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Davies A, Sabharwal S, Liddle AD, Zamora Talaya MB, Rangan A, Reilly P. Revision rate in metal compared to ceramic humeral head total shoulder arthroplasty and hemiarthroplasty. Bone Joint J 2024; 106-B:482-491. [PMID: 38688478 DOI: 10.1302/0301-620x.106b5.bjj-2023-1093.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Metal and ceramic humeral head bearing surfaces are available choices in anatomical shoulder arthroplasties. Wear studies have shown superior performance of ceramic heads, however comparison of clinical outcomes according to bearing surface in total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) is limited. This study aimed to compare the rates of revision and reoperation following metal and ceramic humeral head TSA and HA using data from the National Joint Registry (NJR), which collects data from England, Wales, Northern Ireland, Isle of Man and the States of Guernsey. Methods NJR shoulder arthroplasty records were linked to Hospital Episode Statistics and the National Mortality Register. TSA and HA performed for osteoarthritis (OA) in patients with an intact rotator cuff were included. Metal and ceramic humeral head prostheses were matched within separate TSA and HA groups using propensity scores based on 12 and 11 characteristics, respectively. The primary outcome was time to first revision and the secondary outcome was non-revision reoperation. Results A total of 4,799 TSAs (3,578 metal, 1,221 ceramic) and 1,363 HAs (1,020 metal, 343 ceramic) were included. The rate of revision was higher for metal compared with ceramic TSA, hazard ratio (HR) 3.31 (95% confidence interval (CI) 1.67 to 6.58). At eight years, prosthesis survival for ceramic TSA was 98.7% (95% CI 97.3 to 99.4) compared with 96.4% (95% CI 95.2 to 97.3) for metal TSA. The majority of revision TSAs were for cuff insufficiency or instability/dislocation. There was no significant difference in the revision rate for ceramic compared with metal head HA (HR 1.33 (95% CI 0.76 to 2.34)). For ceramic HA, eight-year prosthetic survival was 92.8% (95% CI 86.9 to 96.1), compared with 91.6% (95% CI 89.3 to 93.5) for metal HA. The majority of revision HAs were for cuff failure. Conclusion The rate of all-cause revision was higher following metal compared with ceramic humeral head TSA in patients with OA and an intact rotator cuff. There was no difference in the revision rate for HA according to bearing surface.
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Affiliation(s)
- Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Sanjeeve Sabharwal
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Alexander D Liddle
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Amar Rangan
- Department of Health Sciences, University of York, York, UK
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, London, UK
- Department of Trauma & Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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Macheras GA, Pallis D, Tsivelekas K, Ampadiotaki MM, Lepetsos P, Tzefronis D, Kateros K, Papadakis SA. Acetabular erosion after bipolar hip hemiarthroplasty for femoral neck fracture in elderly patients: a retrospective study. Hip Int 2024; 34:402-408. [PMID: 37932231 DOI: 10.1177/11207000231208666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND The choice between total hip arthroplasty (THA) and hemiarthroplasty (HA) to treat displaced femoral neck fractures, particularly among the elderly, is still controversial. Acetabular erosion consists of a late multifactorial process that may happen after hip HA resulting in significant postoperative burden. This study aims to investigate the impact of acetabular erosion progress after hip HA in patients over 70 years old. MATERIALS AND METHODS This is a 5-year (2013-2018) retrospective study including consecutive series of patients >70 years who were treated with bipolar hip HA for femoral neck fractures. Patients were categorised into 3 groups for analysis (A = 70-75 years, B = 75-80 years, C = >80 years). The study enrolled a total number of 813 patients who met the inclusion criteria. We assessed acetabular erosion through radiological examinations and measured functional deterioration using the modified Harris Hip Score (mHHS) at 6 and 12 months follow-up. Our comprehensive investigation extended over a maximum period of 5 years. The correlation of patients' characteristics and HA features on erosion progress was assessed. RESULTS There were no significant differences in sex distribution, injury side, BMI, ASA score, bipolar head diameter, mHHS and leg-length discrepancy among the groups (p > 0.05). During the follow-up period, acetabular erosion with consequential conversion to THA was observed in 6.13%, 4.22% and 1.96% for Groups A, B and C respectively (p = 0.009). A statistically significant difference of acetabular erosion was observed in Group A compared to patients of Group C. CONCLUSIONS Age constitutes a significant factor of acetabular wear after HA in the elderly. The higher rate of acetabular wear in patients <75 years suggests that THA is a more viable option, as HA is for patients >80 years old.
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Zhou X, Chen T, Jiang YL, Chen DB, Tian ZY. Comparison of the clinical outcomes between proximal femoral nail anti-rotation with cement enhancement and hemiarthroplasty among elderly osteoporotic patients with intertrochanteric fracture. BMC Musculoskelet Disord 2024; 25:290. [PMID: 38622692 PMCID: PMC11017484 DOI: 10.1186/s12891-024-07414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The proximal femoral nail anti-rotation (PFNA) with cement enhancement enhances the anchorage ability of internal fixation in elderly with osteoporotic intertrochanteric fracture. However, whether it is superior to hemiarthroplasty is still controversial. The present study aimed to determine which treatment has better clinical outcomes among older patients. METHODS We retrospectively analyzed 102 elderly patients with osteoporosis who developed intertrochanteric fractures and underwent PFNA combined with cement-enhanced internal fixation (n = 52, CE group), and hemiarthroplasty (n = 50, HA group) from September 2012 to October 2018. All the intertrochanteric fractures were classified according to the AO/OTA classification. Additionally, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion rates, postoperative weight-bearing time, hospitalization time, Barthel Index of Activities Daily Living, Harris score of hip function, visual analog (VAS) pain score, and postoperative complications were compared between the two groups. RESULTS The CE group had significantly shorter operative time, lesser intraoperative blood loss, lower blood transfusion rate, and longer postoperative weight-bearing time than the HA group. The CE group had lower Barthel's Index of Activities of Daily Living, lower Harris' score, and higher VAS scores in the first and third months after surgery than the HA group, but no difference was observed between the two groups from 6 months to 12 months. There was no significant difference in the total post-operative complications between the two groups. CONCLUSION The use of PFNA combined with a cement-enhanced internal fixation technique led to shorter operative time and lesser intraoperative blood loss and trauma in elderly patients as compared to HA.
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Affiliation(s)
- Xiang Zhou
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Tao Chen
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Yu-Lin Jiang
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - De-Bin Chen
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China
| | - Zhi-Yong Tian
- Department of Articular and Traumatic Orthopedic Surgery, the Fourth People's Hospital of Guiyang, 91# Jiefang west Road, Guiyang, 550001, China.
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Ramadanov N, Voss M, Hable R, Prill R, Hakam HT, Salzmann M, Dimitrov D, Becker R. Patient-related Predictors for the Functional Outcome of SuperPATH Hemiarthroplasty versus Conventional Approach Hemiarthroplasty: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials. Orthop Surg 2024; 16:791-801. [PMID: 38298174 PMCID: PMC10984811 DOI: 10.1111/os.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Specialist literature lacks evidence that explores associations between patient characteristics and the beneficial treatment effect of SuperPATH hemiarthroplasty (HA) compared with conventional approach (CA) HA. To investigate and identify patient-related predictors of the effect size of the short-term functional outcome of SuperPATH HA and CA HA by performing a systematic review and meta-regression analysis of randomized controlled trials (RCTs). A systematic search of literature was performed in PubMed, CNKI, CENTRAL of The Cochrane Library, Clinical trials, and Google Scholar until August 25, 2023. For the continuous outcome parameter Harris hip score (HHS) ≤1 week and 3 months postoperatively, mean differences (MDs) with 95% confidence intervals (CIs) were calculated. A meta-regression analysis was based on random-effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method for continuous covariates. A total of five RCTs with 404 patients were found. The following predictors of HHS ≤1 week postoperatively were identified: patient age (predictor estimate = 1.29; p < 0.01), patient age groups (predictor estimate = 14.07; p < 0.01), time to mobilization (predictor estimate = 5.51; p < 0.01). The following predictors of HHS 3 months postoperatively were identified: incision length (predictor estimate = -2.12; p < 0.01); intraoperative blood loss (predictor estimate = 0.02; p < 0.01). Patient age, time to mobilization, incision length, and intraoperative blood loss were identified as predictors of the effect size of early postoperative functional outcome as measured by HHS. Elderly patients, particularly those over 70 years of age, appear to benefit from SuperPATH HA. Based on these findings, and taking into account our limitations, we recommend that the use of minimally invasive SuperPATH HA in elderly patients should be more widely considered and not limited to elective THA patients.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Maximilian Voss
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Robert Hable
- Faculty of Applied Computer ScienceDeggendorf Institute of TechnologyDeggendorfGermany
| | - Robert Prill
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Hassan Tarek Hakam
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Mikhail Salzmann
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics, Faculty of MedicineMedical University of PlevenPlevenBulgaria
| | - Roland Becker
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
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Ammori MB, Soogumbur A, Sykes D, Francis N, Law E, Marshall P. Replacing hip precautions after hemiarthroplasty with a pose avoidance protocol. Injury 2024; 55:111340. [PMID: 38301490 DOI: 10.1016/j.injury.2024.111340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/10/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
AIMS After hip arthroplasty surgery, hip precautions are often implemented to minimise the risk of dislocation, although existing evidence does not support their effectiveness. At our institution, we replaced post-operative precautions with a novel pose avoidance protocol in patients undergoing hip hemiarthroplasty for neck of femur fracture. The objectives of our study were to validate this new protocol by assessing the incidence of dislocation before and after its introduction and evaluating its impact on the length of hospital stay. METHODS Between 20th September 2021 and 19th March 2023, 200 patients underwent 203 hip hemiarthroplasties. Hip precautions were replaced with the new pose avoidance protocol on 20th June 2022. Data were retrospectively collected and included patient demographics, Abbreviated Mental Test Score, American Society of Anaesthesiologists grade, surgical approach, prosthesis, dislocation, and mortality. RESULTS The incidence of dislocation within 90 days after hip hemiarthroplasty decreased from seven out of 98 cases (7.1%) before 20th June 2022 to one out of 105 cases (1.0%), p-value 0.030. However, there was no significant difference in the length of stay, with a median (interquartile range) of 19 (10 - 29) days before 20th June 2022, and 16 (11 - 22) days thereafter, p-value 0.242. A multivariate logistic regression confirmed the pose avoidance protocol and the anterolateral approach to be independent negative predictors of dislocation, p-value 0.030 (Odds Ratio [OR] 0.077) and p-value 0.005 (OR 0.022), respectively. CONCLUSIONS Hip precautions are unnecessary and potentially detrimental to patient outcomes following hemiarthroplasty. Replacing these precautions with our new pose avoidance protocol may have led to a significant reduction in dislocation rates and saved on the cost of adaptive equipment. We advocate for the anterolateral over the posterior approach in hip hemiarthroplasty to further mitigate the risk of dislocation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mohannad Basil Ammori
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP.
| | - Akash Soogumbur
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - David Sykes
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - Niamh Francis
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - Elizabeth Law
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
| | - Paul Marshall
- Department of Trauma & Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP
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Hasler A, Ker A, Grubhofer F, El Nashar R, Ernstbrunner L, Gerber C, Wieser K. Clinical and radiographic long-term outcomes of hemiarthroplasty for complex proximal humeral fractures. J Shoulder Elbow Surg 2024; 33:698-706. [PMID: 37611843 DOI: 10.1016/j.jse.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Hemiarthroplasty (HA) is a treatment option for complex proximal humeral fractures not suitable for conservative treatment or open reduction-internal fixation. Long-term outcomes using a large-metaphyseal volume prosthesis in the management of proximal humeral fractures have not been reported thus far. METHODS Between 2006 and 2010, 41 patients with proximal humeral fractures were treated with HA at our institution (average age, 62 years; age range, 38-85 years). Nine patients underwent revision surgery, 3 were lost to follow-up, and 7 died unrelated to the index surgical procedure. Twenty-two patients were reviewed clinically and radiographically after a mean period of 10.4 years (range, 9-13 years). RESULTS Of the 9 HA failures, 7 occurred within the first 2 postoperative years: 2 patients had infections and 5 had greater tuberosity nonunions or malunions. The other 2 patients underwent revision for rotator cuff deficiency >5 years after initial surgery. Among the patients available for final follow-up, the implant survival rate was 71% (22 of 31 patients). At final follow-up, these patients showed a mean relative Constant score of 76% (range, 49%-96%), mean active elevation of 116° (range, 60°-170°), and mean external rotation of 28° (range, 0°-55°). The majority had good or excellent internal rotation, with internal rotation to the 12th thoracic vertebra in 13 patients (59%) and to the eighth thoracic vertebra in 7 (31%). The mean Subjective Shoulder Value was 76% (range, 40%-100%). Clinical outcomes did not significantly deteriorate over a period of 10 years, except for flexion (P < .001) and internal rotation (P = .002). On analysis of greater tuberosity healing, 1 patient had a nonunion and 10 patients (45%) had a malunion, whereas the greater tuberosity had healed in an anatomic position in 12 patients (55%). Patients with a displaced malunion of the greater tuberosity did not have inferior clinical results at last follow-up. Only 2 patients showed glenoid erosion, and in no patients could stem loosening be identified at final follow-up. CONCLUSION The revision rate following large-metaphyseal volume HA to treat a proximal humeral fracture was 29% after 10 years postoperatively, with failure within 2 years largely related to greater tuberosity nonunion or malunion and failure later related to rotator cuff insufficiency. Patients with a retained implant showed good clinical and radiographic long-term results, without relevant deterioration over time even when the greater tuberosity healed in a nonanatomic position.
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Affiliation(s)
- Anita Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrew Ker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Florian Grubhofer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rany El Nashar
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Yamamoto S, Takegami Y, Tokutake K, Nakashima R, Naito K, Ogura K, Kato D, Imagama S. Effect of anaesthesia on cemented hemiarthroplasty -A multicentre retrospective study (TRON study). J Orthop Sci 2024; 29:585-588. [PMID: 36822946 DOI: 10.1016/j.jos.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION This study aimed to investigate the survival rate, postoperative complications, and walking ability in cemented hemiarthroplasty (HA) for displaced femoral neck fractures according to the anaesthesia method. METHODS We conducted a retrospective study of a multicentre group (the TRON group). Three hundred fifty-eight patients who underwent cemented HA between 2015 and 2019 were selected; 289 patients of ≥75 years of age with no missing data were included. Patient background factors were matched and patients were assigned to spinal anaesthesia (SA) and general anaesthesia (GA) groups. The primary outcome was death at any time during the follow-up period. Secondary outcomes included postoperative complications and walking ability assessed using the Parker mobility score (PMS). Overall survival was evaluated using the Kaplan-Meier method, and differences were compared using the log-rank test. The incidence of each complication and PMS were compared between the two groups using Fisher's exact test. RESULTS Overall survival during follow-up was significantly higher in the SA group in comparison to the GA group (p = 0.037). In the SA and GA groups, the survival rate at 3 months postoperatively was 98.4% and 95.5%, respectively. The incidence of postoperative pneumonia was significantly higher in the GA (p = 0.012), and PMS at 3 months postoperatively was significantly higher in the SA group (p = 0.016). CONCLUSION The survival rate of elderly patients who underwent cemented HA was better in the SA group. General anaesthesia in cemented HA may be associated with lower life expectancy, increased incidence of pneumonia, and decreased walking ability.
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Affiliation(s)
- Shigeto Yamamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Naito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Ogura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daizo Kato
- Department of Orhopedic Surgery, Okazaki City Hospital, Okazaki, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Olesen BA, Närhi SF, Jensen TG, Overgaard S, Palm H, Sørensen MS. Incidence of dislocation and associated risk factors in patients with a femoral neck fracture operated with an uncemented hemiarthroplasty. BMC Musculoskelet Disord 2024; 25:119. [PMID: 38336702 PMCID: PMC10854108 DOI: 10.1186/s12891-024-07237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Several factors might be associated with risk of dislocating following uncemented hemiarthroplasty (HA) due to femoral neck fracture (FNF). Current evidence is limited with great variance in reported incidence of dislocation (1-15%). Aim of this study was to identify the cumulative incidence of first-time dislocation following HA and to identify the associated risk factors. METHOD We performed a retrospective cohort study of patients receiving an HA (BFX Biomet stem, posterior approach) at Copenhagen University Hospital, Bispebjerg, in 2010-2016. Patients were followed until death or end of study (dec 2018). Dislocation was identified by code extraction from the Danish National Patient Registry. Variables included in the multivariate model were defined pre-analysis to include: age, sex and variables with a p-value < 0.1 in univariate analysis. A regression model was fitted for 90 days dislocation as the assumption of proportional hazard rate (HR) was not met here after. RESULTS We identified 772 stems (some patients occurred with both right and left hip) and 58 stems suffered 90 dislocations during the observation period, resulting in a 7% (CI 5-9) incidence of dislocation 90 days after index surgery. 55 of the 58 stems (95%) experienced the first dislocation within 90 days after surgery. Only absence of dementia was identified as an independent protective factor in the cause-specific model (HR 0.46 (CI 0.23-0.89)) resulting in a 2.4-fold cumulative risk of experiencing a dislocation in case of dementia. Several other variables such as age, sex, various medical conditions, surgery delay and surgical experience were eliminated as statistical risk factors. We found a decrease in survival probability for patients who experienced a dislocation during follow-up. CONCLUSIONS The incidence of first-time dislocation of HA (BFX Biomet stem, posterior approach) in patients with a hip fracture is found to be 7% 90 days after surgery. Due to the non-existing attribution bias, we claim it to be the true incidence. Dementia was among several variables identified as the only risk factor for dislocation. In perspective, we may consider treating patients with dementia by other methods than HA e.g., HA with cement or with a more constrained solution. Also, a surgical approach that reduce the risk of dislocation should be considered.
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Affiliation(s)
- Britt Aaen Olesen
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Staircase 6, 2. Floor, Copenhagen, NV, 2400, Denmark.
| | - Susanne Faurholt Närhi
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Staircase 6, 2. Floor, Copenhagen, NV, 2400, Denmark
| | - Thomas Giver Jensen
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Staircase 6, 2. Floor, Copenhagen, NV, 2400, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Staircase 6, 2. Floor, Copenhagen, NV, 2400, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Staircase 6, 2. Floor, Copenhagen, NV, 2400, Denmark
| | - Michala Skovlund Sørensen
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Staircase 6, 2. Floor, Copenhagen, NV, 2400, Denmark
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Jonsson EÖ, Ekholm C, Hallgren HB, Nestorson J, Etzner M, Adolfsson L. Elbow hemiarthroplasty and total elbow arthroplasty provided a similar functional outcome for unreconstructable distal humeral fractures in patients aged 60 years or older: a multicenter randomized controlled trial. J Shoulder Elbow Surg 2024; 33:343-355. [PMID: 37778655 DOI: 10.1016/j.jse.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/11/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Semiconstrained total elbow arthroplasty (TEA) is an established treatment for elderly patients with distal humeral fractures not amenable to stable internal fixation (unreconstructable). In recent years, there has been increasing interest in elbow hemiarthroplasty (EHA), a treatment option which does not entail restrictions on weight-bearing as opposed to TEA. These 2 treatments have not been compared in a randomized controlled trial (RCT). The aim of this study was to compare the functional outcome of EHA and TEA for the treatment of unreconstructable distal humeral fractures in elderly patients. MATERIAL AND METHODS This was a multicenter randomized controlled trial (RCT). Patients were included between January 2011 and November 2019 at one of 3 participating hospitals. The inclusion criteria were an unreconstructable distal humeral fracture, age ≥60 years and independent living. The final follow-up took place after ≥2 years. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Secondary outcome measures were the Mayo Elbow Performance Score (MEPS), the EQ-5D index, range of motion (flexion, extension, pronation, and supination) and grip strength. RESULTS Forty patients were randomized to TEA (n = 20) and EHA (n = 20). Five patients died before completing the final follow-up, leaving 18 EHA and 17 TEA patients for analysis. There were 31 women. The mean age was 74.0 (SD, 8.5) years in the EHA group and 76.9 (SD, 7.6) in the TEA group (P = .30). The mean DASH score was 21.6 points in the EHA group and 27.2 in the TEA group (P = .39), a difference of -5.6 points (95% CI: -18.6 to 7.5). There were no differences between treatment with EHA and TEA for the mean values of the MEPS (85.0 vs. 88.2, P = .59), EQ-5D index (0.92 vs. 0.86, P = .13), extension (29° vs. 29°, P = .98), flexion (126° vs. 136°, P = .05), arc of flexion-extension (97° vs. 107°, P = .25), supination (81° vs. 75°, P = .13), pronation (78° vs. 74°, P = .16) or grip strength (17.5 kg vs. 17.2 kg, P = .89). There were 6 adverse events in each treatment group. CONCLUSION In this RCT, both elbow hemiarthroplasty (EHA) and total elbow arthroplasty (TEA) resulted in a good and similar functional outcome for unreconstructable distal humeral fractures in elderly patients at a minimum of 2 years of follow-up.
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Affiliation(s)
- Eythor Ö Jonsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Carl Ekholm
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Hanna Björnsson Hallgren
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jens Nestorson
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Lars Adolfsson
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Orthopaedics, Örebro University, Örebro, Sweden
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10
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Okike K, Prentice HA, Chan PH, Fasig BH, Paxton EW, Bernstein J, Ahn J, Chen F. Unipolar Hemiarthroplasty, Bipolar Hemiarthroplasty, or Total Hip Arthroplasty for Hip Fracture in Older Individuals. J Bone Joint Surg Am 2024; 106:120-128. [PMID: 37973035 DOI: 10.2106/jbjs.23.00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Practice patterns regarding the use of unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (THA) for femoral neck fractures in older patients vary widely. This is due in part to limited data stipulating the specific circumstances under which each form of arthroplasty provides the most predictable outcome. The purpose of this study was to investigate the patient characteristics for which unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA might be preferable due to a lower risk of all-cause revision. METHODS A U.S. health-care system's hip fracture registry was used to identify patients ≥60 years old who underwent unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA for hip fracture from 2009 through 2021. Unipolar and bipolar hemiarthroplasty were compared with THA within patient subgroups defined by age (60 to 79 versus ≥80 years) and American Society of Anesthesiologists (ASA) classification (I or II versus III); patients with an ASA classification of IV or higher were excluded. Multivariable Cox proportional hazard regression analysis was used to evaluate all-cause revision risk while adjusting for confounders, with mortality considered as a competing risk. RESULTS There were 14,277 patients in the final sample (median age, 82 years; 70% female; 80% White; 69% with an ASA classification of III; median follow-up, 2.7 years), and the procedures included 7,587 unipolar hemiarthroplasties, 5,479 bipolar hemiarthroplasties, and 1,211 THAs. In the multivariable analysis of all patients, both unipolar (hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.48 to 3.12; p < 0.001) and bipolar (HR = 1.92, 95% CI = 1.31 to 2.80; p < 0.001) hemiarthroplasty had higher revision risks than THA. In the age-stratified multivariable analysis of patients aged 60 to 79 years, both unipolar (HR = 2.17, 95% CI = 1.42 to 3.34; p = 0.004) and bipolar (HR = 1.69, 95% CI = 1.08 to 2.65; p = 0.022) hemiarthroplasty also had higher revision risks than THA. In the ASA-stratified multivariable analysis, patients with an ASA classification of I or II had a higher revision risk after either unipolar (HR = 3.52, 95% CI = 1.87 to 6.64; p < 0.001) or bipolar (HR = 2.31, 95% CI = 1.19 to 4.49; p = 0.013) hemiarthroplasty than after THA. No difference in revision risk between either of the hemiarthroplasties and THA was observed among patients with an age of ≥80 years or those with an ASA classification of III. CONCLUSIONS In this study of hip fractures in older patients, THA was associated with a lower risk of all-cause revision compared with unipolar and bipolar hemiarthroplasty among patients who were 60 to 79 years old and those who had an ASA classification of I or II. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kanu Okike
- Department of Orthopaedic Surgery, Hawaii Permanente Medical Group, Honolulu, Hawaii
| | - Heather A Prentice
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Priscilla H Chan
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Brian H Fasig
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Joseph Bernstein
- Department of Orthopaedic Surgery, Philadelphia Veterans Hospital, Philadelphia, Pennsylvania
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Foster Chen
- Department of Orthopaedic Surgery, Washington Permanente Medical Group P.C., Seattle, Washington
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11
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Song IS, Choi HD. The long-term results of shoulder hemiarthroplasty in irreducible four-part fracture-dislocation of the proximal humerus without rotator cuff tear arthropathy. Eur J Orthop Surg Traumatol 2024; 34:311-317. [PMID: 37490066 DOI: 10.1007/s00590-023-03604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Although there are concerns about nonunion of the greater tuberosity or shoulder weakness, hemishoulder arthroplasty (HSA) is a viable treatment option for irreducible four-part proximal humerus fractures-dislocation without rotator cuff tear arthropathy. This study aims to analyze the long-term radiological and functional outcomes of HSA. METHODS This study enrolled 36 patients who underwent HSA due to irreducible four-part proximal humerus fracture-dislocation without rotator cuff tear arthropathy between March 2005 and May 2020. The exclusion group included 10 reverse total shoulder arthroplasty patients. The mean age and mean follow-up period were 68.6 years old and 48.6 months, respectively. Radiological assessments, such as vertical and horizontal greater tuberosity position, greater tuberosity healing, and implant position, were evaluated. Clinically, American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion were evaluated. RESULTS The greater tuberosity union rate was 55.6% (n = 20), with 44.4% (n = 16) experiencing nonunion, malunion, and bone resorption. The mean vertical and horizontal greater tuberosity positions showed significant difference at last follow-up compared to immediate postoperation. The retroversion of the implant was 23.8 ± 4.61°, and the acromio-humeral interval was 7.6 ± 1.34 mm. The mean last follow-up ASES and CMS were 39.5 ± 4.03 and 55.4 ± 10.41, respectively. The mean active forward flexion, abduction, internal rotation, and external rotation were 100.9 ± 15.04°, 92.5 ± 14.47°, 44.2 ± 12.83°, and 42.5 ± 15.32°, respectively. CONCLUSION In long-term follow-up, the greater tuberosity was superiorly migrated and externally rotated. Active forward flexion and abduction in the last follow-up were significantly limited. However, in terms of pain relief, a satisfactory result was seen.
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Affiliation(s)
- In-Soo Song
- Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea.
- Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Hyun Duck Choi
- Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea
- University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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12
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Ramadanov N, Jóźwiak K, Marinova-Kichikova P, Lazaru P, Dimitrov D. Hemiarthroplasty through SuperPATH versus hemiarthroplasty through conventional approaches in patients with femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2023; 13:22861. [PMID: 38129648 PMCID: PMC10739891 DOI: 10.1038/s41598-023-50206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
The aim was to conduct a systematic review of literature and meta-analysis of randomized controlled trials (RCTs) comparing short-term outcomes of bipolar hemiarthroplasty (HA) through SuperPATH and bipolar HA through conventional approaches (CAs) in patients with femoral neck fractures. The following PICO question was formulated: In human participants with femoral neck fractures, are the short-term outcomes of SuperPATH HA better than the short-term outcomes of CAs HA? The following databases were searched until 25 August 2023: PubMed, CNKI, CENTRAL of The Cochrane Library, Clinical trials, and Google Scholar. Quality assessment of the RCTs was performed, according to the Cochrane's Risk of Bias 2 tool and the recommendations of the GRADE system. Furthermore, we evaluated publication bias with funnel plots. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous variables using the Hartung-Knapp-Sidik-Jonkman method and a random effects model. Nine RCTs with overall 762 patients were included in this meta-analysis. All 9 RCTs were rated with a moderate risk of bias. The quality of evidence of the outcome parameters was rated moderate to very low. The funnel plots were overall broadly symmetrical, possibly indicating low to moderate publication bias. SuperPATH had a longer operation time compared to CAs (MD = 21.79, 95% CI 12.57 to 31.02). SuperPATH decreased incision length (MD = - 4.50; 95% CI - 5.80 to - 3.20), intraoperative blood loss (MD = - 103.96, 95% CI - 150.27 to - 55.66), postoperative drainage volume (MD = - 137.30, 95% CI - 178.74 to - 95.86), time to mobilization (MD = - 3.86; 95% CI - 5.96 to - 1.76), pain VAS ≤ 1 week postoperatively (MD = - 1.81; 95% CI - 2.17 to - 1.45), and hospitalization time (MD = - 4.05; 95% CI - 4.96 to - 3.15). SuperPATH improved HHS ≤ 1 week postoperatively (MD = 11.10; 95% CI 1.65 to 20.54) and HHS 3 months postoperatively (MD = 6.33; 95% CI 3.97 to 8.69). There was no difference in pain VAS 1-3 months postoperatively (MD = - 0.08; 95% CI - 0.22 to 0.05) and HHS 6 months postoperatively (MD = 0.44; 95% CI - 0.11 to 1.00). This is the first meta-analysis comparing SuperPATH HA with CAs HA in patients with femoral neck fractures. SuperPATH HA was superior in the early short-term functional outcome (HHS) compared to CAs HA, reaching minimal clinically important differences. Furthermore, SuperPATH HA showed significantly better results in incision length, blood loss, time to mobilization, pain intensity (VAS), and hospitalization time than CAs HA.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg an der Havel, Neuruppin, Germany.
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Polina Marinova-Kichikova
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Philip Lazaru
- General and Visceral Surgery, Minimally Invasive Surgery and Coloproctology, St. Marien Hospital, Berlin, Germany
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
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13
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Xu Z, Zhang K, Cheng K, Sun G, Zhang Y, Jia J. A meta-analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures. Int Wound J 2023; 20:4122-4129. [PMID: 37555547 PMCID: PMC10681411 DOI: 10.1111/iwj.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023] Open
Abstract
To providing evidence-based recommendations for surgery in patients with femoral neck fractures, a meta-analysis was conducted to comprehensively evaluate the effects of cemented and uncemented prostheses on postoperative surgical site wound infection and pain in these patients. Relevant studies on the use of cemented prostheses in femoral neck fractures were retrieved from PubMed, EMBASE, Cochrane Library, Ovid, CNKI, and Wanfang databases from the time of their establishment until March 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Review Manager 5.4 software was used to perform meta-analyses on the collected data. A total of 27 articles comprising 34 210 patients (24 646 cases in the cemented group and 9564 cases in the uncemented group) were included in the final analysis. The results of the meta-analysis showed that, compared with the uncemented group, cemented prostheses significantly reduced the incidence of surgical site wound infections (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.64-0.88, p < 0.001) and relieved surgical site wound pain (standardised mean difference: -0.76, 95% CI: -1.12-0.40, p < 0.001), but did not reduce the incidence of pressure ulcers after surgery (OR: 0.50, 95% CI: 0.20-1.26, p = 0.140). Therefore, existing evidence suggests that the use of cemented prostheses in femoral neck fracture surgery can significantly reduce the incidence of surgical site wound infections and relieve surgical site wound pain, which is worthy of clinical recommendation.
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Affiliation(s)
- Ze Xu
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Ke Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Kai Cheng
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Guangwei Sun
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Yaning Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Jian Jia
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
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14
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Turhan S, Canbek U, Dubektas-Canbek T, Dogu E. Predicting Prolonged Wound Drainage after Hemiarthroplasty for Hip Fractures: A Stacked Machine Learning Study. Clin Orthop Surg 2023; 15:894-901. [PMID: 38045590 PMCID: PMC10689231 DOI: 10.4055/cios22181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2023] Open
Abstract
Background Prolonged wound drainage (PWD) is one of the most important reasons that increase the risk of early periprosthetic joint infection after arthroplasty. It is very important to evaluate the risk factors for PWD in the surgical field after arthroplasty surgery. This can be accomplished using machine learning or artificial intelligence methods. Our aim in this study was to compare machine learning methods in predicting possible PWD. Methods The study was carried out on clinical, laboratory, and radiological data of 313 patients who underwent hemiarthroplasty (HA) for proximal femur fractures. We preprocessed the dataset and trained and tested machine learning methods using cross validation. We compared various machine learning algorithms (linear discriminant analysis, decision tree, k-nearest neighbors, gradient boosting machine, and logistic regression [LR]) based on performance measures. We also combined the most successful algorithms with a metaclassifier. To help understand the relationship between risk factors, we provided a risk factor severity ranking. Results To estimate the risk of PWD, classification was performed with first-level classifiers and then integrated as a LR-based meta-learner stacking method. More performance improvements were achieved with the stacking method. Conclusions We found that the stacking method was superior to other methods in PWD classification. We determined that the volume of fluid collected from the drain, morbid obesity class, blood transfusion, and body mass index score were the four most important risk factors according to stacking.
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Affiliation(s)
- Sultan Turhan
- Department of Statistics, Mugla Sitki Kocman University, Mugla, Türkiye
| | - Umut Canbek
- Department of Orthopedics and Traumatology, Mugla Sitki Kocman University College of Medicine, Mugla, Türkiye
| | - Tugba Dubektas-Canbek
- Department of Internal Medicine, Mugla Sitki Kocman University College of Medicine, Mugla, Türkiye
| | - Eralp Dogu
- Department of Statistics, Mugla Sitki Kocman University, Mugla, Türkiye
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15
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Lu X, Gou W, Wu S, Wang Y, Wang Z, Xiong Y. Complication Rates and Survival of Nonagenarians after Hip Hemiarthroplasty versus Proximal Femoral Nail Antirotation for Intertrochanteric Fractures: A 15-Year Retrospective Cohort Study of 113 Cases. Orthop Surg 2023; 15:3231-3242. [PMID: 37880497 PMCID: PMC10694023 DOI: 10.1111/os.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Intertrochanteric fracture is a very common but serious type of hip fracture in nonagenarians. The surgical treatment remains a significant challenge for orthopedists. The objective of this study was to investigate postoperative complications and survival outcomes compared between bipolar hemiarthroplasty (HA) and proximal femoral nail anti-rotation (PFNA) in nonagenarians with intertrochanteric fractures, and to evaluate the efficacy and safety of the two surgical procedures in this patient population. METHODS A total of 113 consecutive nonagenarians who underwent bipolar HA or PFNA for the treatment of intertrochanteric fractures from January 2006 to August 2021 were retrospectively studied in the current paper. There were 34 males and 79 females, with a mean age of 92.2 years (range 90-101 years) at the time of operation. The average duration of follow-up was 29.7 months (range 1-120 months). The full cohort was divided into bipolar HA (77 cases) and PFNA (36 cases) groups. Damage control orthopedics was used to determine the optimal surgery time and assist in perioperative management. A restrictive blood transfusion strategy was employed, along with appropriate adjustments under multidisciplinary assessment, throughout the perioperative period. Perioperative clinical information and prognostic data were analyzed. Kaplan-Meier survival curves were used for survival analysis, and landmark analysis divided the entire follow-up period into 1-12 months (short-term), 13-42 months (medium-term) and 43-120 months (long-term) according to the configurations of Kaplan-Meier survival curves. RESULTS Both groups had similar general variables except for the proportion of high adjusted Charlson comorbidity index (aCCI) (≥6 points) (6.5% in bipolar HA group and 22.2% in PFNA group, p = 0.024). Intraoperative blood loss and transfusion requirements were greater, and the intraoperative transfusion rates were higher in the bipolar HA group compared to the PFNA group (all p < 0.05). The complications rates, 1- to 60-month cumulative all-cause mortality, postoperative optimal Harris hip score (HHS), and Barthel index (BI) presented no significant difference between the two groups (all p > 0.05). Both groups had similar overall survival curves (p = 0.37). However, landmark analysis revealed that bipolar HA group exhibited higher survival rates in medium-term (p = 0.01), while similar survival rates were observed in the short- and long-term post-operation periods (both p > 0.05). Cox regression with survival-time-dependent covariate calculated the hazard ratio (HR) of bipolar HA was 0.41 in medium-term (p = 0.039). CONCLUSION Bipolar HA is equally effective and reliable as PFNA for treating intertrochanteric fractures in nonagenarians. Despite resulting in more intraoperative blood loss and transfusions, bipolar HA therapy is associated with a higher medium-term survival rate compared to PFNA treatment. The application of damage control orthopedics and precise perioperative patient blood management could contribute to the positive clinical outcomes observed in this patient population.
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Affiliation(s)
- Xingchen Lu
- Department of Orthopaedics, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Wenlong Gou
- Department of Orthopaedics, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Siyu Wu
- Department of Orthopaedics, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yu Wang
- Department of Orthopaedics, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Ziming Wang
- Department of Orthopaedics, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yan Xiong
- Department of Orthopaedics, Daping HospitalArmy Medical University (Third Military Medical University)ChongqingChina
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16
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Papadopoulos DV, Nikolaou VS, Masouros P, Babis GC, Imbriglia JE. The impact of glenoid parameters and implant overstuffing on functional outcomes of shoulder hemiarthroplasty in patients with glenohumeral joint arthritis. Eur J Orthop Surg Traumatol 2023; 33:3531-3538. [PMID: 37212913 DOI: 10.1007/s00590-023-03584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE The outcomes of shoulder hemiarthroplasty are highly dependent on the baseline glenoid morphology and the rotator cuff integrity. The objective of this study was to assess whether certain glenoid parameters and implant overstuffing are associated with worse clinical outcomes following shoulder hemiarthroplasty. METHODS We retrospectively reviewed 25 patients who underwent shoulder hemiarthroplasty for shoulder arthritis, with a mean follow-up of 5.3 years. The baseline glenoid morphology, the glenoid wear rate, the proximal humeral head migration and implant overstuffing were evaluated radiologically in all patients. The radiological parameters were correlated with the functional outcomes. RESULTS The Constant-Murley score, the ASES score, and the OSS score were significantly better for patients with a concentric baseline glenoid compared to those with an eccentric glenoid. The Constant-Murley score and the ASES score were also improved in patients without implant overstuffing compared to patients with implant overstuffing (p < 0.05). However, glenoid wear was not associated with worse functional outcomes (p = 0.23 for Constant-Murley score, p = 0.15 for ASES score and p = 0.27 for OSS score). Last, a worse Constant-Murley score was strongly correlated with proximal humeral head migration (p < 0.001), while worse ASES and OSS scores were moderately correlated with proximal humeral head migration (p < 0.001). CONCLUSION Our findings indicate that the results of hemiarthroplasty can be improved through careful selection of patients upon the baseline glenoid type morphology and proper implant sizing to avoid implant overstuffing. Moreover, glenoid wear is not associated with worse clinical outcomes, therefore shoulder hemiarthroplasty should be reconsidered as an alternative in younger patients with shoulder arthritis.
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Affiliation(s)
| | - Vasileios S Nikolaou
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | | | - George C Babis
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | - Joseph E Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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17
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Ben Elyahu R, Khateeb B, Yaacobi E, Palmanovich E, Marom O, Segal D, Markushevich M, Ohana N, Brin YS. Better Short-term Outcomes after Total Hip Arthroplasty Compared to Hemiarthroplasty in Active Older Patients with Displaced Intracapsular Femoral Neck Fracture. Isr Med Assoc J 2023; 25:804-808. [PMID: 38142319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
BACKGROUND Hip fractures are a public health problem that disproportionately affects the elderly. Displaced femoral neck fractures were treated historically with hemiarthroplasty, but the use of total hip arthroplasty (THA) is increasing showing superior long-term results. OBJECTIVES To assess whether THA has superior short-term results compared to bipolar hemiarthroplasty for displaced femoral neck fractures. METHODS Two groups of active older patients underwent either cementless bipolar hemiarthroplasty or THA for displaced femoral neck fracture. All patients were operated on using the direct lateral approach to the hip joint. Patients were assessed using the Harris Hip Score at hospital discharge and at 6 weeks follow-up. RESULTS We included 40 patients ages 65-85 years; 18 underwent bipolar hemiarthroplasty and 22 THA. The number of women in each group was similar, as was mean age: 73.1 ± 4.2 years in the hemiarthroplasty group and 71.0 ± 3.7 in THA. Harris Hip Score on hospital discharge was similar in both groups. Walking ability at discharge was better in the THA cohort and they were discharged sooner: 5.2 ± 1.3 vs. 6.4 ± 1.7 days following hemiarthroplasty (P = 0.021). At 6 weeks follow-up, the mean Harris Hip Score was higher in the THA group (78.6 ± 11 vs. 61.5 ± 17 for hemiarthroplasty, P < 0.001). Patients in the THA group walked longer distances, needed less support while walking, and reported less pain. CONCLUSIONS Better short-term results at hospital discharge and at 6 weeks follow-up after THA contributed to earlier patient independence and shorter hospital stays.
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Affiliation(s)
- Ron Ben Elyahu
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Basel Khateeb
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Yaacobi
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ezequiel Palmanovich
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Marom
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Segal
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Markushevich
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Ohana
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron S Brin
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lind D, Nåtman J, Mohaddes M, Rogmark C. Long-term risk of reoperation after modular hemiarthroplasty : Any differences between uni- or bipolar design? BMC Musculoskelet Disord 2023; 24:911. [PMID: 38001417 PMCID: PMC10668427 DOI: 10.1186/s12891-023-07035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND It is unclear whether unipolar (UHA) or bipolar (BHA) hemiarthroplasty should be the preferred treatment of femoral neck fracture (FNF). AIM We investigated the reoperation rate at 13 years post-fracture after BHA and UHA as treatment of FNF, including a subgroup analysis of individuals who survived 5 years or more, and described the reasons for reoperation after BHA and UHA respectively. METHODS In an observational cohort study on prospectively collected national register data, 16,216 BHA and 22,186 UHA were available for matching. A propensity score for treatment with bipolar HA was estimated using logistic regression. Matching was done using the 1:1 nearest neighbor matching without replacement. Of the 16,216 BHA patients, 12,280 were matched to a UHA control. A subgroup analysis based on the matched sample excluded individuals who died within 5 years and comprised 3,637 individuals with BHA and 3,537 with UHA. Kaplan-Meier survival analysis was used. RESULTS In the Kaplan-Meier analysis, 92% of the BHA group was free from reoperation at 13 years (95% CI 0.91-0.93), compared to 92% in the UHA group (CI 0.89-0.94). BHA was associated with more reoperations until 3 years. Reoperation due to infection was most common after BHA, n = 212 (1.7%) compared to n = 141 (1.1%) after UHA. Dislocation led to reoperation in 192 of the BHA cases (1.6%) and in 157 of the UHA cases (1.3%). Acetabular erosion/pain occurred in 0.1% and 0.4%. Amongst those surviving ≥ 5 years, 93% of the BHA group was free from reoperation (CI 0.92-0.94) at 13 years, 92% after UHA (CI 0.90-0.94). BHA had more reoperations during the 1st year only. The causes for reoperations showed similar rates except for acetabular erosion/pain. Here the BHA group had 2 cases (0.1%), the UHA had 39 (1.1%). CONCLUSION With a modular hemiarthroplasty relatively few patients need a reoperation. During the first years, there is a higher reoperation rate after BHA compared to UHA. Thereafter, no differences are seen. In patients who survive ≥ 5 years after the fracture there are more reoperations due to acetabular erosion after UHA, but crude numbers are extremely low, and the total reoperation rate is not affected.
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Affiliation(s)
- Dennis Lind
- Department of Orthopedics, Skane University Hospital, Lund University, Lund, Sweden.
| | - Jonatan Nåtman
- Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Maziar Mohaddes
- Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, Lund, Sweden
- Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
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19
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Parker MJ, Chatterjee R, Onsa M, Cawley S, Gurusamy K. Cemented versus uncemented hemiarthroplasty for displaced intracapsular fractures of the hip. Bone Joint J 2023; 105-B:1196-1200. [PMID: 37907087 DOI: 10.1302/0301-620x.105b11.bjj-2023-0534.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims The aim of this study was to report the three-year follow-up for a series of 400 patients with a displaced intracapsular fracture of the hip, who were randomized to be treated with either a cemented polished tapered hemiarthroplasty or an uncemented hydroxyapatite-coated hemiarthroplasty. Methods The mean age of the patients was 85 years (58 to 102) and 273 (68%) were female. Follow-up was undertaken by a nurse who was blinded to the hemiarthroplasty that was used, at intervals for up to three years from surgery. The short-term follow-up of these patients at a mean of one year has previously been reported. Results A total of 210 patients (52.5%) died within three years of surgery. One patient was lost to follow-up. Recovery of mobility was initially significantly better in those treated with a cemented hemiarthroplasty, although by three years after surgery this difference became statistically insignificant. The mortality was significantly lower in those treated with a cemented hemiarthroplasty (p = 0.029). There was no significant difference in pain scores, or in the incidence of implant-related complications or revision surgery, between the two groups. Conclusion These results further support the use of a cemented hemiarthroplasty for the routine management of elderly patients with a displaced intracapsular fracture of the hip.
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Affiliation(s)
- Martyn J Parker
- Department of Orthopaedics, Peterborough City Hospital, Peterborough, UK
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | | | - Mohamed Onsa
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Shirley Cawley
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London, London, UK
- Comprehensive Clinical Trials Unit, University College London, London, UK
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Edelstein AI, Dillingham TR, McGinley EL, Pezzin LE. Hemiarthroplasty Versus Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Patients: Twelve-Month Risk of Revision and Dislocation in an Instrumental Variable Analysis of Medicare Data. J Bone Joint Surg Am 2023; 105:1695-1702. [PMID: 37678258 PMCID: PMC10609704 DOI: 10.2106/jbjs.23.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND There is practice variation in the selection of a total hip arthroplasty (THA) or a hemiarthroplasty (HA) for the treatment of displaced femoral neck fractures in elderly patients. Large data sets are needed to compare the rates of rare complications following these procedures. We sought to examine the relationship between surgery type and secondary hip surgery (revision or conversion arthroplasty) at 12 months following the index arthroplasty, and that between surgery type and dislocation at 12 months, among elderly Medicare beneficiaries who underwent THA or HA for a femoral neck fracture, taking into account the potential for selection bias. METHODS We performed a population-based, retrospective study of elderly (>65 years of age) Medicare beneficiaries who underwent THA or HA following a femoral neck fracture. Two-stage, instrumental variable regression models were applied to nationally representative Medicare medical claims data from 2017 to 2019. RESULTS Of the 61,695 elderly patients who met the inclusion criteria, of whom 74.1% were female and 92.2% were non-Hispanic White, 10,268 patients (16.6%) underwent THA and 51,427 (83.4%) underwent HA. The findings from the multivariable, instrumental variable analyses indicated that treatment of displaced femoral neck fractures with THA was associated with a significantly higher risk of dislocation at 12 months compared with treatment with HA (2.9% for the THA group versus 1.9% for the HA group; p = 0.001). There was no significant difference in the likelihood of 12-month revision/conversion between THA and HA. CONCLUSIONS The use of THA to treat femoral neck fractures in elderly patients is associated with a significantly higher risk of 12-month dislocation, as compared with the use of HA, although the difference may not be clinically important. A low overall rate of dislocation was found in both groups. The risk of revision/conversion at 12 months did not differ between the groups. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam I. Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy R. Dillingham
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily L. McGinley
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Liliana E. Pezzin
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
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21
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Herzberg G, Burnier M, Ly L. Role for Wrist Hemiarthroplasty in Acute Irreparable Distal Radius Fracture in the Elderly. Hand Clin 2023; 39:545-550. [PMID: 37827607 DOI: 10.1016/j.hcl.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Volar locking plates for distal radius fracture (DRF) in the elderly may show complications in the most comminuted osteoporotic cases. The authors provide criteria for DRF in elderly that may not be amenable to volar plating ("irreparable DRF") and review the current results of a preliminary series of wrist hemiarthroplasty for these injuries. Between 2011 and 2019, 28 wrists with acute irreparable intra-articular DRF were treated with wrist hemiarthroplasty (96% female, mean age 79 years). A total of 17 wrists with a mean follow-up of 32 months were reviewed. At follow-up, mean visual analog scale (VAS) pain was 1/10, mean forearm rotation arc was 148°.
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22
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Onggo J, Nambiar M, McDougall C, Hau R, Babazadeh S. Comparing outcomes of total hip arthroplasty versus hemiarthroplasty in neck of femur fracture patients: an Australian registry study. Eur J Trauma Emerg Surg 2023; 49:2147-2153. [PMID: 37355483 PMCID: PMC10520181 DOI: 10.1007/s00068-023-02305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To determine discharge outcomes of displaced subcapital NOF patients who were from home, with intact pre-operative cognition, ASA 1 or 2 and independent walkers treated with either THA or hemiarthroplasty. METHODS A retrospective registry study was performed using data from the Australia and New Zealand Hip Fracture Registry (ANZHFR). Institutional ethics approval was obtained prior to commencement. Hip fracture registry records between 1st January 2016 and 31st January 2020 were reviewed. RESULTS A total of 930 patients with complete records were identified and included. There were 602 THA and 328 hemiarthroplasty patients. Using multivariate analysis, pre-operative factors associated with THA include younger age (OR = 0.90 for every year older, p < 0.001), females (p = 0.043), private admissions (OR = 1.62, p = 0.028) and receiving pre-operative geriatric assessment (OR = 1.89, p = 0.002). Delay to theatre due to not being fit for surgery was associated with not receiving THA (OR = 0.21, p < 0.001). THA resulted in a shorter total hospital length of stay (MD = 7.24, p < 0.001), higher likelihood of being discharged home (OR = 1.88, p < 0.001) and lower likelihood of being discharged to a residential aged care facility (OR = 0.32, p = 0.019). CONCLUSION Displaced subcapital NOF patients who were admitted from home, had intact pre-operative cognition, ASA 1 or 2, independent walkers and had THAs, had shorter total hospital length of stay, were more likely to be discharged home directly and less likely to end up in residential aged care facilities compared to those undergoing hemiarthroplasty.
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Affiliation(s)
- James Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Catherine McDougall
- Department of Orthopaedic Surgery, Metro North Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
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23
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Chowdary AR, Beale J, Martinez J, Aggarwal V, Mounasamy V, Sambandam S. Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:5615-5621. [PMID: 37061659 DOI: 10.1007/s00402-023-04876-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty. Rates of postoperative complications among the two anesthetic choices have not been directly compared. In this study, we compare the rates of postoperative complications in elderly patients (age greater than 70) undergoing hip hemiarthroplasty for femoral neck fractures using a national database. METHODS Data for the years 2015-2020 from the National Surgical Quality Improvement Program (NSQIP) were used for the study. Patients greater than 70 years of age who received a hip hemiarthroplasty with general anesthesia or spinal anesthesia were identified using CPT procedure codes. Pertinent preoperative variables and rates of postoperative complications were characterized and analyzed. RESULTS Our study found that elderly patients who received spinal anesthesia had, on average, longer length of stays but shorter operative times compared to patients who received general anesthesia. Furthermore, we found that patients who received spinal anesthesia had lower rates of systemic sepsis, cardiac arrests, and blood transfusions when compared to patients who received general anesthesia. Finally, we found that overall rates of mortality were significantly lower in the spinal anesthesia cohort compared to the general anesthesia cohort. CONCLUSION Our work suggests that patients who underwent spinal anesthesia for hip arthroplasty may have lower rates of postoperative complications. This work further highlights the role of anesthetic choice in preventing complications following hip hemiarthroplasty procedures.
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Affiliation(s)
| | - Jack Beale
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Jack Martinez
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Vikram Aggarwal
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA.
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA.
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Yassin M, Gupta V, Ramoutar D, Hunter T. Tönnis angle and acetabular depth ratio: predictors of dislocation following hemiarthroplasty for hip fracture. Hip Int 2023; 33:958-963. [PMID: 36536490 DOI: 10.1177/11207000221142298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite efforts to mitigate possible modifiable risk factors, dislocations following hemiarthroplasty for hip fracture still occur, with reported incidence rates ranging from 1.5 to 11%. The aim of this study was to investigate whether acetabular dysplasia is a significant contributing factor to dislocation, and since non-modifiable, whether it should affect patient selection for this treatment option. METHODS This is a multicentre nested case-control study of patients treated at 2 separate centres over a 10-year period from January 2011 to December 2020. All cases of hemiarthroplasty dislocation following hip fracture were identified from local databases, and 4 random controls were selected for every case. Tönnis angle (TA) and Acetabular-depth-ratio (ADR) was measured on the injured side using AP pelvis radiographs. Patients with TA > 10° and/or ADR < 250 were considered to have abnormal acetabular morphology. RESULTS 35 cases of dislocation were identified and 140 random controls were selected. Cases of dislocation had a larger mean TA (8.8° vs. 5.5°, p < 0.001) and lower mean ADR (254 vs. 289, p < 0.001) than controls. 20 out of 35 (57%) cases were considered to have abnormal acetabular morphology, compared to 19 out of 140 (14%) controls. The odds of dislocation is 8.5 times greater (odds ratio = 8.49, 95%CI = 3.73, 19.39) in patients with abnormal TA and/or ADR. CONCLUSIONS This study demonstrates that TA > 10° and ADR < 250 are useful criteria to identify patients at greater risk of hip hemiarthroplasty dislocation due to acetabular dysplasia. Special consideration to preoperative planning should be taken in these patients. Future research should focus on methods to minimise risk in this subset of patients, including evaluating total hip arthroplasty with dual mobility component vs hemiarthroplasty.
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Affiliation(s)
- Mohamed Yassin
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham, UK
| | - Vatsal Gupta
- Department of Trauma and Orthopaedics, University Hospital of Coventry & Warwickshire, Coventry, UK
| | - Darryl Ramoutar
- Department of Trauma and Orthopaedics, University Hospital of Coventry & Warwickshire, Coventry, UK
| | - Thomas Hunter
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham, UK
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Lanzerath F, Loew M, Schnetzke M. Is there still a place for anatomic hemiarthroplasty in patients with high functional demands in primary, nonreconstructable proximal humeral fractures? A clinical and radiographic assessment. J Shoulder Elbow Surg 2023; 32:1909-1917. [PMID: 36907312 DOI: 10.1016/j.jse.2023.02.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/26/2023] [Accepted: 02/04/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Vitality-threatening proximal humerus fractures often provide an indication for prosthetic treatment. We investigated the issue of how anatomic hemiprostheses perform in younger, functionally challenging patients with the use of a specific fracture stem and systematic tuberosity management in medium-term follow-up. METHODS Thirteen skeletally mature patients with a mean age of 64 ± 9 years and a minimum follow-up of 1 year after primary open-stem hemiarthroplasty for 3- and 4-part proximal humeral fractures were included. All patients were followed up regarding their clinical course. Radiologic follow-up included fracture classification, healing of tuberosities, proximal migration of the humeral head, evidence of stem loosening, and glenoid erosion. Functional follow-up included range of motion, pain, objective and subjective performance scores, complications, and return to sports rates. We statistically compared treatment success based on the Constant score between the cohort with proximal migration and the cohort with regular acromiohumeral distance by means of the Mann-Whitney U test. RESULTS After an average follow-up period of 4.8 years, satisfactory results were obtained. The absolute Constant-Murley score was 73.2 ± 12.4 points. The disabilities of the arm, shoulder, and hand score was 13.2 ± 13.0 points. Patients reported their mean subjective shoulder value as 86.6% ± 8.5%. Pain was reported as 1.1 ± 1.3 points on a visual analog scale. Flexion, abduction, and external rotation values were 138 ± 31°, 134 ± 34°, and 32 ± 17°, respectively. 84.6% of the referred tuberosities healed successfully. Proximal migration was observed in 38.5% of cases and was associated with worse Constant score results (P = .065). No patient showed signs of loosening. Mild glenoid erosion was apparent in 4 patients (30.8%). All patients who were interviewed and participated in sports before surgery were able to return to their primary sport after surgery and continued to do so during the final follow-up. CONCLUSIONS With narrow indications, use of a specific fracture stem and adequate tuberosity management, successful radiographic and functional results are presented after a mean follow-up of 4.8 years after hemiarthroplasty for primary nonreconstructable humeral head fractures. Accordingly, open-stem hemiarthroplasty appears to remain a possible alternative to reverse shoulder arthroplasty in younger, functionally challenging patients with primary 3- or 4-part proximal humeral fractures.
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Affiliation(s)
- Fabian Lanzerath
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany; Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
| | - Markus Loew
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Marc Schnetzke
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
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Krassnig R, Prager W, Wildburger R, Hohenberger GM. Direct anterior versus antero-lateral approach in hip joint hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:4141-4148. [PMID: 36394659 DOI: 10.1007/s00402-022-04685-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Femoral neck fractures are common injuries in the elderly and represent a major source of morbidity and mortality. Due to the benefits, bipolar hip hemiarthroplasty (BHH) is a popular method to treat. The purpose of this study is to evaluate the functional and radiographic outcomes for BHH comparing the direct anterior approach (DAA) to the anterolateral approach (ALA) to the hip joint. METHODS We used a prospective, randomized observational study design, where we enrolled 83 patients at a level-I-trauma center presenting with indication for BHH. We followed up the participants at defined intervals over a period of 1 year. The follow-up examinations were carried out at defined time intervals for a period of 1 year. Calculations were performed with Statistical Package for Social Sciences (SPSS) 21.0. RESULTS Concerning postoperative pain sensation, the anterior group had statistically significantly decreased pain levels at one (p = 0.02), seven (p = 0.04) and 14 days (p = 0.02) following the intervention when compared to the ALA sample. The postoperative modified Barthel-Index showed a statistically significant difference on the first postoperative day at the anterior group. CONCLUSION Although we compared two minimally invasive approaches, our results shows a statistically significant difference in pain intensity and mobility for the early postoperative period using the direct anterior approach.
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Affiliation(s)
- Renate Krassnig
- AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, 8144, Tobelbad, Austria.
| | - Walter Prager
- Department of Trauma Surgery, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße18, 8330, Fürstenfeld, Austria
| | - Renate Wildburger
- AUVA Rehabilitation Clinic Tobelbad, Dr.-Georg-Neubauer-Straße 6, 8144, Tobelbad, Austria
| | - Gloria M Hohenberger
- Department of Trauma Surgery, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße18, 8330, Fürstenfeld, Austria
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27
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Pangaud C, Pioger C, Pauly V, Orleans V, Boyer L, Argenson JN, Ollivier M. Total hip arthroplasty reduces the risk of dislocation after femoral neck fracture. Orthop Traumatol Surg Res 2023; 109:103575. [PMID: 36754167 DOI: 10.1016/j.otsr.2023.103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/28/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Femoral neck fracture in the elderly patient can either be managed using hemi-arthroplasty (HA) or total hip arthroplasty (THA). The aim of this study was to explore the rate of three selected complications in each procedure: is the dislocation rate higher with HA compared to THA? Is the blood transfusion rate higher with THA compared to HA? Do the patients who underwent THA require more ICU transfer than the patients who underwent HA? Is the ICU transfer correlated to the use of cement for stem fixation? METHOD Based on a national health-care database, a comparative and retrospective study was conducted. 96,184 patients were included after having a surgery for femoral neck fracture between 2014 and 2017. The mean follow up was 3.5 years (Min. 2 years-Max. 5 years). The population was divided into two groups: hemiarthroplasty (HA) and total hip arthroplasty (THA). The primary outcome was the dislocation rate and the secondary outcomes were the blood transfusion rate and the need for ICU after surgery. RESULTS At two years of follow up in the Hemiarthroplasty group, 3647 patients had a dislocation episode over 64,106 patients: 5.69%. In the Total Hip Arthroplasty group: 1904 patients had a dislocation episode over 32,078 patients: 5.94% (p=0.26711). The percentage of deceased patient without dislocation was 17.76% in the HA group and 11.56% in the THA group (p<0.001). The univariate hazard ratio for dislocation was higher in the THA group: HR 1.063 IC 95% (0.993-1.138) p=0.077. The multivariate analysis calculating competitive risk with death and dislocation found THA to be a protective factor of dislocation HR 0.926 IC 95% (0.866-0.991) p=0.0266. The rate of blood transfusion was 5.59% in the THA group and 7.03% in the HA group (p<0.001), The multivariate analysis found HR=1.062 IC 95% (0.99-1.139) p=0.0955. The need for ICU transfer after the surgery was 7.04% in the HA group and 8.08% in the THA group (p<0.001). The multivariate analysis found HR 0.995 IC 95% (0.921-1.076) p=0.9094. Finally, only cement was found as an independent risk factor of ICU transfer after surgery: HR 1.254 IC 95% (1.164-1.35) p<0.0001. CONCLUSION THA for femoral neck fracture allows to reduce the risk of dislocation compared to hemiarthroplasty. The multivariate analysis failed to prove the superiority of one procedure over the other regarding blood transfusion risk and the need for ICU transfer. The use of cemented stem appears to be a risk factor of ICU transfer after hip arthroplasty. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Corentin Pangaud
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France.
| | - Charles Pioger
- Public Teaching Hospital of Paris, Ambroise-Paré Hospital, Paris, France
| | - Vanessa Pauly
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Veronica Orleans
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Services Research and Quality of Life Center, faculté de médecine, secteur Timone, EA 3279, CEReSS - centre d'étude et de recherche sur les services de santé et la qualité de vie, Aix-Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France; Department of Epidemiology and Health Economics, AP-HM, Marseille, France; Department of Medical Information, AP-HM, Marseille, France
| | - Jean Noël Argenson
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
| | - Matthieu Ollivier
- Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France
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Sattari SA, Guilbault R, MacMahon A, Salem HS, Khanuja HS. Internal Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures: A Systematic Review and Meta-Analysis. J Orthop Trauma 2023; 37:e219-e226. [PMID: 36575572 DOI: 10.1097/bot.0000000000002558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare internal fixation (IF) versus hemiarthroplasty (HA) for elderly individuals (ie, older than 65 years) with nondisplaced (ie, Garden type I or II) femoral neck fracture (FNF). DATA SOURCE We searched English literature of MEDLINE, PubMed, and Embase from inception to December 4, 2021. STUDY SELECTION Eligibility criteria were randomized controlled trials (RCTs) compared IF versus HA for elderly individuals with nondisplaced FNF. Primary outcomes were Harris hip score (HHS), quality of life per European Quality of Life 5 Dimension (EQ-5D), and mortality. Secondary outcomes were complications, reoperation, intraoperative bleeding, operation duration, and length of hospital stay. DATA EXTRACTION Two authors separately extracted data and assessed the risk of bias of the included studies using Cochrane risk-of-bias tool. DATA SYNTHESIS Three RCTs yielding 400 patients were enrolled, of which 203 (50.7%) underwent IF. Internal fixation was inferior to HA with respect to 6-month HHS [mean difference (MD) = -8.28 (-14.46, -2.10), P = 0.009] and 1-year EQ-5D [MD = -0.07 (-0.14, -0.00), P = 0.04]. The 2 techniques were comparable regarding length of hospital stay (day), HHS at 1 and 2 years, EQ-5D at 2 years, and mortality. IF was inferior to HA in implant-related complication [20.1% vs. 6.0%, relative risk (RR) = 3.18 (1.72, 5.88), P = 0.0002] and reoperation rate [20.1% vs. 6.0%, RR = 3.30 (1.79, 6.08), P = 0.0001]. Hemiarthroplasty had a greater blood loss (mL) [MD = -138.88 (-209.58, -68.18), P = 0.001] and operation duration (min) [MD = -23.27 (-44.95, -1.60), P = 0.04] compared with IF. CONCLUSION HA is the preferred technique for nondisplaced FNF if early recovery, higher mobility, and better quality of life are priorities. The choice of fixation should be weighed on an individual patient level. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Ryan Guilbault
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Aoife MacMahon
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Hytham S Salem
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; and
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Reddy AK, Scott JT, Norris GR, Moore C, Checketts JX, Hughes GK, Small T, Calder MM, Norris BL. Cemented vs Uncemented hemiarthroplasties for femoral neck fractures: An overlapping systematic review and evidence appraisal. PLoS One 2023; 18:e0281090. [PMID: 36827316 PMCID: PMC9955942 DOI: 10.1371/journal.pone.0281090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The purpose of our study is to assess the methodology of overlapping systematic reviews related to cemented vs uncemented hip hemiarthroplasties for the treatment of femoral neck fractures to find the study with the best evidence. Also, we assess the gaps in methodology and information to help with direction of future studies. METHODS A systematic search was conducted in September 2022 using Pubmed, Embase, and Cochrane Library. Clinical outcome data and characteristics of each study were extracted to see which treatment had better favorability. The outcomes and characteristics extracted from each study includes, first author, search date, publication journal and date, number of studies included, databases, level of evidence, software used, subgroup analyses that were conducted, and heterogeneity with the use of I2 statistics Methodological quality information was extracted from each study using four different methodologic scores (Oxford Levels of Evidence; Assessment of Multiple Systematic Reviews (AMSTAR); Quality of reporting of meta-analyses (QUROM); Oxman and Guyatt. After that, the Jadad decision algorithm was used to identify which studies in our sample contained the best available evidence. Finally, overlap of each systematic review was assessed using Corrected Covered Area (CCA) to look at redundancy and research waste among the systematic reviews published on the topic. RESULTS After screening, 12 studies were included in our sample. For the Oxford Levels of Evidence, we found that all the studies were Level I evidence. For the QUORUM assessment, we had 1 study with the highest score of 18. Additionally, we did the Oxman and Guyatt assessment, where we found 4 studies with a maximum score of 6. Finally, we did an AMSTAR assessment and found 2 studies with a score of 9. After conducting the methodological scores; the authors determined that Li. L et al 2021 had the highest quality. In addition, it was found that the CCA found among the primary studies in each systematic review calculated to .22. Any CCA above .15 is considered "very high overlap". CONCLUSIONS The best available evidence suggests that Cemented HAs are better at preventing Prosthesis-related complications. Conversely, the best evidence also suggests that Cemented HA also results in longer operative time and increased intraoperative blood loss. When conducting future systematic reviews related to the topic, we ask that authors restrict conducting another systematic review until new evidence emerges so as not to confuse the clinical decision-making of physicians.
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Affiliation(s)
- Arjun K. Reddy
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Jared T. Scott
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Grayson R. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Chip Moore
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Griffin K. Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Travis Small
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Mark M. Calder
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Orthopaedic & Trauma Service of Oklahoma, Tulsa, Oklahoma
- Department of Orthopaedic Trauma, The University of Oklahoma at Tulsa School of Community Medicine, Tulsa, Oklahoma
| | - Brent L. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Orthopaedic & Trauma Service of Oklahoma, Tulsa, Oklahoma
- Department of Orthopaedic Trauma, The University of Oklahoma at Tulsa School of Community Medicine, Tulsa, Oklahoma
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Bökeler U, Bühler A, Eschbach D, Ilies C, Liener U, Knauf T. The Influence of a Modified 3rd Generation Cementation Technique and Vaccum Mixing of Bone Cement on the Bone Cement Implantation Syndrome (BCIS) in Geriatric Patients with Cemented Hemiarthroplasty for Femoral Neck Fractures. Medicina (Kaunas) 2022; 58:1587. [PMID: 36363544 PMCID: PMC9696240 DOI: 10.3390/medicina58111587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 10/14/2023]
Abstract
Background and Objectives: Cemented hemi arthroplasty is a common and effective procedure performed to treat femoral neck fractures in elderly patients. The bone cement implantation syndrome (BCIS) is a severe and potentially fatal complication which can be associated with the implantation of a hip prosthesis. The aim of this study was to investigate the influence of a modified cementing technique on the incidence of BCIS. Material and Methods: The clinical data of patients which were treated with a cemented hip arthroplasty after the introduction of the modified 3rd generation cementing technique were compared with a matched group of patients who were treated with a 2nd generation cementing technique. The anesthesia charts for all patients were reviewed for the relevant parameters before, during and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1,2, or 3 depending on the severity of hypotension, hypoxia loss of consciousness. Results: A total of 92 patients with complete data sets could be included in the study. The mean age was 83 years. 43 patients (Group A) were treated with a 2nd and 49 patients (Group B) with a 3rd generation cementing technique. The incidence of BCIS grade 1,2, and 3 was significantly higher (p = 0,036) in group A (n = 25; 58%) compared to group B (n = 17; 35%). Early mortality was higher in group A (n = 4) compared to group B (n = 0). Conclusions: BCIS is a potentially severe complication with a significant impact on early mortality following cemented hemiarthroplasty of the hip for the treatment of proximal femur fracture. Using a modified 3rd generation cementing technique, it is possible to significantly reduce the incidence of BCIS and its associated mortality.
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Affiliation(s)
- Ulf Bökeler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Alissa Bühler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
| | - Christoph Ilies
- Department for Anesthesia and Intensive Care, Marienhospital Stuttgart, 70199 Stuttgart, Germany
| | - Ulrich Liener
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
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31
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Suárez-Quintero A, Fernández-Domínguez JM, López-Sorroche E. [Functional results after shoulder hemiarthroplasty for proximal humerus fracture: experience in our center]. Acta Ortop Mex 2022; 36:359-366. [PMID: 37669655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
INTRODUCTION shoulder hemiarthroplasty is being relegated as a treatment for non-osteosynthetic proximal humerus fractures. Our objective is to analyze the functional results of patients treated with hemiarthroplasty for this reason in our hospital. MATERIAL AND METHODS cross-sectional descriptive study that includes patients operated between February 2016 and November 2021; 24 patients, with an average follow-up of 44.6 months. Active joint balance, the Constant-Murley test, the DASH questionnaire and current pain (VAS) were collected. The radiographic parameters analyzed were the number of fracture fragments and the consolidation of the tuberosities. RESULTS a mean of 71.65 ± 13.75 was obtained in the Constant-Murley and 18.14% ± 13.92 in the DASH. For shoulder flexion, the mean was 108.75° ± 41.26; 104.5° ± 43.68 for abduction and 33° ± 14.73 for external rotation. About internal rotation, 60% of the patients reached the scapular plane. Average VAS was 1.25 ± 1.74. Consolidated tuberosities in 90.5%. There were no significant differences comparing the Constant-Murley test, DASH or rotations between both, over and under 65 years old group of patients. Those over 65 years of age obtained a mean flexion of 125.91° ± 26.82 whereas those under 87.78° ± 26.82 (p = 0.038). The mean abduction in those over 65 was 125.45 ± 28.94 vs 78.89 ± 46.29 in the young group (p = 0.012). CONCLUSION hemiarthroplasty provides quality of life with acceptable functionality and good pain control, therefore it should continue to be an alternative to consider in selected patients.
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Affiliation(s)
- A Suárez-Quintero
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas. Almería, Andalucía, España
| | - J M Fernández-Domínguez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas. Almería, Andalucía, España
| | - E López-Sorroche
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas. Almería, Andalucía, España
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32
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Çelen ZE, Gazi O. Distal fixation modular stem hemiarthroplasty versus proximal femoral nailing for unstable intertrochanteric fractures: a retrospective cohort study. Acta Orthop Belg 2022; 88:599-608. [PMID: 36791715 DOI: 10.52628/88.3.9875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The treatment of unstable intertrochanteric fractures (UITF) is a controversial issue in the current literature. The aim of this study was to compare the curative effects of distal fixation modular stem (DFMS) hemiarthroplasty with proximal femoral nailing (PFN) on UITFs in the elderly. From February 2017 to November 2019, 98 elderly (≥65 years) patients with UITF were included in this single-center retrospective cohort study. Mean follow-up duration was 24.1±11.9 months. Patients were divided into the DFMS group (52 patients) and the PFN group (46 patients). In the DFMS group, trochanteric fixation was performed using a trochanteric cable plate system. Primary outcome measures included Harris hip score (HHS), mobility score, implant related complications and mortality. Secondary outcome measures included hospitalization duration, surgical time and transfusion rate. Mean age of the patients was 78.7±7.2 years (65-96 years). DFMS group had longer surgical time, higher transfusion rates and longer hospital stays (p<0.05). Mean HHS was 80.7±10.5 and 81.9±12.2 in the DFMS group and PFN group, respectively. There was no statistically significant difference between the two groups in terms of HHS, mobility score and mortality. Implant failure rates were significantly higher in the PFN group (p=0.015). Implant failure, one year mortality and overall mortality rates were 0%, 15.4% and 17.3% in DFMS group and 10.9%, 15.2% and 19.5% in PFN group, respectively. Both surgical methods can be effectively used in the treatment of UITFs with similar satisfactory functional results and similar mortality rates. In addition, the DFMS group exhibited significantly lower implant failure rates and PFN group provided significantly lower surgical time duration, transfusion rate and hospital stay duration.
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Rajput IM, Memon I, Azam ME, Siddiqui AA, Kumar J, Ali Z, Junejo S, Abid K. Is Cemented Bipolar Hemiarthroplasty Good Choice For Unstable Intertrochanteric Fractures In Elderly: Multicentric Prospective Study At Karachi. J Ayub Med Coll Abbottabad 2022; 34(Suppl 1):S617-S621. [PMID: 36414579 DOI: 10.55519/jamc-03-s1-9770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND To analyse the functional outcome of primary cemented bipolar hemi arthroplasty (PCBH) for unstable osteoporotic intertrochanteric femur fractures in elderly patients. METHODS : It was a multicentre prospective study conducted at Institute of Orthopaedics & Surgery, Medicare Cardiac & General Hospital and Dr Ruth K M Pfau Civil Hospital Karachi, Pakistan from February 2015 to July 2020. Thirty-eight patients of 60-90 years of either gender diagnosed as close UIF, severe osteoporosis as per Singh index grade ≤3, time since injury <2 weeks, ASA status II & III and pre-injury independent walking were enrolled in this study. All patients with UIF underwent PCBH. The radiographs were performed before surgery and at intervals postoperatively. All patients were requested to come for follow up visits at 2 weeks, 4 weeks, 3 months, 6 months 1 year and then at 3 years to assess the functional outcome of patients. At first postoperative day check X-rays taken and rehabilitation started as per institutional rehabilitation protocol, at 2-week stiches removed, at 4 weeks' x-ray was done and all the patients were followed for 3 years. The primary outcomes were noted using Harris Hip Score (HHS) for the functional outcome assessed at the end of 1 year and at final follow up. RESULTS The mean age of the study participants was 68.29±8.04 years. One male (2.6%) died at 6th month, then 2 females (5.2%) patients died at 1 year and 2 females (5.2%) patients died at the end of 3 years due to multiple comorbid conditions. During 1st year 3 patients (7.4%) developed DVT and 4 patients (10.5%) having diabetes and hypertension developed superficial wound infection. The mean Harris Hip Score between time points which indicated that the mean Harris Hip Score significantly improve over the period of time (p=0.001). Post hoc tests revealed that there were statistically significant differences between each time points (p<0.05). The functional outcome at 3 years, shown, one patient had excellent outcome, 24 patients had good outcome and 8 had fair outcome, respectively. CONCLUSION The Primary Cemented Bipolar Hemiarthoplasty is a good choice of treatment in terms of reasonable functional outcome such as early mobilization and associated with less post-operative complications in elderly patients of UIF.
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Affiliation(s)
| | | | | | | | | | - Zulfiqar Ali
- Liaqat University of Medical & Health Sciences Jamshoro
| | | | - Khadijah Abid
- Shaheed Zulfiqar Ali Bhutto Institute of Science and Technology, Karachi, Pakistan
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Shah SA, Kim JY, Cho HW, Shon WY, Kim SM. A larger sized cup accelerates cartilage erosion of acetabulum after bipolar hemiarthroplasty in elderly with femur neck fracture. Medicine (Baltimore) 2022; 101:e29081. [PMID: 35446290 PMCID: PMC9276361 DOI: 10.1097/md.0000000000029081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/26/2022] [Indexed: 01/04/2023] Open
Abstract
Bipolar hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up.We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65-96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A - bipolar cup size > actual head size, Group B - cup size < head size, Group C - cup size = head size. The degree of both superior and medial acetabular cartilage erosion was identified and calculated on postoperative radiographs using line of acetabular margin and Kohler line.The mean superior and medial acetabular erosion were 1.62 ± 1.6 mm (range, 0-4.4) and 4.15 ± 2.7 mm (range, 0-8.2) in Group A, 1.30 ± 1.3 mm (range, 0-3.8) and 4.11 ± 2.7 mm (range, 0-7.8) in Group B, and 0.90 ± 1.1 mm (range, 0-2.6) and 3.16 ± 2.9 mm (range, 0-7.9) in Group C (P = .039 and P = .187, respectively). The superior acetabular erosion showed significant difference between the 3 groups. During mean follow-up period of 12.3 years, 5 patients (5/117, 4.3%) underwent conversion to total hip arthroplasty due to superior acetabular erosion. All of 3 patient underwent BHA with a larger bipolar cup than the actual femoral head.A lager sized cup accelerated superior cartilage erosion of acetabulum after BHA. An optimal cup size should be considered when undergoing BHA in elderly patients.
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Affiliation(s)
- Saumil Ashvin Shah
- Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Jae Young Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Hyun-Woo Cho
- Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea
| | - Won-Yong Shon
- Department of Orthopedic Surgery, Bumin Hospital, Pusan, Korea
| | - Sang-Min Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea
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35
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DURGUT F, ŞAHİN E, ÇİFTCİ S, AYDIN BK. Proximal femoral nail antirotation versus cemented calcar-replacement hemiarthroplasty for unstable intertrochanteric fracture in elderly: an overall survival study. Turk J Med Sci 2022; 52:463-466. [PMID: 36161603 PMCID: PMC10381198 DOI: 10.3906/sag-2105-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 04/14/2022] [Accepted: 12/16/2021] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The aim of this study is to compare the perioperative complications and overall survival of patients who underwent proximal femoral nail antirotation (PFNA) and patients who underwent cemented calcar-replacement hemiarthroplasty (CCRH) for unstable intertrochanteric fracture in patients aged 75 years and older. METHODS A total of 94 patients who underwent PFNA or CCRH between 2010 and 2012 because of femur fracture (A2.2 and A2.3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification) were analyzed retrospectively. Hospitalization times, blood transfusion needs, reoperation rates, and overall survival were compared. RESULTS Forty-eight patients in the PFNA group and 46 patients in the CCRH group were included for analysis. There was no statistically significant difference between the two groups in terms of hospitalization times, blood transfusion needs, reoperation rates, and survival rates. DISCUSSION Both PFNA and CCRH techniques can be used for surgical treatment of unstable intertrochanteric femur fractures.
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Affiliation(s)
- Fatih DURGUT
- Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakir,
Turkey
| | - Erdem ŞAHİN
- Department of Orthopaedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum,
Turkey
| | - Sadettin ÇİFTCİ
- Department of Orthopaedics and Traumatology, Medical Faculty, Selçuk University, Konya,
Turkey
| | - Bahattin Kerem AYDIN
- Department of Orthopaedics and Traumatology, Medical Faculty, Selçuk University, Konya,
Turkey
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36
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Beauchamp-Chalifour P, Pelet S, Belhumeur V, Angers-Goulet M, Bédard L, Belzile EL. Should We Use Bipolar Hemiarthroplasty in Patients ≥70 Years Old With a Femoral Neck Fracture? A Review of Literature and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2022; 37:601-608.e1. [PMID: 34915132 DOI: 10.1016/j.arth.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Bipolar (BHA) and unipolar hemiarthroplasties (UHA) are interchangeably used in elderly patients with a displaced femoral neck fracture. We ask if there is a difference between BHA and UHA with regards to hip function, in elderly patients. METHODS Systematic review and meta-analysis was conducted of randomized controlled trials comparing BHA to UHA. The primary outcome was postoperative hip function scores. Secondary outcomes were overall health-related quality of life patient-reported outcomes, acetabular erosion, and postoperative complications. Data sources, last searched on June 1, 2020, were MEDLINE, EMBASE, Cochrane Library, and Web of Science. RESULTS Fourteen randomized controlled trials were eligible for meta-analysis. There was no difference in hip function scores between BHA and UHA (standardized mean difference 0.32, 95% confidence interval [CI] -0.06 to 0.71, n = 1084, I2 = 87%). Patients with BHA with more than 2-year follow-up had better hip function scores (standardized mean difference 0.68, 95% CI 0.18-1.18, n = 700, I2 = 87%). There was no difference in European Quality of life- five dimensions scores with BHA (mean difference 0.08, 95% CI -0.01 to 0.17, n = 967, I2 = 82%). The use of BHA decreased the risk of acetabular erosion (relative risk 0.38, 95% CI 0.17-0.83, n = 1239, I2 = 0%). There was no difference for revision, mortality, infection, and dislocation (I2 = 0%). CONCLUSION There seems to be no difference between BHA and UHA with regards to hip function at 2 years. BHA might decrease the risk of acetabular erosion. There is a need for a large randomized controlled trial with a follow-up >2 years and better measurement tools to assess clinical benefits. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Philippe Beauchamp-Chalifour
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Stéphane Pelet
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Vincent Belhumeur
- Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Mathieu Angers-Goulet
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Luc Bédard
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
| | - Etienne L Belzile
- Faculty of Medicine, Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Quebec, Canada; Department of Orthopedic Surgery, CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada; Centre de recherche FRQS du CHU de Québec - Hôpital Enfant-Jésus, Québec, Québec, Canada
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Abstract
BACKGROUND Controversy exists over the use of bone cement in hip fractures treated with hemiarthroplasty. Only limited data on quality of life after cemented as compared with modern uncemented hemiarthroplasties are available. METHODS We conducted a multicenter, randomized, controlled trial comparing cemented with uncemented hemiarthroplasty in patients 60 years of age or older with an intracapsular hip fracture. The primary outcome was health-related quality of life measured with the use of utility scores on the EuroQol Group 5-Dimension (EQ-5D) questionnaire at 4 months after randomization (range of scores, -0.594 to 1, with higher scores indicating better quality of life; range for minimal clinically important difference, 0.050 to 0.075). RESULTS A total of 610 patients were assigned to undergo cemented hemiarthroplasty and 615 to undergo modern uncemented hemiarthroplasty; follow-up data were available for 71.6% of the patients at 4 months. The mean EQ-5D utility score was 0.371 in patients assigned to the cemented group and 0.315 in those assigned to the uncemented group (adjusted difference, 0.055; 95% confidence interval [CI], 0.009 to 0.101; P = 0.02). The between-group difference at 1 month was similar to that at 4 months, but the difference at 12 months was smaller than that at 4 months. Mortality at 12 months was 23.9% in the cemented group and 27.8% in the uncemented group (odds ratio for death, 0.80; 95% CI, 0.62 to 1.05). Periprosthetic fractures occurred in 0.5% and 2.1% of the patients in the respective groups (odds ratio [uncemented vs. cemented], 4.37; 95% CI, 1.19 to 24.00). The incidences of other complications were similar in the two groups. CONCLUSIONS Among patients 60 years of age or older with an intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and a lower risk of periprosthetic fracture than uncemented hemiarthroplasty. (Funded by the National Institute for Health Research; WHiTE 5 ISRCTN number, ISRCTN18393176.).
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Affiliation(s)
- Miguel A Fernandez
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Juul Achten
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Nicholas Parsons
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Xavier L Griffin
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - May-Ee Png
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Jenny Gould
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Alwin McGibbon
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
| | - Matthew L Costa
- From Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre (M.A.F., J.A., M.L.C.), and the Nuffield Department of Primary Care Health Sciences (M.-E.P.), University of Oxford, and patient and public representative (J.G., A.M.), Oxford, University Hospitals Coventry and Warwickshire NHS Trust (M.A.F.) and the Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick (N.P.), Coventry, and the Department of Trauma and Orthopaedic Surgery, Blizard Institute, Queen Mary University of London, and the Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London (X.L.G.) - all in the United Kingdom
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Dahl OE, Pripp AH. Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated with Cemented and Cementless Implants? A Meta-analysis of Large, National Registries. Clin Orthop Relat Res 2022; 480:343-350. [PMID: 34491939 PMCID: PMC8747483 DOI: 10.1097/corr.0000000000001952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although current recommendations suggest that hip hemiarthroplasties performed for femoral neck fractures be implanted with bone cement, it is known to cause cardiorespiratory and hemodynamic reactions that in some patients can be fatal. Older patients may be at particular risk of this complication, but because of its relative infrequency, large studies-perhaps even larger than can be achieved in the context of single-country national registries-are needed to get reasonably precise estimates as to its frequency. Pooling results from national registries reporting on death within 48 hours of cement exposure in this setting may therefore be helpful. QUESTION/PURPOSE In a systematic review of studies based on large national registries, we asked: Does the risk of death within 48 hours of hip hemiarthroplasty differ between patients treated with cemented and cementless implants? METHODS MEDLINE and Embase data sources were searched for cohort studies on patients with hip fractures treated with cement or cementless hip hemiprostheses based on results from national registries that tracked perioperative deaths within 48 hours of surgery, from 2010 or later (to include only studies that used contemporary cement techniques). We excluded registry research on elective THAs for other indications (such as degenerative joint disease), mixed populations (registries that combined patients having arthroplasty for fracture and for other diagnoses like osteoarthritis, such that we could not separate them), and overlapping data from the same registers (to avoid double and triple publications of similar data). Five studies met our inclusion criteria. The cohorts ranged from about 11,000 to about 25,000 patients. About 31% of the patients were in the cementless group. Two studies reported the age ranges of participating patients, and three studies communicated mean ages (which were 82 years for both sexes). Twice as many females as males were present in both the cemented and cementless group. When reported, more than 50% in both groups were in the American Society of Anesthesiologists physical status classification 3 or 4. Study quality was deemed good according to the Newcastle-Ottawa Scale. Publication bias was assessed using a funnel plot and the Egger test, and study heterogeneity was evaluated using the I2 heterogeneity statistic and Cochran Q heterogeneity test. There was some heterogeneity between the studies, with a Cochran Q statistics of 8.13 (degrees of freedom = 4; p = 0.08) and an I2 statistic of 50.8%. There was evidence for a small amount of publication bias (Egger test; p = 0.02). The pooled risk ratio (RR) from a random-effects model is presented with 95% confidence intervals. The primary endpoint was the occurrence of any fatalities within 48 hours of hip fracture treatment with cementless compared with cemented prostheses. We performed a sensitivity analysis to assess the needed association of a potential unmeasured or uncontrolled confounding, and we made an estimate of the amount of unmeasured confounding that would need to be present in order to change the direction of the result. We summarized this using a parameter known as the "E-value." Based on that sensitivity analysis, we found it unlikely that an unmeasured hypothetical confounder could explain the significant association between cemented and cementless implants and risk of death within 48 hours of hip hemiarthroplasty. RESULTS Compared with the cementless group, mortality was increased in the cemented group (RR 1.63 [95% CI 1.31 to 2.02]; p < 0.001). The number needed to harm from the pooled data was 1 of 183 operated patients; that is, for every 183 patients treated with cemented implants, one death would be expected. CONCLUSION Bone cement is associated with a higher risk of fatalities within 48 hours of surgery compared with cementless prostheses. However, numerous prior studies have found a higher risk of serious complications resulting in additional surgical procedures associated with cementless devices in this population; those complications, as well, may result in death. Based on our study alone, we cannot recommend cementless implants in this setting. Large, national registries should evaluate fixation choice in older patients with hip fractures, and those studies should consider both early death and the potential for later harms. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ola E. Dahl
- Centre of Medical Science, Education and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
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Dubin J, Atzmon R, Feldman V, Farkash U, Nyska M, Rath E, Palmanovich E. Bipolar hemiarthroplasty may reduce cerebrovascular accidents and improve early weight-bearing in the elderly after femoral neck fracture. Medicine (Baltimore) 2022; 101:e28635. [PMID: 35089201 PMCID: PMC8797593 DOI: 10.1097/md.0000000000028635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023] Open
Abstract
Cerebrovascular accidents (CVA) in the elderly population after femoral neck fracture remain great concern for physicians. Specifically, surgical fixation techniques, such as bipolar hemiarthroplasty (HA) and internal fixation play a significant role in influencing the occurrence of postoperative CVA in the elderly population.In order to identify 2 cohorts, we used a rigid selection process based on our institution's database. The cohorts were comprised of a HA cohort and a cannulated screw cohort, of which underwent femoral neck surgery, performed by 3 fellowship trained surgeons from 2003 to 2014. Risk factors were documented and measured, including Coumadin use and hypertension, and postoperative complications such as CVA and death rate were also recorded. A P-value of <.05 was determined to be statistically significant.A power analysis was performed and achieved a power of 0.95. We found a non-significant reduction in CVA for bipolar HA (3.6% CVA vs 0.0% in the non-CVA group, P = .48) and a non-significant increase in CVA for cannulated screw use (7.6% CVA vs 14.4% in the non-CVA group, P = .11). In addition, we found a significant difference in terms of weight-bearing status at 6-weeks postoperatively (0.95 vs 2.0, P < .0001), favoring the bipolar HA group.Among the advantages of bipolar HA surgery, surgeons should consider its value in reducing the occurrence of postoperative CVA. Furthermore, patients who underwent bipolar HA had improved weight-bearing status postoperatively compared with cannulated screw fixation.
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Affiliation(s)
- Jeremy Dubin
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Ran Atzmon
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ashdod, Israel
| | - Viktor Feldman
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Farkash
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Nyska
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Tel Aviv Medical Center, Department of Orthopaedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Esequiel Palmanovich
- Meir Hospital, Orthopedic Department, Sapir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cecere AB, De Cicco A, Bruno G, Toro G, Errico G, Braile A, Schiavone Panni A. SuperPath approach is a recommendable option in frail patients with femoral neck fractures: a case-control study. Arch Orthop Trauma Surg 2022; 142:3265-3270. [PMID: 34482424 PMCID: PMC9522763 DOI: 10.1007/s00402-021-04153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The treatment of intracapsular femoral neck fractures (FNFs) in the elderly is usually based on hip replacement, both total hip arthroplasty (THA) and hemiarthroplasty (HA). Recently, several tissue-sparing approaches for hip arthroplasty had been described with promising results in terms of hospitalization length, blood loss and dislocation rate. The aim of the present study was to compare the blood loss and the transfusion rate in a cohort of patients with FNF treated using an HA through both the SuperPath (SP) and the traditional posterolateral (PL) approaches. MATERIALS AND METHODS We retrospectively collected data from patients affected by FNFs between January 2018 and February 2020. All patients with intracapsular FNF treated with a single HA implant (Profemur L, MicroPort Orthopedics Inc., USA) via PL or SP approaches were included. Exclusion criteria were pathological fractures, polytrauma and preoperatively transfused patients. RESULTS Thirty-five patients were included and analysed in the present study. 17 patients were classified in the SP group, and 18 in the PL one. The rate of antithrombotic therapy was higher in the SP group compared with the PL group [10 (58, 82%) vs 4 (22, 2%)]. While the two groups did not differ in terms of preoperative haemoglobin (Hb), 48 h postoperative Hb and Hb reduction, a significative difference was observed in terms of blood transfusion rate (1 SP vs 9 PL, p = 0.0072). CONCLUSIONS The SuperPath approach in patients with FNF under antithrombotic therapy assures lower transfusion rate, potentially reducing complication rates and improving patients' outcomes.
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Affiliation(s)
- Antonio Benedetto Cecere
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Gaetano Bruno
- Unit of Orthopaedics and Traumatology, AORN Sant'Anna E San Sebastiano, Caserta, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy.
| | - Giacomo Errico
- Unit of Orthopaedics and Traumatology, AORN Sant'Anna E San Sebastiano, Caserta, Italy
| | - Adriano Braile
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
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Lee A, Weintraub S, Xi IL, Ahn J, Bernstein J. Predicting life expectancy after geriatric hip fracture: A systematic review. PLoS One 2021; 16:e0261279. [PMID: 34910791 PMCID: PMC8673659 DOI: 10.1371/journal.pone.0261279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background Displaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient’s life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient’s life expectancy beyond two years and to identify those patient variables affecting survival of that duration. Methods Pubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables. Results There were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies. Discussion There are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.
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Affiliation(s)
- Alexander Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sara Weintraub
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ianto Lin Xi
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Huddleston JI, De A, Jaffri H, Barrington JW, Duwelius PJ, Springer BD. Cementless Fixation Is Associated With Increased Risk of Early and All-Time Revision After Hemiarthroplasty But Not After THA for Femoral Neck Fracture: Results From the American Joint Replacement Registry. Clin Orthop Relat Res 2021; 479:2194-2202. [PMID: 34398846 PMCID: PMC8445546 DOI: 10.1097/corr.0000000000001932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite ample evidence supporting cemented femoral fixation for both hemiarthroplasty and THA for surgical treatment of displaced femoral neck fractures, cementless fixation is the preferred fixation method in the United States. To our knowledge, no nationally representative registry from the United States has compared revision rates by fixation for this surgical treatment. QUESTION/PURPOSE After controlling for relevant confounding variables, is femoral fixation method (cemented or cementless) in hemiarthroplasty or THA for femoral neck fracture associated with a greater risk of (1) all-cause revision or (2) revision for periprosthetic fracture? METHODS Patients with Medicare insurance who had femoral neck fractures treated with hemiarthroplasty or THA reported in the American Joint Replacement Registry database from 2012 to 2017 and Centers for Medicare and Medicaid Services claims data from 2012 to 2017 were analyzed in this retrospective, large-database study. Of the 37,201 hemiarthroplasties, 42% (15,748) used cemented fixation and 58% (21,453) used cementless fixation. Of the 7732 THAs, 20% (1511) used cemented stem fixation and 80% (6221) used cementless stem fixation. For both the hemiarthroplasty and THA cohorts, most patients were women and had cementless femoral fixation. Early revision was defined as a procedure that occurred less than 90 days from the index procedure. All patients submitted to the registry were included in the analysis. Patient follow-up was limited to the study period. No patients were lost to follow-up. Due to inherent limitations with the registry, we did not compare medical complications, including deaths attributed directly to cemented fixation. A logistic regression model including the index arthroplasty, age, gender, stem fixation method, hospital size, hospital teaching affiliation, and Charlson comorbidity index score was used to determine associations between the index procedure and revision rates. RESULTS For the hemiarthroplasty cohort, risk factors for any revision were cementless stem fixation (odds ratio 1.42 [95% confidence interval 1.20 to 1.68]; p < 0.001), younger age (OR 0.96 [95% CI 0.95 to 0.97]; p < 0.001), and higher Charlson comorbidity index (OR 1.06 [95% CI 1.02 to 1.11]; p = 0.004). Risk factors for early revision were cementless stem fixation (OR 1.77 [95% CI 1.43 to 2.20]; p < 0.001), younger age (OR 0.98 [95% CI 0.97 to 0.99]; p < 0.001), and higher Charlson comorbidity index (OR 1.09 [95% CI 1.04 to 1.15]; p < 0.001). Risk factors for revision due to periprosthetic fracture were cementless fixation (OR 6.19 [95% CI 3.08 to 12.42]; p < 0.001) and higher Charlson comorbidity index (OR 1.16 [95% CI 1.06 to 1.28]; p = 0.002). Risk factors for early revision due to periprosthetic fracture were cementless fixation (OR 7.38 [95% CI 3.17 to 17.17]; p < 0.001), major teaching hospital (OR 2.10 [95% CI 1.08 to 4.10]; p = 0.03), and higher Charlson comorbidity index (OR 1.20 [95% CI 1.09 to 1.33]; p < 0.001). For the THA cohort, there were no associations. CONCLUSION These data suggest that cemented fixation should be the preferred technique for most patients with displaced femoral neck fractures treated with hemiarthroplasty. The fact that stem fixation method did not affect revision rates for those patients with displaced femoral neck fractures treated with THA may be due to current practice patterns in the United States. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | - Ayushmita De
- American Academy of Orthopaedic Surgeons, Rosemont, IL, USA
| | - Heena Jaffri
- American Academy of Orthopaedic Surgeons, Rosemont, IL, USA
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Charles-Lozoya S, Cobos-Aguilar H, Manilla-Muñoz E, De La Parra-Márquez ML, García-Hernández A, Rangel-Valenzuela JM. Survival at 30 days in elderly patients with hip fracture surgery who were exposed to hypothermia: Survival study. Medicine (Baltimore) 2021; 100:e27339. [PMID: 34596139 PMCID: PMC8483871 DOI: 10.1097/md.0000000000027339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
The effect of hypothermia as a mortality risk factor at 30 days in the elderly who had hip fracture (HF) surgery is still controversial because it may be due to a set of poorly identified factors. In this study, we aim to determine if exposure to intra and immediate postoperative hypothermia increases the incidence of mortality at 30 days in elderly patients who had HF surgery.Survival study in the elderly who had HF surgery with and without exposure to hypothermia. Sociodemographic, anesthetic and surgical factors were collected. The temperature of the rectum was measured at the end of the surgery and in the recovery room. The effect of hypothermia was analyzed by the incidence of mortality at 30 days. Other results were considered, such as, surgical site infection (SSI), blood transfusions, and influence of implants used in the 30-day mortality.Three hundred eighty five subjects were eligible, to include 300. Inadvertent hypothermia was 12%, the 30-day overall mortality was 9% and in subjects with hypothermia it was 25% (P = .002). Subjects with hypothermia had a higher risk of SSI (relative risk 4.2, 95% confidence interval 1.3-13.6, P = .03) and receive more transfusions (relative risk 3.6, 95% confidence interval 2.0-6.5, P < .001).Elderly subjects with HF exposed to hypothermia who undergo hip hemiarthroplasty and who receive 2 or more blood transfusions during their treatment, are at greater risk of dying after 30 days of the surgery. Hypothermia, as a possible causative factor of mortality, should continue to be studied.
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Affiliation(s)
- Sergio Charles-Lozoya
- Health Science Division, Division of Plastic and Reconstructive Surgery, Unit of Hip and Pelvis Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey, N.L., México
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza García, N.L., México
| | - Héctor Cobos-Aguilar
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza García, N.L., México
| | - Edgar Manilla-Muñoz
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza García, N.L., México
| | - Miguel Leonardo De La Parra-Márquez
- Health Science Division, Division of Plastic and Reconstructive Surgery, Unit of Hip and Pelvis Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey, N.L., México
| | - Adrián García-Hernández
- Health Science Division, Division of Plastic and Reconstructive Surgery, Unit of Hip and Pelvis Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social, Monterrey, N.L., México
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Varady NH, Gillinov SM, Yeung CM, Rudisill SS, Chen AF. The Charlson and Elixhauser Scores Outperform the American Society of Anesthesiologists Score in Assessing 1-year Mortality Risk After Hip Fracture Surgery. Clin Orthop Relat Res 2021; 479:1970-1979. [PMID: 33930000 PMCID: PMC8373577 DOI: 10.1097/corr.0000000000001772] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Risk adjustment has implications across orthopaedics, including informing clinical care, improving payment models, and enabling observational orthopaedic research. Although comorbidity indices (such as the American Society of Anesthesiologists [ASA] classification, Charlson comorbidity index [CCI], and Elixhauser comorbidity index [ECI]) have been examined extensively in the immediate perioperative period, there is a dearth of data on their three-way comparative effectiveness and long-term performance. Moreover, the discriminative ability of the CCI and ECI after orthopaedic surgery has not been validated in the ICD-10 era, despite new diagnosis codes from which they are calculated. QUESTION/PURPOSE Which comorbidity index (ASA, CCI, or ECI) is associated with the greatest accuracy on receiver operating curve (ROC) analysis with respect to the endpoint of death at 90 days and 1 year after hip fracture surgery in the ICD-10 era? METHODS A retrospective study was conducted on all patients undergoing surgical fixation of primary hip fractures at two Level I trauma centers and three community hospitals from October 2016 to May 2019. This time frame allowed for a 1-year baseline period of ICD-10 data to assess comorbidities and at least a 1-year follow-up period to assess mortality. Initially 1516 patients were identified using Common Procedural Terminology and ICD codes, of whom 4% (60 of 1516) were excluded after manual review; namely, those with pathologic fractures (n = 38), periprosthetic fractures (n = 12), and age younger than 18 years (n = 10). Of the patients who were studied, 69% (998 of 1456) were women and the mean ± SD age was 77 ± 14 years; 45% (656 of 1456) were treated with intramedullary nails, 32% (464 of 1456) underwent hemiarthroplasties, 10% (149 of 1456) underwent THAs, 7% (104 of 1456) underwent percutaneous fixations, and 6% (83 of 1456) were treated with plates and screws. The mean ± SD ASA score was 2.8 ± 0.6, CCI was 3.1 ± 3.2, and ECI was 5.2 ± 3.5. Hip fracture fixation was chosen as the operation of interest given the high incidence of this injury, the well-documented effects of comorbidities on complications, and the critical importance of risk stratification and perioperative medical management for these patients. Demographics, comorbidities, surgical details, as well as 90-day and 1-year mortality were collected. Logistic regressions with ROC curves were used to determine the accuracy and comparative effectiveness of the three measures. The 90-day mortality rate was 7.4%, and the 1-year mortality rate was 15.0%. RESULTS The accuracy (area under the curve [AUC]) for 1-year mortality was 0.685 (95% CI 0.656 to 0.714) for the ASA, 0.755 (95% CI 0.722 to 0.788) for the ECI, and 0.769 (95% CI 0.739 to 0.800) for the CCI. The CCI and ECI were more accurate than ASA (p < 0.001 for both), while the CCI and ECI did not differ (p = 0.30). The ECI (AUC 0.756 [95% CI 0.712 to 0.800]) was more accurate for 90-day mortality than the ASA (AUC 0.703 [95% CI 0.663 to 0.744]; p = 0.04), while CCI (AUC 0.742 [95% CI 0.698 to 0.785]) with ASA (p = 0.17) and CCI with ECI (p = 0.46) did not differ at 90 days. CONCLUSION Performance measures and research results may vary depending on what comorbidity index is used. We found that the CCI and ECI were more accurate than the ASA score for 1-year mortality after hip fracture surgery. Moreover, these data validate that the CCI and ECI can perform reliably in the ICD-10 era. If other studies from additional practice settings confirm these findings, as would be expected because of the objective nature of these indices, the CCI or ECI may be a useful preoperative measure for surgeons to assess 1-year mortality for hip fracture patients and should likely be used for institutional orthopaedic research involving outcomes 90 days and beyond. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Nathan H. Varady
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen M. Gillinov
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Caleb M. Yeung
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel S. Rudisill
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonia F. Chen
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Marom O, Yaacobi E, Shitrit P, Brin Y, Cohen S, Segal D, Ohana N. Proximal Femoral Fractures in Geriatric Patients: Identifying the Major Risk Factors for Postoperative Infection in a Single-Center Study. Isr Med Assoc J 2021; 23:494-496. [PMID: 34392624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Proximal femoral fractures (PFF) are among the most common injuries in the elderly population treated by orthopedic surgeons. Postoperative complications, especially infections, are of great importance due to their effect on patient mortality and morbidity and healthcare costs. OBJECTIVES To assess the main causes for postoperative infection among PFF patients. METHODS We conducted a retrospective analysis of PFF patients in our medical center between 2015 and 2017. Patients were divided into two groups based on whether there was postoperative infection during immediate hospitalization and 30 days after surgery. Factors such as time from admission to surgery, duration of surgery, and length of stay were analyzed. Groups were analyzed and compared using a t-test, chi-squared and Fisher's exact tests. RESULTS Of 1276 patients, 859 (67%) underwent closed reduction internal fixation, 67 (5%) underwent total hip arthroplasty, and 350 (28%) underwent hemiarthroplasty. Of the total, 38 patients (3%) were diagnosed with postoperative infection. The demographics and co-morbidities were similar between the two study groups. The incident of infection was the highest among patients undergoing hemiarthroplasty (6%, P < 0.0001). Length of hospitalization (15 vs. 8 days, P = 0.0001) and operative time (117 vs. 77 minutes, P = 0.0001) were found to be the most significant risk factors for postoperative infection. CONCLUSIONS Predisposition to postoperative infections in PPF patients was associated with prolonged length of surgery and longer hospitalization. We recommend optimizing fast discharge, selecting the appropriate type of surgery, and improving surgical planning to reduce intraoperative delays and length of surgery.
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Affiliation(s)
- Omer Marom
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Yaacobi
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Shitrit
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Brin
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Cohen
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Segal
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Ohana
- Department of Orthopedics, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Irianto KA, Widajanti N, Julianto E, Ien S, Panggabean RTM, Kloping YP. A Beneficial Bipolar Hemiarthroplasty on a Centenarian in One Developing Country. Acta Med Indones 2021; 53:202-207. [PMID: 34251349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Geriatric hip fractures are common; however, surgery on a 100-year-old patient is rare in Indonesia. We report arthroplasty in 100-year-old woman with right hip fracture and right Colles fracture; which benefits her a three year of active and qualified life. Despite her age, the patient was quite independent, active, and mobile beforehand. Hence a meticulous preoperative planning and post-operative rehabilitation were structured by a comprehensive medic and non-medic geriatric team. Cementless bipolar hemiarthroplasty was perfectly sufficient for the hip fracture under regional anesthesia while the Colles fracture was managed with a close reduction and plastering. Rehabilitation was started on Day-2 and continued weeks after discharge. The patient is still alive and well 3 years after the surgery. Surgery is beneficial for the 100-year-old patient; it is in the best interests of the patient's mobility and quality of life. Age alone should not limit a surgical decision as long as all comorbidities are controlled by a comprehensive medic and non-medic geriatric team.
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Affiliation(s)
- Komang Agung Irianto
- 1. Faculty of Medicine, Airlangga University - dr. Soetomo Hospital, Surabaya, Indonesia. 2. Surabaya Orthopedic and Traumatology Hospital, Surabaya, Indonesia.
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Weingärtner K, Störmann P, Schramm D, Wutzler S, Zacharowski K, Marzi I, Lustenberger T. Bone cement implantation syndrome in cemented hip hemiarthroplasty-a persistent risk. Eur J Trauma Emerg Surg 2021; 48:721-729. [PMID: 33495852 PMCID: PMC9001528 DOI: 10.1007/s00068-020-01587-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
Background Every year, ~ 210,000 initial implantations of hip endoprostheses are carried out in Germany alone. The “bone cement implantation syndrome” (BCIS) is considered a severe peri- and early-postoperative complication when implanting cemented prostheses. The origin of the BCIS and its impact on the clinical outcome are still uncertain. This study investigates the clinical progression after BCIS cases in patients with cemented hemiarthroplasty. Risk factors for the occurrence of BCIS are evaluated. Material and methods Clinical data of all patients with a proximal femur fracture and which received a cemented hemiarthroplasty within a period of 9.5 years have been collected. BCIS (+) patients and BCIS (−) patients were compared with respect to their demographics and clinical outcome. Risk factors for the development of BCIS were identified. Results A total of 208 patients could be included with complete data sets. The mean age was 81.1 ± 10.0 years. Overall, 37% of the patients showed symptoms of BCIS. In comparison to BCIS (−) patients there was a significantly higher rate of cardiovascular complications (27.3% vs. 13.7%, p = 0.016) and a higher in-hospital mortality rate (15.6% vs. 4.6%, p = 0.006) in BCIS (+) patients. Age, absence of a femoral borehole and ASA status were identified as statistically significant risk factors of BCIS. Conclusion BCIS is frequently observed and in some cases severe complication. The therapy is exclusively symptomatic; identifying preventional measures might reduce the occurrence of BCIS.
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Affiliation(s)
- Karoline Weingärtner
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Philipp Störmann
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - David Schramm
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
- Department of Trauma, Hand and Orthopedic Surgery, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Street 100, 65199, Wiesbaden, Germany
| | - Sebastian Wutzler
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
- Department of Trauma, Hand and Orthopedic Surgery, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Street 100, 65199, Wiesbaden, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Lustenberger
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany.
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Kennedy JS, Garrigues GE, Pozzi F, Zens MJ, Gaunt B, Phillips B, Bakshi A, Tate AR. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation for anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2149-2162. [PMID: 32534209 PMCID: PMC8262512 DOI: 10.1016/j.jse.2020.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 02/01/2023]
Abstract
Anatomic total shoulder arthroplasty is the gold standard shoulder replacement procedure for patients with an intact rotator cuff and sufficient glenoid bone to accommodate prosthetic glenoid implant and offers reliable patient satisfaction, excellent implant longevity, and a low incidence of complications. Disparity exists in the literature regarding rehabilitation strategies following anatomic total shoulder arthroplasty. This article presents a consensus statement from experts in the field on rehabilitation following anatomic total shoulder arthroplasty. The goal of this consensus statement is to provide a current evidence-based foundation to inform the rehabilitation process after anatomic total shoulder arthroplasty. These guidelines apply to anatomic total shoulder arthroplasty (replacement of the humeral head and glenoid), hemiarthroplasty (replacing only the humeral head), and hemiarthroplasty with glenoid reaming or resurfacing. The consensus statement integrates an extensive literature review, as well as survey results of the practice patterns of members of the American Society of Shoulder and Elbow Therapists and the American Shoulder and Elbow Surgeons. Three stages of recovery are proposed, which initially protect and then gradually load soft tissue affected by the surgical procedure, such as the subscapularis, for optimal patient outcomes. The proposed guidelines should be used in collaboration with surgeon preferences and patient-specific factors.
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Affiliation(s)
- June S Kennedy
- Department of Physical and Occupational Therapy, Duke University Health Systems, Durham, NC, USA.
| | | | | | | | - Bryce Gaunt
- Human Performance Rehabilitation Centers at St Francis Rehabilitation Center, Columbus, GA, USA
| | - Brian Phillips
- Human Performance Rehabilitation Centers at St Francis Rehabilitation Center, Columbus, GA, USA
| | - Ashim Bakshi
- The Hand and Orthopedic Rehab Clinic, Terre Haute, IN, USA
| | - Angela R Tate
- Excel Physical Therapy, Blue Bell, PA, USA; Arcadia University, Glenside, PA, USA
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Tan WL, Shi YX, Zhang JY, Tang CR, Guan QB, Tan JJ. Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more. Medicine (Baltimore) 2020; 99:e21862. [PMID: 32925723 PMCID: PMC7489614 DOI: 10.1097/md.0000000000021862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more.This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared.There are no statistically significant differences when compared general data in patients from group A and B (P > .05). Operation time in Group A is less than Group B (103.33, 40-230 min vs 122.64, 75-180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50-100 mL vs 194.44, 100-500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7-100 days vs 6.67, 4-14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0-91 points vs 64.41, 0-90 points, P > .05).Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more.
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Affiliation(s)
- Wen-Le Tan
- Department of Orthopedics, Luoding People's Hospital, Luoding
| | - Yan-Xin Shi
- Department of Lower Extremity Orthopedics, Zhengzhou Orthopedic Hospital, Zhengzhou, Henan, P.R.China
| | - Jing-Yi Zhang
- Department of Lower Extremity Orthopedics, Zhengzhou Orthopedic Hospital, Zhengzhou, Henan, P.R.China
| | - Chan-Rui Tang
- Department of Orthopedics, Luoding People's Hospital, Luoding
| | - Qing-Bin Guan
- Department of Orthopedics, Luoding People's Hospital, Luoding
| | - Jian-Ji Tan
- Department of Orthopedics, Luoding People's Hospital, Luoding
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50
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Tu DP, Liu Z, Yu YK, Xu C, Shi XL. Internal Fixation versus Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fractures in the Elderly: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:1053-1064. [PMID: 32691520 PMCID: PMC7454150 DOI: 10.1111/os.12736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/03/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy of internal fixation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. METHODS A search was conducted in PubMed, Web of Science, Embase, and Cochrane Library databases up to April 2020. The present study compared internal fixation and hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly. RevMan5.3 software provided by the International Cochrane Group was used for the meta-analysis. To compare the differences in the operation time, intraoperative bleeding, length of hospital stay, superficial infection, Harris hip score, mortality within 1 year, mortality within 2 years, reoperation, incidence of deep venous thrombosis (DVT), partial weight-bearing time, non-union, and implant-related complications between an internal fixation group and an hemiarthroplasty group. RESULTS A total of 1300 patients were included in nine studies. The results showed that the operation time (MD = -18.09, 95% CI: -27.85--8.34, P = 0.0003), intraoperative bleeding (MD = -195.31, 95% CI: -244.8--147.74, P < 0.0001), implant-related complications (MD = 3.83, 95% CI: 1.74-8.45, P = 0.0008), and partial weight-bearing time (MD = 17.21, 95% CI: 1.63-32.79, P = 0.03) have statistical significance. However, there is not statistical significance for the Harris hip joint function scale (HHS) (MD = 5.60, 95% CI: -1.13-12.33, P = 0.10), DVT (MD = 1.02, 95% CI: 0.45-2.27, P = 0.97), length of hospital stay (MD = -1.08, 95% CI: -2.82-0.66, P = 0.22), superficial Infection (OR = 0.92, 95% CI: 0.43-1.98, P = 0.89), mortality within 1 year (OR = 0.95, 95% CI: 0.61-1.48, P = 0.81), mortality within 2 years (OR = 0.93, 95% CI: 0.61-1.43, P = 0.75), reoperation (MD = 1.80, 95% CI: 0.64-5.04, P = 0.26), and non-union (OR = 1.20, 95% CI: 0.48-3.03, P = 0.70). The result of the subgroup analysis showed no significant differences between the less than 2 years follow-up and the 2 years or more follow-up group. The only difference was for the Harris hip score: the internal fixation group was superior to the hemiarthroplasty group in the less than 2 years subgroup analysis, while there was no difference between the internal fixation group hemiarthroplasty group in the 2 years or more subgroup analysis. CONCLUSION Compared with the internal fixation group, those in the hemiarthroplasty group could carry out weight-bearing training early and implant-related complications were reduced, but it requires longer operation time and there is greater intraoperative blood loss. There is no difference in mortality, the incidence of DVT, non-union, HHS, reoperation, length of hospital stay, and superficial infection. Hemiarthroplasty may be a better choice for unstable intertrochanteric fractures in the elderly.
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Affiliation(s)
- Dong-Peng Tu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
- Department of Orthopaedics, Xinhua Hospital of Zhejiang Province, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zheng Liu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
| | - Yi-Kang Yu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
| | - Chao Xu
- Zhejiang Chinese Medical University, Second Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, China
- Department of Orthopaedics, Xinhua Hospital of Zhejiang Province, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao-Lin Shi
- Department of Orthopaedics, Xinhua Hospital of Zhejiang Province, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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