada.
| | | | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND Meta-analysis has become accepted as a methodically rigorous research tool, and as a result, many meta-analyses have been undertaken in orthopedic trauma, the implication being that their conclusions have improved surgeons' knowledge and facilitated improved clinical care. There have been criticisms of the methodology used in a number of meta-analyses; however, there has been no previous study of the clinical usefulness of their conclusions. METHODS A study of 60 orthopedic trauma meta-analyses published during or after 2000 was undertaken. We divided the conclusions of the meta-analyses into four types depending on their innovation and potential for improving clinical care. We also separated the meta-analyses according to whether they were undertaken by the Cochrane Collaboration or by independent surgeons. RESULTS Only 4 (6.7%) of the meta-analyses contained new, clinically useful, information, and 22 (36.7%) had no conclusions at all. A further 25 (41.7%) contained conclusions that were already in the standard orthopedic trauma literature. Approximately 70% of the Cochrane Collaborations had no conclusions. CONCLUSIONS We found considerable variability in the clinical usefulness of orthopedic trauma meta-analyses, and we question the clinical usefulness of this type of research.
Collapse
|
31
|
Font-Vizcarra L, Zumbado A, García S, Bosch J, Mensa J, Soriano A. Relationship between haematoma in femoral neck fractures contamination and early postoperative prosthetic joint infection. Injury 2011; 42:200-3. [PMID: 20951990 DOI: 10.1016/j.injury.2010.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 08/24/2010] [Accepted: 09/06/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prosthetic joint infection (PJI) after femoral neck fracture is associated with a higher mortality, morbidity and economic costs. Although is well known that the presence of a post surgical haematoma is associated with infection, in our knowledge there are no articles evaluating the contamination of the femoral neck fracture haematoma and the possible relationship with early postoperative PJI. The aim of our study was to evaluate the prevalence of positive cultures from haematoma in patients with femoral neck fracture and the relationship with early PJI. METHODS A prospective observational study was performed. All patients who underwent hiphemiarthroplasty for a femoral neck fracture from April'08 to February'09 were included. Three samples were taken just after the arthrotomy, a tissue sample, a swab of haematoma and blood of haematoma inoculated into blood culture flasks. Patients received the standard prophylaxis. RESULTS A total of 109 patients were treated during this period in our center, 16 were excluded for mistakes during taking samples or for receiving extra antibiotic treatment after or before the surgery of the fracture. In 29 patients (31.2%) one or more intraoperative cultures were positive. Four patients developed an early PJI caused by Gram-negative bacilli (GNB) in all cases. The early PJI rate in the group of patients with negative intraopertive cultures was 3.1% while in the group with one or more positive cultures was 6.9% (p = 0.3). In 3 cases the haematoma was contaminated with a GNB. The PJI rate inpatients with intraoperative cultures positive for a GNB was 66.6% (2/3) while in the group of patients without a GNB the infection rate was 2.2% (2/89, p = 0.004, Fisher exact-test). Furthermore in these two patients the microorganism that caused the PJI was the same that had been isolated from the haematoma. CONCLUSION The haematoma in femoral neck fractures was contaminated in 31.2% of cases before surgery. The contamination of the haematoma with a GNB was associated with a higher risk of early postoperative PJI.
Collapse
Affiliation(s)
- Lluís Font-Vizcarra
- Department of Orthopaedics and Trauma Surgery of Hospital Clínic of Barcelona, University of Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
| | | | | | | | | | | |
Collapse
|
32
|
Takamine B, Morii T, Watanabe H, Tajima T, Satomi K. Short-term postoperative mortality events in patients over 80 years of age with hip fracture: analysis at a single institution with limited medical resources. J Orthop Sci 2010; 15:437-42. [PMID: 20721709 DOI: 10.1007/s00776-010-1480-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 03/11/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lethal events represent the most important complication in the treatment of hip fracture in elderly patients. Despite the increasing chance for treatment of such conditions, few data regarding risk factors associated with lethal events have been determined for ordinary hospitals with limited medical and human resources, particularly in Japan. METHODS The incidence of postoperative lethal events and related preoperative risk factors in extremely elderly patients (>80 years) with hip fracture were retrospectively analyzed in our hospital for the past 2 years. RESULTS Lethal events occurred in 11 (10.7%) of 103 patients within 3 months postoperatively. In both univariate and multivariate analyses, an elevated number of co-morbidities and preoperative respiratory dysfunction were identified as significant risk factors. Delay in surgery was not a risk factor for lethal events. CONCLUSIONS A valid reason for delay is the need to stabilize concurrent medical conditions due to multiple co-morbidities in extremely elderly patients with hip fracture. Considering the limited resources and extreme age of the subjects, the mortality rate in the present study was quite acceptable. Patients, families of patients, and physicians should recognize the increased risk of mortality for patients with significant risk factors in the surgical treatment of hip fracture.
Collapse
Affiliation(s)
- Bunsei Takamine
- Department of Orthopaedic Surgery, Choufu Hospital, Tokyo, Japan
| | | | | | | | | |
Collapse
|