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Assi C, Otayek J, Mansour J, Daher J, Caton J, Samaha C, Yammine K. Outcomes of total hip arthroplasty using dual mobility cups following failed internal fixation of proximal femoral fractures at a mean follow-up of 6 years. SICOT J 2024; 10:3. [PMID: 38240729 PMCID: PMC10798229 DOI: 10.1051/sicotj/2023038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/09/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Performing total hip arthroplasty (THA) after failed internal fixation of proximal femoral fractures (PFF) is known to be associated with high rates of complications. Dual mobility cups (DMC) are known to lower dislocation events in high-risk patients. Very few reports investigated the outcomes of THA using DMC following failure of internal fixation for PFF. METHODS This is a retrospective monocentric continuous study of 31 patients who underwent THA with DMC after failed internal fixation of PFF. The clinical assessment was based on the modified Harris hip score (mHHS) at the last follow-up. The complication rates and radiological analyses were recorded. RESULTS The mean follow-up period was 5.96 ± 4.2 years. At the last follow-up, the mean mHHS was 92.9 ± 9.1 with 71% of the patients describing their operated hip as a forgotten hip. No dislocation or aseptic loosening events were noted. One patient developed a septic loosening of the implant. No significant radiological changes were recorded. Sixteen stems (51.6%) were placed in a neutral position, 13 (42%) in valgus (2.74 ± 1.72°), and 2 (6.4%) in varus (6.94 ± 2.02°). CONCLUSION This study emphasizes the advantage of using DMC following failed internal fixation of PFF in reducing dislocation and complication events in this high-risk population.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
- Center of Evidence-based Anatomy, Sports & Orthopedic Research Beirut Lebanon
| | - Joeffroy Otayek
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Jimmy Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | | | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine Beirut Lebanon
- Institut de Chirurgie Orthopédique Lyon France
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Sakellariou E, Galanis A, Vavourakis M, Papagrigorakis E, Vlachos C, Zachariou D, Vasiliadis E, Pneumaticos S. Peri-implant proximal femur fracture in a poliomyelitis survivor: A surgical and medical challenge. Clin Case Rep 2023; 11:e7465. [PMID: 37287621 PMCID: PMC10242085 DOI: 10.1002/ccr3.7465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
Key Clinical Message The treatment of long bone fractures in post-polio survivors is indubitably an exacting task. Out of this complicated case presented in this paper, it can be deduced that it is attainable to repair a peri-implant subtrochanteric refracture or a complex non-union of the proximal femur with plate and screws with grafting. Abstract Post-polio survivors are prone to low-energy bone fractures. The management of such cases is exigent, as no literature data indicate the best surgical approach. This paper presents an intricate peri-implant proximal femoral fracture in a polio survivor treated in our institution and accentuates the various challenges we encountered.
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Affiliation(s)
- Evangelos Sakellariou
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Athanasios Galanis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Michail Vavourakis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Eftychios Papagrigorakis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Christos Vlachos
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Dimitrios Zachariou
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Elias Vasiliadis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Spiros Pneumaticos
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
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Rougereau G, Naline C, Boisrenoult P, Langlais T, Pujol N. Proximal femoral fracture and female gender are risk factors for recurrent fracture: Cohort study of 292 patients over 75 years-old with iterative osteoporotic fractures. Injury 2023:S0020-1383(23)00187-0. [PMID: 36931968 DOI: 10.1016/j.injury.2023.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The purpose of this study was to: 1/ describe the characteristics of a cohort of patients over 75 years of age hospitalized in perioperative geriatric units (UPOG) for iterative fractures; 2/ investigate the risks of institutionalization related to the first fracture; and 3/ search for potential risk factors for iterative fracture. METHODS This is a retrospective single-center study analyzing patients over 75 years old, hospitalized in UPOG. RESULTS Of the 3207 patients hospitalized, 292 patients had a refracture (9.1%), with a mean age of 85.4+/-5.8 years. Initial fractures were mainly intertrochanteric (43.2%) and the femoral neck (32.9%). Refractures occurred mainly in the first year (55.5%), with a median delay of 9.6 months. Refractures were mainly intertrochanteric (29.5%), peri‑implant (prosthesis, osteosynthesis) (28.8%), and femoral neck (26.7%). Dementia was the only factor for institutionalization after the first fracture episode (p = 0.0002). Proximal femoral fracture (PFF) and female gender were risk factors for iterative fracture (10.2% vs. 6.8%, p = 0.003; 10.7% vs. 6.8%, p = 0.005 respectively), but not age (85.4 vs. 85.8 years, p = 0.24). PFF were more likely to result in the same fracture type in the second episode (58.1% vs 7.1%, p<0.0001). The time to refracture was shorter in case of peri‑implant fracture (p = 0.0002), or discharge directly to home (p = 0.04). CONCLUSION PFF and female gender are risk factors for recurrent fracture, which is even more likely to occur early in case of home discharge or peri‑implant fracture.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France.
| | - Charlotte Naline
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France; Department of Geriatrics, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Philippe Boisrenoult
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Tristan Langlais
- Department of Orthopaedic paediatric Surgery, Hôpital des enfants, Purpan, Université de Toulouse, Toulouse, France; Department of Orthopaedic paediatric Surgery, Sorbonne Université, A. Trousseau, APHP, Paris, France
| | - Nicolas Pujol
- Department of Orthopaedic and Trauma Surgery, Hôpital André Mignot, Université Île-de-France Ouest, 177 Rue de Versailles, 78150 Le Chesnay, France
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Conversion arthroplasty after failed extracapsular hip fracture fixation is associated with high complication rates. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background/Aim: There is no standard treatment of choice that addresses all extracapsular fractures, which account for approximately half of the elderly hip fractures. Arthroplasty is mostly favored secondary to unsuccessful fixation or unstable primary fractures. However, conversion arthroplasty complication rates are high in the literature. This study compares arthroplasty performed after unsuccessful fixation and primary arthroplasty for unstable extracapsular hip fractures.
Methods: In this retrospective study, we compared the first-year results of the groups that underwent conversion arthroplasty (cHA) and the primary arthroplasties (pHA) for extracapsular hip fractures. In the cHA group, patients were indicated for operation if there was a failure of fixation after extracapsular hip fractures (n=44). In the pHA group, patients were for unstable extracapsular hip fractures (n=44). In the cHA group, failure of fixation causes were cut-out of lag screws (54.5%), cut-through of lag screws (9.1%), non-union of fractures (27.3%), and osteonecrosis of femoral heads (9.1%). While total hip replacement was applied to all patients in the cHA group, total hip replacement was applied to ten patients in the pHA group and hemiarthroplasty to 34 patients. In comparing groups, duration of operation, amount of bleeding, intraoperative complications, post-operative complications, mobilization capacities, functional status, and mortality rates were used.
Results: There were 44 patients in both groups. The surgical time (134.3 [34.5)] vs. 66 [16], [P<0.001]), the amount of bleeding (1000 ml [400] vs. 300ml [200], [P<0.001]), the need for red blood cell transfusion in the operations (80% vs. 32%, [P<0.001]), and the frequency of intraoperative femur fracture (30% vs. 0%, [P<0.001]) were larger or longer in the cHA group compared to pHA group (P<0.001). While 14 complications requiring surgical intervention were observed in 12 of 44 patients in the CHA group in the post-operative 1st year, four complications were observed in four of 44 patients in the pHA group. There was no difference in mortality rates (3 vs. 3, [P =1]), mobilization capacities (5.9 [2.1] vs. 5.7 [2.0], [P=0.597]), and functional status (12.5 [3.3] vs. 13.0 [2.7], [P=0.434]) between the groups.
Conclusion: Arthroplasty performed as conversion surgery after unsuccessful fixation has a higher risk of intraoperative and post-operative complications than primary arthroplasty performed after extracapsular hip fractures. We believe the cases prone to implant failure, non-union, or restricted mobilization because of the patient and fracture-type reasons should be treated with primary arthroplasty.
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Hung CC, Chen KH, Chang CW, Chen YC, Tai TW. Salvage total hip arthroplasty after failed internal fixation for proximal femur and acetabular fractures. J Orthop Surg Res 2023; 18:45. [PMID: 36647088 PMCID: PMC9843827 DOI: 10.1186/s13018-023-03519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear. QUESTIONS/PURPOSES The primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip. PATIENTS AND METHODS We enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip. RESULTS A total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications. CONCLUSION Salvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture. Level of Evidence level III.
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Affiliation(s)
- Ching-Chieh Hung
- grid.64523.360000 0004 0532 3255Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428 Taiwan
| | - Kuan-Hsiang Chen
- grid.64523.360000 0004 0532 3255Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428 Taiwan
| | - Chih-Wei Chang
- grid.64523.360000 0004 0532 3255Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428 Taiwan
| | - Yi-Chen Chen
- grid.64523.360000 0004 0532 3255Departments of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Wei Tai
- grid.64523.360000 0004 0532 3255Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428 Taiwan ,grid.64523.360000 0004 0532 3255Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Oranger A, Zerlotin R, Buccoliero C, Sanesi L, Storlino G, Schipani E, Kozloff KM, Mori G, Colaianni G, Colucci S, Grano M. Irisin Modulates Inflammatory, Angiogenic, and Osteogenic Factors during Fracture Healing. Int J Mol Sci 2023; 24:ijms24031809. [PMID: 36768133 PMCID: PMC9915346 DOI: 10.3390/ijms24031809] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Bone fractures are a widespread clinical event due to accidental falls and trauma or bone fragility; they also occur in association with various diseases and are common with aging. In the search for new therapeutic strategies, a crucial link between irisin and bone fractures has recently emerged. To explore this issue, we subjected 8-week-old C57BL/6 male mice to tibial fracture, and then we treated them with intra-peritoneal injection of r-Irisin (100 µg/kg/weekly) or vehicle as control. At day 10 post fracture, histological analysis showed a significant reduced expression of inflammatory cytokines as tumor necrosis factor-alpha (TNFα) (p = 0.004) and macrophage inflammatory protein-alpha (MIP-1α) (p = 0.015) in the cartilaginous callus of irisin-treated mice compared to controls, supporting irisin's anti-inflammatory role. We also found increased expressions of the pro-angiogenic molecule vascular endothelial growth factor (VEGF) (p = 0.002) and the metalloproteinase MMP-13 (p = 0.0006) in the irisin-treated mice compared to the vehicle ones, suggesting a myokine involvement in angiogenesis and cartilage matrix degradation processes. Moreover, the bone morphogenetic protein (BMP2) expression was also upregulated (p = 0.002). Taken together, our findings suggest that irisin can contribute to fracture repair by reducing inflammation and promoting vessel invasion, matrix degradation, and bone formation, supporting its possible role as a novel molecule for fracture treatment.
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Affiliation(s)
- Angela Oranger
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Roberta Zerlotin
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Cinzia Buccoliero
- Department of Biosciences, Biotechnology and Environment, University of Bari, 70124 Bari, Italy
| | - Lorenzo Sanesi
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70124 Bari, Italy
| | - Giuseppina Storlino
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70124 Bari, Italy
| | - Ernestina Schipani
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19107, USA
| | - Kenneth Michael Kozloff
- Departments of Orthopedic Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Giorgio Mori
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Graziana Colaianni
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
| | - Silvia Colucci
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70124 Bari, Italy
| | - Maria Grano
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-0805478311
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van de Kuit A, Oosterhoff JHF, Dijkstra H, Sprague S, Bzovsky S, Bhandari M, Swiontkowski M, Schemitsch EH, IJpma FFA, Poolman RW, Doornberg JN, Hendrickx LAM. Patients With Femoral Neck Fractures Are at Risk for Conversion to Arthroplasty After Internal Fixation: A Machine-learning Algorithm. Clin Orthop Relat Res 2022; 480:2350-2360. [PMID: 35767811 PMCID: PMC9653184 DOI: 10.1097/corr.0000000000002283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral neck fractures are common and are frequently treated with internal fixation. A major disadvantage of internal fixation is the substantially high number of conversions to arthroplasty because of nonunion, malunion, avascular necrosis, or implant failure. A clinical prediction model identifying patients at high risk of conversion to arthroplasty may help clinicians in selecting patients who could have benefited from arthroplasty initially. QUESTION/PURPOSE What is the predictive performance of a machine-learning (ML) algorithm to predict conversion to arthroplasty within 24 months after internal fixation in patients with femoral neck fractures? METHODS We included 875 patients from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial. The FAITH trial consisted of patients with low-energy femoral neck fractures who were randomly assigned to receive a sliding hip screw or cancellous screws for internal fixation. Of these patients, 18% (155 of 875) underwent conversion to THA or hemiarthroplasty within the first 24 months. All patients were randomly divided into a training set (80%) and test set (20%). First, we identified 27 potential patient and fracture characteristics that may have been associated with our primary outcome, based on biomechanical rationale and previous studies. Then, random forest algorithms (an ML learning, decision tree-based algorithm that selects variables) identified 10 predictors of conversion: BMI, cardiac disease, Garden classification, use of cardiac medication, use of pulmonary medication, age, lung disease, osteoarthritis, sex, and the level of the fracture line. Based on these variables, five different ML algorithms were trained to identify patterns related to conversion. The predictive performance of these trained ML algorithms was assessed on the training and test sets based on the following performance measures: (1) discrimination (the model's ability to distinguish patients who had conversion from those who did not; expressed with the area under the receiver operating characteristic curve [AUC]), (2) calibration (the plotted estimated versus the observed probabilities; expressed with the calibration curve intercept and slope), and (3) the overall model performance (Brier score: a composite of discrimination and calibration). RESULTS None of the five ML algorithms performed well in predicting conversion to arthroplasty in the training set and the test set; AUCs of the algorithms in the training set ranged from 0.57 to 0.64, slopes of calibration plots ranged from 0.53 to 0.82, calibration intercepts ranged from -0.04 to 0.05, and Brier scores ranged from 0.14 to 0.15. The algorithms were further evaluated in the test set; AUCs ranged from 0.49 to 0.73, calibration slopes ranged from 0.17 to 1.29, calibration intercepts ranged from -1.28 to 0.34, and Brier scores ranged from 0.13 to 0.15. CONCLUSION The predictive performance of the trained algorithms was poor, despite the use of one of the best datasets available worldwide on this subject. If the current dataset consisted of different variables or more patients, the performance may have been better. Also, various reasons for conversion to arthroplasty were pooled in this study, but the separate prediction of underlying pathology (such as, avascular necrosis or nonunion) may be more precise. Finally, it may be possible that it is inherently difficult to predict conversion to arthroplasty based on preoperative variables alone. Therefore, future studies should aim to include more variables and to differentiate between the various reasons for arthroplasty. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Anouk van de Kuit
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jacobien H. F. Oosterhoff
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hidde Dijkstra
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Sheila Sprague
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Marc Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudolf W. Poolman
- Department of Orthopaedic Surgery, University Medical Center Leiden, Leiden University, Leiden, the Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia
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Shi T, Fang X, Huang C, Li W, You R, Wang X, Xia C, Zhang W. Conversion Hip Arthroplasty Using Standard and Long Stems after Failed Internal Fixation of Intertrochanteric Fractures. Orthop Surg 2022; 15:124-132. [PMID: 36394199 PMCID: PMC9837238 DOI: 10.1111/os.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/01/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Failed internal fixation of intertrochanteric fractures (FIF-ITF) is often treated by conversion hip arthroplasty (CHA). This study aimed to evaluate the results and complications of using standard and long femoral stems in this operation. METHODS This retrospective, multi-center study enrolled 31 total hip arthroplasty (THA) and 23 hemiarthroplasties (HA) cases (30 women, 24 men; mean age 76 years) after FIF-ITF between 2012 and 2019, divided into two groups: standard stem group (n = 20) and long stem group (n = 34). The initial internal fixation includes 38 cases of proximal femoral nail anti-rotation (PFNA), eight cases of the dynamic hip screw (DHS), and eight cases of locking proximal femoral plate (LPFP). The indications for CHA included 38 cases of failure of fixation, seven cases of nonunion, and nine cases of avascular necrosis or posttraumatic osteoarthritis. Perioperative data and complications related to fracture and operation were collected, and preoperative and postoperative clinical and radiological data were analyzed. Clinical outcomes were assessed using Harris hip score (HHS) and 36-item Short Form survey (SF-36: including physical function (PF) score and body pain (BP) score). Statistical analyses were performed using the chi-square or Fisher's exact test, and the 2-sample t-test or Wilcoxon rank sum test. RESULTS At an average of 5.6 years with a minimum of 2 years follow-up. A significant overall surgeon-related complication rate was detected (27.8% [15/54]), five cases had an intraoperative femur fracture, one case had a late periprosthetic femoral fracture, two cases had a stem penetration, one case had a cement leakage, and two patients had an early postoperative dislocation, one infection and three cases of stem loosening or subsidence. Long stems had an increased risk of complication (13/34) compared to standard stems (2/20) (P = 0.031). The operation time and blood loss in the long stem group were higher than those in the standard stem group (P = 0.002; 0.017). HHS and SF-36 significantly improved in both groups from preoperative to the final follow-up and did not present significant differences at the final follow-up (P > 0.05). CONCLUSION CHA following FIF-ITF showed a successful mid-term clinical result, long stem arthroplasty should be approached with caution for the risks of higher complication rate, especially intraoperative femoral fractures.
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Affiliation(s)
- Tengbin Shi
- Department of OrthopaedicFujian Medical University Union HospitalFuzhouChina,Department of OrthopaedicThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xinyu Fang
- Department of OrthopaedicThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Changyu Huang
- Department of OrthopaedicThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Weiming Li
- Department of OrthopaedicsFuzhou Second Hospital Affiliated to Xiamen UniversityFuzhouChina
| | - Ruijin You
- Department of Orthopaedics910th Hospital of PLAQuanzhouChina
| | - Xu Wang
- Department of Joint SurgeryMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Chun Xia
- Department of Joint SurgeryZhongshan Hospital Xiamen UniversityXiamenChina
| | - Wenming Zhang
- Department of OrthopaedicThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
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Mathur HH, Shah HS, Vishwanathan K. Functional outcome of conversion total hip arthroplasty (CTHA) using uncemented distally loading femoral stem for failed fixation of proximal femoral nail - A case series. J Orthop 2022; 34:14-20. [PMID: 35992612 PMCID: PMC9382133 DOI: 10.1016/j.jor.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and aims There is paucity of prospective studies on conversion total hip arthroplasty (CTHA) for failed proximal femoral nailing. The objective of this study is to evaluate the functional outcome of CTHA using extensively porous coated distal loading stem for failed proximal femoral nailing. Patients and methods Fifteen consecutively operated patients for failed proximal femoral nail treated with single stage procedure of nail extraction and CTHA were included in this prospective observational study. All patients received metal-on-polyethylene bearing with uncemented press-fit acetabular cup (Pinnacle cup; DePuy, Warsaw [IN], USA) and extensively porous coated distally loading revision stem (Solution stem; DePuy, Warsaw [IN], USA). All patients were assessed preoperatively and postoperatively at one, three, six and more than twelve months using the Harris Hip Score (HHS). The responsiveness of HHS was assessed using Effect Size (ES) and Standardised Response Mean (SRM). ES and SRM >0.8 indicates adequate responsiveness. Results The mean duration of follow-up was 16.9 months for the overall cohort (SD: 7.9; range: 6-28 months). The mean preoperative HHS was 32 ± 6.1, the mean HHS at six months follow-up was 89.7 ± 4.0 and the mean HHS at final follow-up of atleast one year was 93.7 ± 3.0. There was a statistically and clinically significant improvement in the HHS from preoperatively to final follow-up postoperatively (p < 0.0001). At the final follow-up, twelve patients (80%) had an excellent outcome and three patients (20%) had a good outcome as per HHS grading. The ES was 9.87 and the SRM was 8.86 thereby suggesting adequate responsiveness. One patient developed surgical site infection and another patient developed dislocation. Both were successfully treated and subsequently the patients made uneventful recovery. None of the patients required revision surgery. Conclusion HHS has adequate responsiveness for assessing the functional outcome of CTHA. We recommend the use of an uncemented cup and uncemented extensively porous coated, distal loading stem for failed PFN fixation in intertrochanteric hip fractures.
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Affiliation(s)
- Hemant H. Mathur
- Department of Orthopaedics, Medical College and SSG Hospital, Baroda, Gujarat, India
| | - Harsh S. Shah
- Department of Orthopaedics, Medical College and SSG Hospital, Baroda, Gujarat, India
| | - Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Limda, Waghodia, Vadodara, Gujarat, 391760, India
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10
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Mory N, Saab M, Kaba A, Chantelot C, Jan N. Mortality and functional consequences after revision osteosynthesis for peritrochanteric fractures treated by intramedullary nail: A retrospective study of 312 patients. Orthop Traumatol Surg Res 2022; 108:103325. [PMID: 35589084 DOI: 10.1016/j.otsr.2022.103325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/15/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Osteosynthesis of peritrochanteric fractures by intramedullary nail is associated with a 3 to 15% rate of complications requiring revision surgery. The objective of our study was to compare mortality and autonomy between patients who required revision surgery after osteosynthesis, and patients without revision surgery. HYPOTHESES Patients who underwent revision surgery after osteosynthesis of a peritrochanteric fracture by intramedullary nail did not exhibit excess mortality or loss of autonomy compared to those who did not undergo revision surgery. METHODS Between January 2017 and October 2019, 312 consecutive patients were operated on for a peritrochanteric fracture by intramedullary nail. Among them, 23 patients (7.4%) required revision surgery (change, nail removal, total hip arthroplasty). Mortality at 90 days and at one year was evaluated and compared between the group of "revision" patients and "no revision" patients. The level of autonomy was assessed by the Parker and Palmer score, one year postoperatively and compared between the 2 groups. RESULTS The patients requiring revision surgery were younger: 73 years old vs. 86 years old (p<0.011). The overall mortality was 7.25% at 90 days after surgery and 15% at one year. Mortality was zero at 90 days, and at 1 year, postoperatively for patients requiring revision surgery. There was no significant difference for the mortality at 90 days (p=0.39) between the 2 groups, however at 1 year, it was significantly less for the revision patients (0% vs. 17%, p=0.032). There was no significant difference for the Parker score between the "revision" group; 5 (4-9) and the "no revision" group; 4 (3-7), at one year postoperatively (p=0.24). CONCLUSION This study did not show any excess mortality, nor loss of autonomy at 1 year postoperatively, for patients who required osteosynthesis for a trochanteric fracture, and who presented with a complication requiring revision surgery. LEVEL OF EVIDENCE III, comparative retrospective study.
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Affiliation(s)
- Nicolas Mory
- Service orthopédie 2, CHU de Lille, hôpital Roger-Salengro, 59000 Lille, France.
| | - Marc Saab
- Service orthopédie 1 et traumatologie, CHU Lille, hôpital Roger-Salengro, 59000 Lille, France
| | - Arnaud Kaba
- Service orthopédie et traumatologie, centre hospitalier Dunkerque, 59240 Dunkerque, France
| | - Christophe Chantelot
- Service orthopédie 1 et traumatologie, CHU Lille, hôpital Roger-Salengro, 59000 Lille, France
| | - Nicolas Jan
- Service orthopédie et traumatologie, centre hospitalier Dunkerque, 59240 Dunkerque, France
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11
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van Leent EAP, Schmitz PP, de Jong LD, Zuurmond RG, Vos CJ, van Susante JLC, Somford MP. Complications and survival of conversion to total hip arthroplasty after failed primary osteosynthesis compared to primary total hip arthroplasty in femoral neck fractures. Injury 2022; 53:2853-2858. [PMID: 35236573 DOI: 10.1016/j.injury.2022.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical treatment options for patients with an intracapsular fracture of the femoral neck (FFN) are primary osteosynthesis as a femoral head-spearing technique or primary (hemi)arthroplasty. The most common complications after primary osteosynthesis, such as avascular necrosis (AVN) or non-union, can result in conversion to Total Hip Arthroplasty (cTHA). Data concerning complications and survival rates of cTHA in comparison to primary Total Hip Arthroplasty (pTHA) after FFN are limited due to the absence of well-designed studies. METHODS A multicentre retrospective cohort study was conducted in three Dutch hospitals comparing the rate of postoperative dislocations, periprosthetic fractures, prosthetic joint infections, blood loss during surgery (>1000 mL), postoperative cardiac- and pulmonary complications after pTHA and cTHA in the first year after surgery. As a secondary outcome implant survival of pTHA and cTHA in terms of revision rates was evaluated. RESULTS In total 548 patients were included (pTHA n = 264 and cTHA n = 284) with a mean follow-up of 5 years (±3.5 SD). No significant differences were found in postoperative complications rates. The revision rate in the pTHA group was 7.2% in comparison to 7.7% in the cTHA group (p = 0.81). No difference in the short-term implant survival was found between both groups (p = 0.81). CONCLUSION This study showed no significant differences in terms of postoperative complication rates in the first year after pTHA and cTHA in patients with FFN. Also, no significant difference in short-term implant survival of primary and conversion total hip arthroplasty was found.
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Affiliation(s)
- E A P van Leent
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands.
| | - P P Schmitz
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
| | - L D de Jong
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
| | - R G Zuurmond
- Department of Orthopaedics, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, the Netherlands
| | - C J Vos
- Department of Orthopaedics, Noordwest ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands
| | - J L C van Susante
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
| | - M P Somford
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands
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12
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Conversion of failed internal fixation in proximal femur fractures using calcar-guided short-stem total hip arthroplasty. J Orthop Traumatol 2022; 23:34. [PMID: 35876963 PMCID: PMC9310680 DOI: 10.1186/s10195-022-00655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Reoperations for secondary osteoarthritis, osteonecrosis, or hardware failure following failed internal fixation after intertrochanteric fracture (ITF) or femoral neck fracture (FNF) are common. An effective salvage treatment often involves complete removal of the hardware followed by total hip arthroplasty (THA). Almost no data are available regarding conversion to short-stem THA. This study aimed to evaluate clinical and radiological outcomes, potential complications, and the survival rate of short-stem THA following revision surgery. METHODS We investigated 27 patients who underwent conversion THA using a calcar-guided short stem. Patient-reported outcome measurements were obtained, including the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, as well as pain and satisfaction on the visual analogue scale. Radiological follow-up was also performed. RESULTS We identified 18 (66.7%) patients diagnosed with FNF and 9 (33.3%) patients with ITF. Clinical and radiological outcomes were satisfactory at the last follow-up (30.56 ± 11.62 months). One patient required early revision surgery due to dislocation and greater trochanter fracture. At the last follow-up, none of the short stems required revision. No other major complications occurred. CONCLUSION Given the low rate of complications and 100% survival, our findings indicate that short stems for conversion THA due to failed internal fixation may be considered an option in a properly selected patient population. However, it should not be considered a standard procedure and should only be performed by experienced surgeons.
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13
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Egol KA, Walden T, Gabor J, Leucht P, Konda SR. Hip-preserving surgery for nonunion about the hip. Arch Orthop Trauma Surg 2022; 142:1451-1457. [PMID: 33635401 DOI: 10.1007/s00402-021-03820-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nonunions about the hip occur as a result of femoral neck, intertrochanteric, and certain subtrochanteric fractures. Treatment of a hip fracture nonunion allows for the choice between hip preservation or arthroplasty. The goal of this study was to examine outcomes of hip-preservation nonunion surgery METHODS: Patients who underwent hip preservation for a fracture nonunion of the femoral neck, intertrochanteric and subtrochanteric region to 1 cm below the lesser trochanter over a 10-year period were identified in our nonunion registry. Patients were followed for a minimum of 1 year. Functional outcomes were recorded at follow-up visits. For comparison regarding surgical and hospital outcomes, a group of 23 patients who underwent conversion total hip arthroplasties (cTHA) at the same academic medical center was reviewed. Quality measures such as length of stay, reoperation, and complications were collected. All statistics analysis utilized IBM SPSS 25 (Armonk, NY) RESULTS: Thirty patients who underwent 30 hip-preserving nonunion surgeries were analyzed and compared with 23 cTHA patients. Twenty-nine nonunions went on to heal (average time to union 6.3 months). There was improvement in functional outcome scores for the hip preservation group between baseline and latest follow-up (p < 0.001). Reoperation was required in five patients (17%), including four failed to heal and required a second repair to gain union and one failure that was converted to THA rather than attempt a second nonunion repair. Hip preservation failures were older than those that healed with the index treatment (p = 0.11). There was no significant difference in hospital length of stay, complication rate, or need for reoperation when compared to cTHA group. CONCLUSION Hip-preserving surgery is an option that should be considered for patients with nonunion of fractures about the hip. The rates of complications (20.3 vs 17.3%) and reoperation (16.7 vs 17.3%) were equivalent to conversion THA. Excellent outcomes can be achieved in terms of radiographic union and function with hip preservation.
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Affiliation(s)
- Kenneth A Egol
- NYU Langone Orthopedic Hospital, New York, NY, USA. .,Jamaica Hospital Medical Center, New York, NY, USA.
| | | | | | | | - Sanjit R Konda
- NYU Langone Orthopedic Hospital, New York, NY, USA.,Jamaica Hospital Medical Center, New York, NY, USA
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14
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Stołtny T, Pasek J, Rokicka D, Wróbel M, Dobrakowski M, Kamiński P, Domagalski R, Czech S, Strojek K, Koczy B. Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement. J Int Med Res 2022; 50:3000605221095225. [PMID: 35726568 PMCID: PMC9218464 DOI: 10.1177/03000605221095225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.
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Affiliation(s)
- Tomasz Stołtny
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Jarosław Pasek
- Department of Physiotherapy, Faculty of Health Sciences, University of Jan Długosz, Częstochowa, Poland
| | - Dominika Rokicka
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Marta Wróbel
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Michał Dobrakowski
- Department of Medical Radiology and Radiodiagnostics, Independent Public Clinical Hospital No. 1, Zabrze, Poland.,Department of Biochemistry, Faculty of Medical Sciences, Medical University of Silesia, Zabrze, Poland
| | - Paweł Kamiński
- Department of Medical Radiology and Radiodiagnostics, Independent Public Clinical Hospital No. 1, Zabrze, Poland
| | - Rafał Domagalski
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Szymon Czech
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Krzysztof Strojek
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Bogdan Koczy
- Department of Adult Orthopaedics, District Hospital of Orthopaedics and Trauma Surgery, Piekary Śląskie, Poland
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15
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Wong RMY, Zu Y, Chau WW, Tso CY, Liu WH, Ng RWK, Chow SKH, Cheung WH, Tang N, Ho KKW. High Charlson Comorbidity Index Score is associated with early fracture-related complication for internal fixation of neck of femur fractures. Sci Rep 2022; 12:4749. [PMID: 35306533 PMCID: PMC8934361 DOI: 10.1038/s41598-022-08855-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/14/2022] [Indexed: 12/19/2022] Open
Abstract
The incidence of geriatric hip fractures continues to rise in our aging population and has become a major public health concern globally. The primary outcome of this study was to determine whether Age-adjusted Charlson Comorbidity Index (ACCI) is associated with increased fracture-related complications in neck of femur fractures treated by internal fixation. This was a cohort study between January 2014 to June 2018. All patients ≥ 50 years old with an acute neck of femur fracture after low-energy trauma fixed with cannulated hip screws were included and followed-up for 1 year at a tertiary centre. Primary outcome was to determine whether ACCI was associated with increased fracture-related complications. Secondary outcomes were revision rate, mortality, and function after surgery. Further analysis were performed within a “younger” group (age 50–65) and “elder” group (age > 65), as displaced fractures (Garden Type III/IV) were in “younger” group. 233 hip fractures (68 males; 165 females) with a mean age of 73.04 ± 12.89 were included in the study. Surgical outcomes showed that the complication rate of hip screw fixation for all patients was 21.5% (50 patients) at 1 year. ACCI was significantly higher in all patients with complications (p = 0.000). Analysis within “younger” (p = 0.000) and “elder” groups (p = 0.006) both showed significance. Stepwise logistic regression modelling showed ACCI had positive correlation with complications with ACCI = 6 (OR 4.27, p = 0.02). R2 values were comparatively better after controlled by Garden Type III/IV at ACCI = 4 (OR 6.42 (1.70, 24.25), p = 0.01). The authors recommend that for patients with a Garden Type I/II and ACCI ≥ 6 or a Garden Type III/IV and ACCI ≥ 4, a direct arthroplasty surgery should be considered.
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16
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Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM. Is there a role for cementless primary stem in hip arthroplasty for early or late fixation failures of intertrochanteric fractures? BMC Musculoskelet Disord 2022; 23:266. [PMID: 35303844 PMCID: PMC8933997 DOI: 10.1186/s12891-022-05223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background The choice of femur stems during the hip arthroplasty procedures for patients with treatment failure of intertrochanteric fractures (ITF) remains controversial. We aimed to compare the surgical complication and reoperation rates between cementless primary and revision stems in the early (≤3 months) and late (> 3 months) fixation failures of ITF. Methods This was a retrospective, cohort study conducted in a single, tertiary referral hospital of Taipei, Taiwan. We included hip arthroplasty procedures for failed ITF using cementless primary or revision stems. There were 40 and 35 patients who had early and late fixation failure of ITF, respectively. The patient demographics, time to fixation failure, surgical complications and medical complications were recorded for analysis. Results We included 75 patients that underwent hip arthroplasty procedure for failed ITF using cementless primary (n = 38) or revision (n = 37) stems. The mean age was 79.3 years and 56% of the patients were female. In the early fixation failure group, the complication rate was similar between the primary and revision stems (44% vs. 29%, p = 0.343). However, there was a trend toward a higher reoperation rate (31% vs. 8%, p = 0.061) of using the primary stem, compared with the revision stem. In the late fixation failure group, the rate of complication and reoperation was similar between the two stem types. Conclusion For early fixation failures of ITFs, we caution against the use of cementless primary stems due to a trend towards an increased risk of reoperations compared to the use of cementless revision stems. However, in late fixation failures of ITFs, there is a role for cementless primary stems. Level of evidence III, retrospective cohort study. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05223-x.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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17
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De Meo D, Ferraro D, Petriello L, Zucchi B, Calistri A, Persiani P, Villani C. Outcome and technical consideration of conversion total hip arthroplasty after failed fixation of intracapsular and extracapsular hip fractures: Are they really that different? Injury 2022; 53 Suppl 1:S23-S28. [PMID: 32993969 DOI: 10.1016/j.injury.2020.09.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Conversion Total Hip Arthroplasty (cTHA) is a rescue strategy for proximal femur osteosynthesis failures. However, it is unclear whether cTHAs performed for extra-capsular fracture fixation failures (ECF) or for intra-capsular fracture fixation failures (ICF) share the same complexity and efficacy. The purpose of our study was to compare cTHAs performed on pre-existing ICFs and pre-existing ECFs, focusing on surgical complications and functional outcomes in both groups. METHODS An observational retrospective study was conducted on cTHA patients, treated between 2014 and 2018, divided into 2 groups: ICF-group and ECF-group. The main outcomes were: type of implant used, duration of surgery, need for transfusions, incidence of complications, functional outcomes. RESULTS 28 patients were included (15 in the ECF group and 13 in the ICF group); the average follow-up was of 31 ± 17.3 months. No significant differences were identified in terms of the type of implant used and duration of surgery. The number of transfused patients was 4 in the ICF group and 12 in the ECF group (p = 0.02); the average transfused units were 0.4 ± 0.7 in the ICF group and 1.3 ± 0.9 in the ECF group (p = 0.01). The incidence of complications - an infection and a dislocation, both of which occurred in the ICF group - and functional outcomes did not present significant differences. CONCLUSION The conversion surgery on ECFs patients is technically more difficult for the surgeon and prone to greater blood loss. The outcomes are satisfactory and overlap between the two groups.
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Affiliation(s)
- D De Meo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science - Sapienza University of Rome, Department of Orthopaedics and Traumatology - Policlinico Umberto I, Piazzale A. Moro 3 00185, Rome, Italy.
| | - D Ferraro
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science - Sapienza University of Rome, Department of Orthopaedics and Traumatology - Policlinico Umberto I, Piazzale A. Moro 3 00185, Rome, Italy
| | - L Petriello
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science - Sapienza University of Rome, Department of Orthopaedics and Traumatology - Policlinico Umberto I, Piazzale A. Moro 3 00185, Rome, Italy
| | - B Zucchi
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science - Sapienza University of Rome, Department of Orthopaedics and Traumatology - Policlinico Umberto I, Piazzale A. Moro 3 00185, Rome, Italy
| | - A Calistri
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science - Sapienza University of Rome, Department of Orthopaedics and Traumatology - Policlinico Umberto I, Piazzale A. Moro 3 00185, Rome, Italy
| | - P Persiani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science - Sapienza University of Rome, Department of Orthopaedics and Traumatology - Policlinico Umberto I, Piazzale A. Moro 3 00185, Rome, Italy
| | - C Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science - Sapienza University of Rome, Department of Orthopaedics and Traumatology - Policlinico Umberto I, Piazzale A. Moro 3 00185, Rome, Italy
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18
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Colucci SC, Buccoliero C, Sanesi L, Errede M, Colaianni G, Annese T, Khan MP, Zerlotin R, Dicarlo M, Schipani E, Kozloff KM, Grano M. Systemic Administration of Recombinant Irisin Accelerates Fracture Healing in Mice. Int J Mol Sci 2021; 22:ijms221910863. [PMID: 34639200 PMCID: PMC8509717 DOI: 10.3390/ijms221910863] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/25/2022] Open
Abstract
To date, pharmacological strategies designed to accelerate bone fracture healing are lacking. We subjected 8-week-old C57BL/6 male mice to closed, transverse, mid-diaphyseal tibial fractures and treated them with intraperitoneal injection of a vehicle or r-irisin (100 µg/kg/weekly) immediately following fracture for 10 days or 28 days. Histological analysis of the cartilaginous callus at 10 days showed a threefold increase in Collagen Type X (p = 0.0012) and a reduced content of proteoglycans (40%; p = 0.0018). Osteoclast count within the callus showed a 2.4-fold increase compared with untreated mice (p = 0.026), indicating a more advanced stage of endochondral ossification of the callus during the early stage of fracture repair. Further evidence that irisin induced the transition of cartilage callus into bony callus was provided by a twofold reduction in the expression of SOX9 (p = 0.0058) and a 2.2-fold increase in RUNX2 (p = 0.0137). Twenty-eight days post-fracture, microCT analyses showed that total callus volume and bone volume were increased by 68% (p = 0.0003) and 67% (p = 0.0093), respectively, and bone mineral content was 74% higher (p = 0.0012) in irisin-treated mice than in controls. Our findings suggest that irisin promotes bone formation in the bony callus and accelerates the fracture repair process, suggesting a possible use as a novel pharmacologic modulator of fracture healing.
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Affiliation(s)
- Silvia Concetta Colucci
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy; (S.C.C.); (L.S.); (M.E.); (T.A.); (M.D.)
| | - Cinzia Buccoliero
- Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (C.B.); (G.C.); (R.Z.)
| | - Lorenzo Sanesi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy; (S.C.C.); (L.S.); (M.E.); (T.A.); (M.D.)
| | - Mariella Errede
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy; (S.C.C.); (L.S.); (M.E.); (T.A.); (M.D.)
| | - Graziana Colaianni
- Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (C.B.); (G.C.); (R.Z.)
| | - Tiziana Annese
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy; (S.C.C.); (L.S.); (M.E.); (T.A.); (M.D.)
| | - Mohd Parvez Khan
- Departments of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.K.); (E.S.)
| | - Roberta Zerlotin
- Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (C.B.); (G.C.); (R.Z.)
| | - Manuela Dicarlo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy; (S.C.C.); (L.S.); (M.E.); (T.A.); (M.D.)
| | - Ernestina Schipani
- Departments of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.K.); (E.S.)
| | - Kenneth M. Kozloff
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Maria Grano
- Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (C.B.); (G.C.); (R.Z.)
- Correspondence: ; Tel.: +39-080-5478361
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Moon JK, Lee H, Yoon PW, Park KC, Chang JS, Kim JW. Total hip arthroplasty for failed acetabular fracture: a double-center comparative study on failed proximal femur fracture. Eur J Trauma Emerg Surg 2021; 48:2319-2329. [PMID: 34226942 DOI: 10.1007/s00068-021-01744-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to compare the clinical and radiological outcomes of patients who underwent total hip arthroplasty (THA) after failed osteosynthesis of acetabular fractures vs. fractures of the proximal femur. METHODS This is a retrospective comparative study in two centers. A total of 110 patients who underwent THA after osteosynthesis of acetabular or proximal femur fractures were categorized into groups: group 1 (53 patients with acetabular fracture) and group 2 (57 patients with proximal femur fracture). The mean follow-up period was 6.3 (range 2-16.5) years. The Harris hip scores (HHSs), complications, radiological results, and Kaplan-Meier survival curves were evaluated. RESULTS The mean preoperative HHSs of 39.4 (group 1) and 41.2 (group 2) were improved to 83.6 and 84.7 at the final follow-up (p < 0.001 and p < 0.001, respectively). There were two cases of aseptic cup loosening, two cases of septic cup loosening, two cases of deep infection, two cases of dislocation, two cases of sciatic nerve palsy, and one case of periprosthetic fracture in group 1, and one case of dislocation and two cases of infection in group 2, which showed a statistical difference in complication rate (p = 0.021). Total cup migration was significantly higher in group 1 (p = 0.015). After a mean follow-up period of 6.3 years, the survival rate was significantly lower in group 1 (69.4% vs. 97.1%, p = 0.015). CONCLUSION THA following osteosynthesis of acetabular fracture showed poorer survival, higher complication rate, and higher migration of the acetabular cup than THA following osteosynthesis of proximal femur fracture.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu , Seoul, 05505, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu , Seoul, 05505, Republic of Korea
| | - Ki-Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopaedic Surgery, Good Gangan Hospital, Busan, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu , Seoul, 05505, Republic of Korea.
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Jin SY, Jin JY, Kim MG, Kim WJ, Yoon TR, Park KS. Cementless total hip arthroplasty for failed treatment of subtrochanteric fracture. BMC Musculoskelet Disord 2021; 22:384. [PMID: 33894763 PMCID: PMC8070273 DOI: 10.1186/s12891-021-04268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Failed treatment of subtrochanteric fractures commonly leads to pain, limping, and poor limb function. Cementless total hip arthroplasty (THA) could serve as an efficient salvage procedure in such cases. This study aimed to evaluate the outcomes and complications of salvage THA in failed subtrochanteric fracture fixation cases. Methods From January 2001 to December 2017, cementless THA for failed treatment of subtrochanteric fractures was performed in 18 hips of 11 men and 7 women (average age, 74 years; age range, 57.0–89.0 years). Patients were followed up for clinical and radiological assessments in terms of implant survival and complications after a minimum follow-up of 2 years. The Wagner femoral stems (Zimmer, Warsaw, USA) were used in all 18 patients (100%), with the long-length stem (Wagner SL stem) and standard-length stem (Wagner cone stem) used in 11 and 7 patients, respectively. Results The mean follow-up period was 5.2 years (range: 2.2–10.8 years). The mean Harris hip score (HHS) was 38.2 (range: 24–56) preoperatively and 85.4 (range: 79–92) at the last follow-up. The mean postoperative limb length discrepancy was 6.4 mm (range: 4–9 mm). Only one patient underwent revision due to bone in-growth failure of the femoral stem. One patient had an episode of postoperative dislocation and was treated with closed reduction without reoccurrence. Delayed union of the fracture site occurred in one patient. Patients who were previously treated with an intramedullary nail had a significantly shorter surgical duration, lesser intraoperative blood loss, and fewer blood transfusions than those who were previously treated with plate and screws. Kaplan–Meier survival rate with an endpoint of revision was 94.4% (95% confidence interval 72.7–99.9) at 5 years. Conclusion Our results indicate that cementless THA is a beneficial and effective procedure for salvaging the failed treatment of subtrochanteric fractures. The Wagner conical prosthesis has shown satisfactory function outcomes, stable fixation, and survival rate for these complex situations. However, attention should be paid to increased operation time, blood loss, and complications when performing THA for subtrochanteric fractures with failed fixation devices especially, plates and screws.
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Affiliation(s)
- Sheng-Yu Jin
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Jing-Yao Jin
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Min-Gwang Kim
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Woo-Jong Kim
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea.
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21
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Madariaga S, Vargas-Reverón C, Tornero E, Alías A, Capurro B, Combalia A, Fernández-Valencia JÁ, Muñoz-Mahamud E. Outcomes of hip arthroplasty with concomitant hardware removal: influence of the type of implant retrieved and impact of positive intraoperative cultures. Arch Orthop Trauma Surg 2021; 141:333-339. [PMID: 33241448 DOI: 10.1007/s00402-020-03692-0] [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: 06/12/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The impact of residual internal fixation devices on subsequent procedures about the hip has not been clearly well defined. The objective of the current study is to evaluate the outcome of hip arthroplasty after hardware retrieval as a one-stage replacement, to analyze possible differences related to the type of removed implant, and to assess the impact of unexpected intraoperative cultures during implant retrieval. MATERIALS AND METHODS We present a retrospective study including all those cases undergoing hip arthroplasty with concomitant hardware removal (cannulated screws, intramedullary nail, or dynamic hip screw) from 2005 to 2018. We evaluated demographics, intraoperative cultures, early infection rate, and other complications. RESULTS A total of 55 cases were included in the study. The median time between the implant surgery and the hip arthroplasty was 113 days. The removed devices included 6 cannulated screws, 34 intramedullary nails, and 15 dynamic hip screws. Up to 74.5% of the failed osteosynthesis belonged to intertrochanteric femoral fractures. Dislocation rate was 9.1% (1.8% requiring revision surgery), 25.5% of the cases needed further new surgeries after the hip arthroplasty, and 49.1% died during the follow-up period. Any-cause revision surgery and mortality rates were significantly increased after intramedullary nail removal. Intraoperative cultures were performed in 46 cases, and in 9 (16.4%), there was bacterial contamination: 6 cases (10.9%) presented one single positive culture and 3 (5.5%) presented ≥ 2 positive cultures for the same microorganism. A total of five cases (9.1%) presented early prosthetic joint infection that required debridement. None of these five cases had presented positive cultures at the implant removal. CONCLUSION According to our results, hip arthroplasty with concomitant hardware removal is related to a high 5-year mortality rate, mainly when intramedullary nail is retrieved. Whereas a high risk of early prosthetic joint infection is associated, it seems not to be related to the elevated presence of unexpected positive cultures.
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Affiliation(s)
- Salvador Madariaga
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Caribay Vargas-Reverón
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Eduard Tornero
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.,Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Alfonso Alías
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Bruno Capurro
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Andreu Combalia
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.,Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Jenaro Ángel Fernández-Valencia
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.,Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain
| | - Ernesto Muñoz-Mahamud
- Department of Orthopaedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain. .,Bone and Joint Infection Unit, Hospital Clinic of Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.
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Chiou BL, Chen YF, Chen HY, Chen CY, Yeh SCJ, Shi HY. Effect of referral systems on costs and outcomes after hip fracture surgery in Taiwan. Int J Qual Health Care 2020; 32:649-657. [PMID: 32945841 DOI: 10.1093/intqhc/mzaa115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore the economic burdens of hip fracture surgery in patients referred to lower-level medical institutions and to evaluate how referral systems affect costs and outcomes of hip fracture surgery. DESIGN A nationwide population-based retrospective cohort study. SETTING All hospitals in Taiwan. PARTICIPANTS A total of 7500 patients who had received hip fracture surgery (International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes 820.0 ∼ 820.9 and procedure codes 79.15, 79.35, 81.52, 81.53) performed in 1997 to 2013. MAIN OUTCOME MEASURES Total costs including outpatient costs, inpatient costs and total medical costs and medical outcomes including 30-day readmission, 90-day readmission, infection, dislocation, revision and mortality. RESULTS The patients were referred to a lower medical institution after hip fracture surgery (downward referral group) and 3034 patients continued treatment at the same medical institution (non-referral group). Demographic characteristics, clinical characteristics and institutional characteristics were significantly associated with postoperative costs and outcomes (P < 0.05). On average, the annual healthcare cost was New Taiwan Dollars (NT$)2262 per patient lower in the downward referral group compared with the non-referral group. The annual economic burdens of the downward referral group approximated NT$241 million (2019 exchange rate, NT$30.5 = US$1). CONCLUSIONS Postoperative costs and outcomes of hip fracture surgery are related not only to demographic and clinical characteristics, but also to institutional characteristics. The advantages of downward referral after hip fracture surgery can save huge medical costs and provide a useful reference for healthcare authorities when drafting policies for the referral system.
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Affiliation(s)
- Bo-Lin Chiou
- Division of Physical Medicine & Rehabilitation, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Yu-Fu Chen
- Department of Medical Education & Research, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Hong-Yaw Chen
- Superintendent and Division of Gastrointestinal Surgery, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Cheng-Yen Chen
- Division of Orthopedic Surgery, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Business Management, National Sun Yat-sen University, No. 70 Lien-hai Road, Kaohsiung 80424 Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Business Management, National Sun Yat-sen University, No. 70 Lien-hai Road, Kaohsiung 80424 Taiwan.,Deoartment of Medical Research, Kaohsiung Medical University Hospital, No. 100 Tzyou 1st Road, Kaohsiung 80756, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40433, Taiwan
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23
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Yun A, Qutami M, Pasko KBD. Salvage of Failed Femoral Neck Fracture Fixation with Conversion Total Hip Arthroplasty Using the Direct Anterior Approach. Hip Pelvis 2020; 32:199-206. [PMID: 33335868 PMCID: PMC7724028 DOI: 10.5371/hp.2020.32.4.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/03/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Failed femoral neck fracture (FNF) fixation with in situ pinning presents a surgical challenge. Osteoporotic bone, retained hardware, and a typically elderly population magnify the risks of surgery. Here, outcomes of conversion total hip arthroplasty (THA) using two separate incisions in these high-risk patients were examined. Materials and Methods Medical records for 42 patients with a prior history of FNF fixation who underwent conversion THA with hardware removal between 2009 and 2019 were retrospectively reviewed. Surgery was performed by a single surgeon at a single institution. All patients underwent hardware removal followed by direct anterior approach (DAA) THA using two separate incisions. Clinical outcomes, radiographic findings, and perioperative morbidity and mortality are reported. Results Clinically, there were no postoperative dislocations, periprosthetic fractures, or infections at follow-up. After a mean follow-up of 4 years, the mean hip disability and osteoarthritis outcome score, junior (HOOS, Jr) was 91. Radiographically, the mean postoperative cup abduction was 44 degrees and the mean cup anteversion was 21 degrees with an improvement in preoperative leg length discrepancy. Perioperative complications included one case of immediate foot drop and two readmissions for medical issues. One patient died one month after conversion THA. Conclusion Salvage of failed FNF treatment may be managed with conversion THA and DAA with a separate incision for hardware removal. Preservation of posterior soft tissues using a DAA and intraoperative fluoroscopy may mitigate well-known complications related to fracture and dislocation. While favorable clinical outcomes are possible, salvage surgery is still not without substantial surgical and medical risks.
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Affiliation(s)
- Andrew Yun
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Marilena Qutami
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Kory B Dylan Pasko
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, CA, USA
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Liu P, Jin D, Zhang C, Gao Y. Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art. BMC Musculoskelet Disord 2020; 21:573. [PMID: 32828132 PMCID: PMC7443291 DOI: 10.1186/s12891-020-03593-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Failed treatment of intertrochanteric (IT) femoral fractures leads to remarkable disability and pain, and revision surgery is frequently accompanied by higher complication and reoperation rates than primary internal fixation or primary hip arthroplasty. There is an urgent need to establish a profound strategy for the effective surgical management of these fragile patients. Salvage options are determined according to patient physiological age, functional level, life expectancy, nonunion anatomical site, fracture pattern, remaining bone quality, bone stock, and hip joint competency. In physiologically young patients, care should be taken to preserve the vitality of the femoral head with salvage internal fixation; however, for the elderly population, conversion arthroplasty can result in early weight bearing and ambulation and eliminates the risks of delayed fracture healing. Technical challenges include a difficult surgical exposure, removal of broken implants, deformity correction, critical bone defects, poor bone quality, high perioperative fracture risk, and prolonged immobilization. Overall, the salvage of failed internal fixations of IT fractures with properly selected implants and profound techniques can lead to the formulation of valuable surgical strategies and provide patients with satisfactory clinical outcomes.
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Affiliation(s)
- Pei Liu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China
| | - Dongxu Jin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China.
| | - Youshui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Xuhui, Shanghai, 200233, China.
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Favreau H, Ehlinger M, Adam P, Bonnomet F. Total hip arthroplasty with exclusive use of dual-mobility cup after failure of internal fixation in trochanteric fracture. Orthop Traumatol Surg Res 2020; 106:645-649. [PMID: 32409271 DOI: 10.1016/j.otsr.2020.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Failure of internal fixation in trochanteric fracture (or extracapsular proximal femoral fracture: PFF) is a serious complication often requiring total hip arthroplasty (THA). THA after PPF incurs a higher risk of complications than in intracapsular fracture due to frequent impact on local anatomy, notably with risk of implant dislocation. Recent studies demonstrated a protective effect of dual-mobility (DM) cups against instability in these cases but in a population mixing failure of internal fixation in intra- and extracapsular fractures. We therefore conducted a retrospective study focusing on fixation failure in PFF: 1) to assess surgical complications and notably dislocation rate using DM cups, and 2) to analyse the characteristics of the initial fixation and assess conformity with established standards. HYPOTHESIS DM cups exert a protective effect in PFF fixation failure at high risk of instability. MATERIALS AND METHODS A single-centre retrospective study included 40 cases over a 10-year period: 30 women, 10 men; mean age, 77 years [range, 31-91 years]. All THAs used DM cups. Approaches were transgluteal in 24 cases, posterior in 15 and anterolateral in one. Clinical assessment comprised of: pain on visual analog scale (VAS), Harris Hip Score (HSS), and Postel Merle-d'Aubigné score (PMA). The rate of surgical complications (periprosthetic fracture, infection, non-union, dislocation) was assessed and the primary fixation quality was analysed for fracture complexity and conformity to standards. RESULTS At a mean 54 months' follow-up [range, 24-122 months], the post-THA complications rate was 22% (9/40), although with no cases of implant dislocation. Pre- to postoperative comparison found significant improvements on VAS (7.9±1.6 versus 1.35±1.5, respectively), HHS (20±11.8 versus 78±12.3) and PMA (4.7±2.9 versus 14.6±2.1) (p<0.0001), but non-significant change in Parker-Palmer score (5.5±2 and 4.8±1.9) (p=0.4). Fracture instability rate was 77% and 85% (31 and 34/40) on the AO and Evans-Jensen classifications respectively. Analysis of primary fixation found non-conformity with reduction standards in 68% of cases (27/40): most frequently, cervical screw centering defect (58%, 23/40) and reduction defect (28%, 11/40). The non-conformity rate was 44% (4/9) in AO stable fracture and 74% (23/31) in unstable fracture. CONCLUSION The study hypothesis was confirmed, with no dislocations in this high-risk population. This can be attributed to exclusive use of DM cups, which should be systematic in high-risk contexts. The study confirmed the importance of primary fixation quality, although a risk of failure remains, even in stable fractures. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Henri Favreau
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Laboratoire INSERM-UNISTRA UMR 1260, Bâtiment 3, 11, rue Humann 67085, Strasbourg, France.
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, CNRS UMR 7357, 30, boulevard Sébastien-Brant, 67400 Illkirch, France
| | - Philippe Adam
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - François Bonnomet
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
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26
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Ehlinger M, Favreau H, Eichler D, Adam P, Bonnomet F. Early mechanical complications following fixation of proximal femur fractures: From prevention to treatment. Orthop Traumatol Surg Res 2020; 106:S79-S87. [PMID: 31680016 DOI: 10.1016/j.otsr.2019.02.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/02/2023]
Abstract
Proximal femur fractures have significant functional repercussions in both older adults (sometimes life-threatening) and younger adults (socioeconomic). This study will review the early mechanical complications (EMC) associated with the fixation of femoral neck (FNF) and trochanteric (TF) fractures. What is the nature of these complications? They consist of incorrect fracture fixation, secondary displacement and/or fixation failure (FNF: 3-10%; TF: 5-7%), and more rarely, secondary fractures distal to the implant. What are the risk factors and how can they be controlled? They are related to the patient (osteoporosis), to the type of fracture (FNF: posterior comminution, magnitude of displacement, vertical fracture line, fracture of calcar/TF: comminution of calcar, lesser trochanter fracture, metaphyseal comminution, lateral cortex fracture, greater trochanter comminution), to the chosen treatment (FNF: triple screw fixation or screw-plate are preferable/TF: all implants suitable for simple fractures, cervicomedullary implants for complex fractures), and to the surgical technique (quality of reduction, implant positioning). How should they be treated? Early revision of internal fixation can be difficult and increases the infection risk. Inter- or subtrochanteric valgus osteotomy leads to satisfactory results but is difficult to carry out. Secondary arthroplasty, which is the preferred option in older adults, leads to good outcomes but is technically more difficult, and has a higher complication rate in EMC of trochanteric fractures. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, CNRS UMR 7357, 30, boulevard Sébastien-Brant, 67400 Ilkirch, France.
| | - Henri Favreau
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - David Eichler
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Philippe Adam
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Laboratoire ICube, CNRS UMR 7357, 30, boulevard Sébastien-Brant, 67400 Ilkirch, France
| | - François Bonnomet
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
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