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Huang T, Zhang S, Liu X, Lv G, Huang H, Wang S, Zhao M, Xiong M, Yu W, Cheng Q, Huang T. Mid-Term Outcomes of Cemented or Uncemented Total Hip Arthroplasty for Failed Proximal Femoral Nail Antirotation Following Intertrochanteric Femur Fractures: A Retrospective Observational Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221132400. [PMID: 36238963 PMCID: PMC9551333 DOI: 10.1177/21514593221132400] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction The aim of this retrospective study was to assess the clinical outcomes of cemented or uncemented total hip arthroplasty (CTHA or UTHA) following prior failed proximal femoral nail antirotation (PFNA) fixation in patients with intertrochanteric femur fractures (IFFs). Materials and methods Data from 244 patients with IFFs who experienced a conversion of PFNA to CTHA (n = 120) or to UTHA (n = 124) due to screw cut-out, mal/nonunion, or osteonecrosis during 2008-2018 were retrospectively analyzed. Follow-up occurred 1, 3, 6, and 12 months postoperatively and yearly thereafter. The primary outcome was the incidence of orthopedic complications; the secondary outcome was the Harris hip score (HHS). Results The median follow-up was 60 months (range, 50-67 months). The incidences of orthopedic complications were 10% in the PFNA to CTHA group and 19.3% in the PFNA to UTHA group (P = .040). Significant differences were also observed regarding the incidence of prosthesis revision (1.7% for PFNA to CTHA vs 7.2% for PFNA to UTHA, P = .036). From the three years after conversion surgery to the final follow-up, significant differences were detected in HHS between groups (each P < .05). At the final follow-up, a statistically significant difference was detected in the HHS (79.54±18.85 for PFNA to CTHA vs. 75.26±18.27 for PFNA to UTHA, P = .014). Conclusion The results of the study may demonstrate a significant statistical advantage with respect to the orthopedic complication rate and HHS in favor of CTHA compared to UTHA in patients with failed PFNA.
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Affiliation(s)
- Tao Huang
- Department of Orthopaedics, Wuhan
Third Hospital, Tongren
Hospital of Wuhan University, Wuhan,
China
| | - Shi Zhang
- Department of Anesthesiology,
Renmin
Hospital of Wuhan University, Wuhan,
China
| | - Xinhang Liu
- Department of Anesthesiology, East
Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gang Lv
- Department of Anesthesiology,
Renmin
Hospital of Wuhan University, Wuhan,
China
| | - Heng Huang
- Department of Anesthesiology, Wuhan
Fourth Hospital, Puai Hospital, Tongji Medical College,
Huazhong
University of Science and Technology,
Wuhan, China
| | - Shuxin Wang
- Department of Orthopaedics, The
First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan
Hospital, Fudan
University, Shanghai, China
| | - Min Xiong
- Department of Orthopaedics, Jinshan
Hospital, Fudan
University, Shanghai, China
| | - Weiguang Yu
- Department of Orthopaedics, The
First Affiliated Hospital, Sun Yat-sen
University, Guangzhou, China
| | - Qiuxia Cheng
- Department of Obstetrics,
Renmin
Hospital of Wuhan University, Wuhan,
China,Qiuxia Cheng, Department of Obstetrics,
Renmin Hospital of Wuhan University, No. 238, Jiefang Road, Wuchang District,
Wuhan, Hubei, 430060, China.
| | - Ting Huang
- Department of Anesthesiology, East
Hospital, Renmin Hospital of Wuhan University, Wuhan, China,Ting Huang, Department of
Anesthesiology, Renmin Hospital of Wuhan University, No. 238, Jiefang Road,
Wuchang District, Wuhan, Hubei, 430060, China.
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Wang L, Yu M, Zhang Y, Wang S, Zhao M, Yu M, Li S, Gao S, Xiong M, Yu W. Long-term survival of hybrid total hip replacement for prior failed proximal femoral nail antirotation: a retrospective study with a median 10-year follow-up. BMC Musculoskelet Disord 2022; 23:868. [PMID: 36114570 PMCID: PMC9482191 DOI: 10.1186/s12891-022-05827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/14/2022] [Indexed: 11/14/2022] Open
Abstract
Background Hybrid total hip replacement (THR) is commonly used in the management of proximal femur fractures in elderly individuals. However, in the context of the revision, the literature on hybrid THR is limited, and differences in the long-term survival outcomes reported in the literature are obvious. This retrospective study aimed to evaluate the long-term survival of hybrid THR for failed proximal femoral nail antirotation (PFNA) in elderly individuals aged ≥ 75 years. Methods An observational cohort of 227 consecutive individuals aged ≥ 75 years who experienced hybrid THRs following prior primary PFNAs was retrospectively identified from the Joint Surgery Centre, the First Affiliated Hospital, Sun Yat-sen University. Implant survival was estimated using the Kaplan–Meier method. The primary end point was the implant survivorship calculated using the Kaplan–Meier method with revision for any reason as the end point; secondary end points were the function score measured using the modified Harris Hip Score (mHHS) and the incidence of main orthopaedic complications. Results In total, 118 individuals (118 THRs) were assessed as available. The median follow-up was 10 (3–11) years. The 10-year survivorship with revision for any reason as the endpoint was 0.914 (95% confidence interval [CI], 0.843–0.960). The most common indication for revision was aseptic loosening (70.0%), followed by periprosthetic fracture (30.0%). At the final follow-up, the median functional score was 83.6 (79.0–94.0). Among the 118 patients included in this study, 16 experienced 26 implant-related complications. The overall incidence of key orthopaedic complications was 13.5% (16/118). Conclusion For patients aged ≥ 75 years old with prior failed PFNAs, hybrid THR may yield satisfactory long-term survival, with good functional outcomes and a low rate of key orthopaedic complications.
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Raja BS, Gowda AK, Singh S, Ansari S, Kalia RB, Paul S. Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis. J Clin Orthop Trauma 2022; 29:101876. [PMID: 35515344 PMCID: PMC9062326 DOI: 10.1016/j.jcot.2022.101876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. MATERIAL AND METHODS The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. RESULTS A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. CONCLUSION Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya K.S. Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India,Corresponding author.
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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