ABSTRACT
Objective To compare the clinical effects of improved posterolateral minimally invasive approach and traditional posterolateral approach combined with modular femoral head prosthesis in the treatment of femoral neck fractures in the elderly. Methods The study involved 70 patients with femoral neck fractures (26 males and 44 females; at age range of 67-95 years,mean 78.3 years) treated from October 2008 to June 2010.There were 62 patients with fresh femoral neck fractures and eight with old femoral neck fractures (2-4 months post-injury),all of whom were type Ⅲ or Ⅳ fractures according to the Garden' s classification.All surgeries were completed by the same operation group.The improved posterolateral minimally invasive approach group involved 32 patients including 12 males and 20 females and the traditional posterolateral approach group involved 38 patients including 14 males and 24 females.The two groups were compared in aspects of incision size,operative time,perioperative complications,prosthesis stability and hip functional recovery. Results All patients were followed up for an average of 16 weeks (range,12-18 weeks).The differences between the two groups were significant regarding the incision length,perioperative blood loss,and blood product transfusio amount (P ＜0.01 ),but insignificant in operative time ( P ＞ 0.05 ).All patients were able to take weight-bearing walk six weeks postoperatively.The two groups showed significant difference in the hip joint function by Chamley's criteria six weeks postoperatively ( P ＜ 0.05 ),but insignificant difference in the hip joint function by Harris' s criteria at the last follow-up ( P ＜ 0.05). Conclusion The modified posterolateral minimally invasive approach combined with modular femoral head prosthesis is a satisfactory method in treatment of femoral neck fractures in senile patients,for it can result in less intra-operative soft tissue damage and blood loss,as well as shorter rehabilitation time.
ABSTRACT
Objective To retrospectively study the perioperative complications and postoperative function recovery of 93 patients treated with simultaneous bilateral total hip arthroplasty (THA). Methods A total of 93 patients (186 hips) undergone simultaneous bilateral THA from January 1999 to January 2009 in our hospital were involved in this study. There were 70 males and 23 females (at age range of 25-65 years, average 41. 8 years). The preoperative diagnosis included bilateral avascular necrosis of femoral head in 48 patients, rheumatoid arthritis in 11, developmental dysplasia of the hip in 26 and ankylosing spondylitis in 8. The intraoperative blood loss, Harris scores before operation and at final followup as well as perioperative complications were analyzed. Results All the patients were followed up for average 65 months (12-118 months), which showed femur fracture in one patient and infection six months after discharge in one patient. The Harris score was increased from (36.7 ±6.1) points preoperatively to (91.2±6.2) points at the final follow-up. Hip pain disappeared in 92 patients after operation and radiograph showed no loosening. Actebular loosening occurred in one patient 49 months after operation and was revised accordingly. Conclusion Under strict control of operation indications, suitable choice and implantation of the prosthesis and emphasis on perioperative management and postoperative rehabilitation, simultaneous bilateral THA is a safe and effective choice for bilateral hip diseases.
ABSTRACT
These case series on open reduction with internal fixation (ORIF) and total hip arthroplasty (THA) suggest that the type of surgery may not strongly affect the clinical outcome among patients. However, complications such as heterotopic ossification may be increased among ORIF patients compared to THA patients.Differences in study populations, especially age, may influence the outcome independent of the treatment. Studies evaluating THA involved older patients on average than ORIF studies, making conclusions regarding treatment superiority impractical. A randomized control trial might be warranted to provide more conclusive results on this topic.