EVALUATION OF FUNCTIONAL OUTCOME OF DUAL MOBILITY CUPS IN TOTAL HIP ARTHROPLASTY IN ARTHRITIS HIP AND FEMORAL NECK FRACTURES

Background- Osteoarthritis hip and femoral neck fractures in old age can be treated by total hip arthroplasty using dual mobility cup designs. The posterior approach (Kocher-Langenbeck) was used earlier however, lateral (Harding) and anterior approach (Smith-Petersen) are more often used. Evaluation of functional outcomes of total h Aim- ip arthroplasty using dual mobility cups in patients with osteoarthritis hip and femur neck fractures in terms of time of surgery, re-operation rate and mortality in 1 year, length of hospital stay and post-operative complications, using Harris Hip Score (HHS). Study Design- Hospital based prospective cohort study. Material and Methods- 40 cases were include in the study of which, 20 cases are of osteoarthritis hip and 20 cases are of femur neck fracture managed by dual mobility total hip arthroplasty. Clinical and functional outcome was graded using HHS. Anatomical reduction was assessed at 8 weeks, 3months, 6 months and 9 months. The mean HHS at 8 weeks, 3months, 6 months and 9 mont Result- hs in osteoarthritis hip was 56.40, 69.80, 80.90 and 91.50 and in femur neck fractures was 51.10, 63.50, 74.60 and 84.50, achieved. Better result was found in osteoarthritis hip. Conclusion- We concluded that using dual mobility total hip arthroplasty in osteoarthritis hip is far better than femur neck fractures due to better clinical and functional outcome, better anatomical reduction.

Comparison of Anterior and Lateral Approach in Hip Hemiarthroplasty for Femur Neck Fractures in the Elderly: Clinical and Radiographic Outcomes

@#Introduction: Many surgical approaches have been described for hip hemiarthroplasty (HHA) treating femur neck fractures (FNFs). Direct lateral approach (DLA) is one of the most used. Today, the direct anterior approach (DAA) has become very attractive, but it seems to involve more intra-operative fractures. Our main endpoint was to demonstrate that the DAA may be a valid alternative comparing to the DLA. Materials and methods: Patients affected by FNFs and treated with HHA between the years 2016 and 2020 were studied. We divided the treatment of the fractures according to the surgical approach. The analysis was focused on perioperative complications and radiological outcomes. Results: There were a total of 166 patients. The DLA group included patients with an average age of 83.5 years and the DAA group of 83 years. We found similar surgical times (DLA 67 min vs DAA 61 min; p = 0,55), number of transfusions (DLA 3/person vs DAA 4/person; p = 0,91), perioperative complications (fractures: DLA 0 vs DAA 0 – dislocations: DLA 2,50% vs DAA 0) and functional outcomes (HHS: DLA 83 points vs DAA 87 points; p = 0,71). There were no statistical differences comparing diaphyseal filling (Canal Fill Index at the proximal third: DLA 0,79 vs DAA 0,78; p= 0,24), bone loss (Paprosky I: DLA 96,25% vs DAA 91,86%; p = 0,47) and prevalence of heterotopic ossification (Broker low degree: DLA 93,75% vs 95, 34%; p = 0,87). Conclusion: Analysing perioperative complications and studying post-operative radiographic evolution, our results suggest that the DAA is a valid alternative to the DLA in HHA treating FNFs.

Femur Neck Fracture in a Young Marfan Syndrome Patient / 대한고관절학회지

Marfan syndrome is an autosomal dominant and could decrease bone mineral density. So patients with Marfan syndrome could vulnerable to trauma in old ages. We present the first report, to the best of our knowledge, of a rare fracture of the femoral neck with a minor traumatic history in a juvenile Marfan syndrome patient whose physis is still open. Although the patient is young, her bone mineral density was low and the geometry of femur is changed like old ages. The femur neck fracture in children is very rare and only caused by high energy trauma, we concluded that the Marfan syndrome makes the bone weaker in young age and preventative medications to avoid fractures in younger Marfan syndrome patients are necessary in early ages.

Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures

BACKGROUND: The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality. METHODS: Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery. RESULTS: Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036). CONCLUSIONS: Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients.

The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures / 대한고관절학회지

PURPOSE: This study aims to determine the correlation between the fracture patterns and the complications in patients with femoral neck fracture treated with internal fixation. MATERIALS AND METHODS: The study comprises 45 patients with femoral neck fracture treated with multiple screws or compression hip screw between May 2008 and April 2012. The mean age was 48 years at the time of the surgery and the mean duration from initial injury to surgery was 20 hours. The fracture patterns were identified according to the anatomical location, the Garden classification and the Pauwels classification. The occurrence of nonunion and avascular necrosis were reviewed with clinical results including Harris hip score and Lunceford hip function test. The correlation between the fracture pattern and occurrence of complications were analyzed. RESULTS: Fracture site union was achieved in 40 hips with the average union time of 17 weeks. Five nonunions occurred which showed high likelihood to occur in subcapital type, displaced (Garden stage III or IV) and Pauwels type III fractures (P0.05). The mean Harris hip score was 91 points, and Lunceford functional results were excellent in 15 hips, good in 24, fair in 4 and poor in 2. CONCLUSION: There was high risk of nonunion in subcapital type fracture, displaced fracture (Garden stage III and IV) and vertically oriented fracture (Pauwels type III). Careful attention is needed in these fracture types.

The Early Result of Cementless Arthroplasty for Femur Neck Fracture in Elderly Patients with Severe Osteoporosis / 대한고관절학회지

PURPOSE: The purposes of the current study were to assess the early results of cementless hip arthroplasty (HA) for femoral neck fractures in elderly patients with severe osteoporosis and to compare the clinical outcomes between those who underwent total HA (THA) or bipolar hemiarthroplasty (BHA). MATERIALS AND METHODS: From April 2011 to May 2012, we performed 87 cementless HAs for displaced femoral neck fractures in elderly patients (> or =65 years) with severe osteoporosis. Among them, we studied 70 hips that were able to be followed-up for >24 months. Of these, 34 underwent THA and 36 underwent BHA. Clinical results were evaluated using the Harris hip score (HHS), Koval classification, and radiographs. RESULTS: Only one instance of femoral stem loosening was observed. Additionally, no dislocations were observed and no revision surgeries were required. The mean changes in the functional items of the HHS scores were 2.8 and 5.2 for those who underwent THA and BHA, respectively (P<0.05). According to the Koval classification used for the ambulatory status analysis, the mean perioperative change in the grade was 0.8 (0-4), with no significant differences noted between the THA and BHA groups. CONCLUSION: The early results of cementless HA for femur neck fractures in elderly patients with osteoporosis were satisfactory, and THA was found to have a functional advantage over BHA.

Funcionalidade após fratura do colo do fêmur / Outcome after femoral neck fracture / Funcionalidad después de la fractura del cuello del fêmur

As fraturas do colo do fêmur são comuns no idoso, condicionando-lhe a qualidade de vida, aumentandoa morbilidade, mortalidade e os custos com a saúde. Foram objetivos deste estudo caracterizar a evolução dafuncionalidade do idoso após fratura do colo do fêmur e identificar as variáveis que condicionam a evolução dessa.Por meio de revisão sistemática de literatura, realizada no segundo semestre de 2010, identificaram-se cinco estudosque permitem responder às questões centrais deste estudo: Como evolui a funcionalidade do idoso após fratura docolo do fêmur? Que variáveis condicionam a evolução da funcionalidade? Da análise dos estudos concluiu-se queuma elevada percentagem dos idosos não é independente no momento da alta, a maioria é dependente e necessitade ajuda para a realização de pelo menos uma atividade de vida diária. Há uma deterioração da funcionalidadeao longo do primeiro ano pós-fratura, não sendo possível recuperar a autonomia para os níveis pré-fratura. Asalterações decorrentes do processo de envelhecimento, a patologia associada e a imobilidade perioperatóriacontribuem para o declínio da funcionalidade. Concluiu-se que a capacidade de marcha é o melhor preditor paraa recuperação do autocuidado.

Femoral neck fractures are common in elderly people, constraining their quality of life, increasing morbidity,mortality and health costs. The aim of this study is to characterize the evolution of the functionality of the elderlyafter femoral neck fracture and to identify the variables that influence its evolution. Through systematic literaturereview, conducted in the second semester of 2010, five primary studies were identified which allowed the answer ofthe following central questions of this study: How does functional ability of older patient evolves after femoral neckfracture? What variables influence in regaining functional ability? The analysis of the primary studies concluded thata high percentage of elderly patients are not independent at the moment of discharge. The majority of these patientsis dependent on someone in at least one daily activity and needs help to achieve it. There is a decline of functionalability over the first year post fracture and the patients cannot regain their pre-fracture functional status. The changesthat naturally occur in the aging process, the pathology and the immobility after surgery promote functional decline.It can be concluded that walking skills are the best predictors for recovering self-care.

Las fracturas del cuello del fémur son comunes en personas mayores, restringiendo su calidad de vida, aumentandola morbilidad, la mortalidad y los costes con salud. Los objetivos de este estudio son caracterizar la evolución de lafuncionalidad de las personas mayores después de la fractura del cuello del fémur e identificar las variables queinfluyen en la evolución de esta. A través de la revisión sistemática de la literatura, realizada en el segundo semestrede 2010, se identificaron cinco estudios que permiten responder a las cuestiones centrales de esta investigación:¿Cómo se desarrolla la funcionalidad de la persona mayor después de la fractura del cuello del fémur?; ¿Quévariables influyen en la evolución de la funcionalidad? Del análisis de los estudios se concluye que un alto porcentajede personas mayores no es independiente al recibir el alta, la mayoría es dependiente y necesita de ayuda al menos en una actividad diaria. Hay un deterioro de la funcionalidad durante el primer año post-fractura, siendodifícil recuperar la autonomía a los niveles de pre-fractura. Los cambios decurrentes del proceso de envejecimiento,la patología asociada y la inmovilidad peri operatoria contribuyen para la disminución de la funcionalidad. Seconcluye que la capacidad de marcha es el mejor predictor para la recuperación del autocuidado.