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.

Geriatric intertrochanteric fractures – A challenge to manage

Background: Intertrochanteric fractures are among the frequently seen fractures in the elderly population. Treating these fractures is very challenging considering the fact that the quality of bone is poor and highly osteoporotic. The high failure rates with dynamic hip screw (DHS) especially in unstable fractures lead to the development of intramedullary devices such as proximal femoral nail (PFN) which has got multiple advantages over DHS. Materials and Methods: This prospective study included 30 patients above the age group of 60 years with unstable intertrochanteric fractures conducted in a tertiary institute between February 2021 and June 2022. Results were analyzed clinically and radiologically using the Modified Harris hip score. Results: Patients’ age group was 61–85 years with a mean age of 69 years, comprising 63% female and 37% male. The average Harris hip score was 83.76 at 24 weeks’ follow-up with 33.33% excellent, 56.66% good, 3.33% fair, and 6.67% poor. Postoperative complications included revision surgery in two patients, superficial infection in one patient, Z effect in one patient, peri-implant fracture in one patient. Conclusion: Treatment with PFN for unstable intertrochanteric fracture has the advantages of closed reduction, less tissue damage, early rehabilitation, and return to work. Osteosynthesis with short PFN resulted in good-to-excellent functional and radiological outcomes.

Pre-operative Factors Predicting Mortality in Six Months and Functional Recovery in Elderly Patients with Hip Fractures

@#Introduction: This study aimed to determine on-admission and perioperative factors predicting six-month mortality and functional recovery in Vietnamese patients with hip fracture. Materials and methods: Between April 2020 and July 2021, 118 patients participated in this prospective study. Patients’ data were collected from medical records. Harris hip score (HHS) was used to evaluate the functional recovery six months after fractures. The obtained data were analysed using a univariate and multivariate model. Results: The mean age of the participants was 79.5±9.4 years and 68.6% of the patients were female. The six-month mortality rate was 5.9% and independently associated with age (odds ratio (OR): 3.512, 95% confidence interval (CI) 1.538 – 8.019; P<0.001, patients aged >80 years vs those aged ≤80 years) and hypoproteinemia (OR: 2.859, 95% CI: 1.001 – 8.166, P=0.049). Among 111 survivors there were 66 (59.5%) of patients with a good functional recovery. Patients aged >80 years had a higher risk of poor functional outcome (OR: 3.167, 95% CI: 1.386 – 7.235, P: 0.006) compared to those aged ≤ 80 years. No significant correlations between other clinical (gender, body mass index, comorbidities, type of fractures or surgery, time until surgery) or laboratory parameters (anaemia, hyperglycemia, marked elevation of C reactive protein level, electrolyte abnormalities, elevated urea) and mortality or functional outcome were found. Conclusion: Advanced age is the most important factor affecting both mortality and functional outcome while hypoproteinemia is associated with a higher risk of mortality in elderly patients with hip fractures.

Analysis of influence of MR signs on Harris score in ARCO stages 2-4 femoral head necrosis / 中国骨伤

OBJECTIVE@#To analysis and determine MR signs of Harris score ARCO stages 2-4 in osteonecrosis of femoral head (ONFH).@*METHODS@#Thirty-four patients with ONFH of ARCO stages 2 to 4 who underwent routine MR, T2 mapping, 3D-SPACE sequence examination and Harris score were retrospectively collected from January 2019 to June 2020, and 3 patients were excluded, and 31 patients were finally included, including 23 males and 8 females, aged from 18 to 62 years old with an average of(40.0±10.8) years old. Among them 21 patients with bilateral femoral head necrosis, totally 52 cases, including 17 with ARCO stage 2 patients, 24 ARCO stage 3, and 11 ARCO stage 4. MR imaging signs (femoral head collapse depth, ONFH index, bone marrow edema, hyperplasia, grade and T2 value of cartilage injury, and joint effusion) were scored and measured on the picture archiving and communication system (PACS) workstation, and the cartilage quantitative parameter T2 value was calculated and measured on Siemens postprocessing workstation. Pearson correlation analysis was used to evaluate the correlation between various MR signs and Harris score, and then multiple linear regression analysis was used to examine impact of MR signs on Harris hip score.@*RESULTS@#Femoral head collapse depth(r=-0.563, P=0.000), grade of cartilage injury(r=-0.500, P=0.000), and joint effusion (r=-0.535, P=0.000) were negatively correlated with Harris score by Pearson correlation analysis. Multiple linear regression analysis showed that joint effusion(β=-6.198, P=0.001) and femoral head collapse depth(β=-4.085, P=0.014) had a significant negative impact on Harris hip score.@*CONCLUSION@#Femoral head collapse depth and joint effusion both had significant negative relationship with Harris hip score. It is recommended to routinely evaluate femoral head collapse depth and joint effusion quantitatively and gradedly, so as to efficiently and accurately assist clinical diagnosis and treatment.

Comparitive Analysis of Outcome of Proximal Femoral Nail Antirotation II (PFNA-II) and Dynamic Hip Screw (DHS) in the Management of Intertrochanteric Fractures of Femur

Background: To compare the clinical and radiological outcomes of patients with intertrochanteric fractures treated with PFNA-II versus DHS. Material & Methods:50 adult patients with inter-trochanteric fractures, >20 years old, were randomly distributed into the PFNA-II and DHS groups. DHS with side-plate and proximal femoral nail A-II of appropriate size was used. The patients were regularly followed up till 1 year post-operatively. The clinical, radiological and functional evaluations were done at regular intervals. The peri-operative, early and delayed complications were recorded, and the final outcome of either group was evaluated using the Harris Hip Score. Results:In the DHS group, the mean Harris Hip Score was slightly lower than that of the PFNA-II group at six month follow-up. However, at the 1 year follow-up, both the groups achieved similar Harris Hip Scores. Conclusion:PFNA-II provides a significantly shorter operative time with a smaller incision that leads to lesser blood loss and wound-related complications. However, the incidence of procedural errors was significantly higher in PFNA-II when compared with DHS as it is a technically more demanding procedure that leads to more implant failures and consequent re-operations.

EVALUATION OF SURGICAL OUTCOME OF DUAL MOBILITY TOTAL HIP REPLACEMENT

INTRODUCTION;To reduce the incidence of instability anddislocation rate following primary Total Hip Replacement (THR)surgery, Dual Mobility Total Hip Replacement (DMTHR)component has been developed.AIMS AND OBJECTIVES ;This study is aimed to assess thefunctional result and complications following DMTHR.MATERIALS AND METHODS 26 patients who have undergoneDMTHR between June 2018 to February 2020 were included inthis retrospective study. Modified Harris Hip Score was used toevaluate surgical and functional outcome.RESULT ;Out of 26 patients in this study, 17 were males and 9were females. The mean age was 52 years (Range 21 to 81years). As per Modified Harris Hip Score functional outcome wasExcellent in 20 (77%), Good in 4 (15%), Fair in 1 (4%) and poorin 1 (4%), patients.CONCLUSION Dual mobility total hip replacement providesgood hip range of movement and stability and is also associatedwith lower dislocation rate.

Femoral Stem Subsidence and its Associated Factors after Cementless Bipolar Hemiarthroplasty in Geriatric Patients

@#Introduction: Early femoral stem subsidence has been a concern as a predictor of the beginning of implant loosening, especially on cementless hip arthroplasty implants. This study aimed to determine the factors that affect femoral stem subsidence and outcome following hemiarthroplasty in the geriatric population. Materials and Methods: This is a retrospective study of 179 patients who underwent cementless bipolar hemiarthroplasty during the 2011-2019 period at an orthopaedic and traumatology hospital. Data on the patient's demography, pre-operative American Society Anaesthesiologist (ASA) score, body mass index (BMI), canal flare index (CFI), Dorr classification, and stem alignment were obtained. The primary outcomes were post-operative femoral stem subsidence, post-operative pain, and functional outcome using Harris Hip Score (HHS). Statistical analysis was conducted to identify risk factors associated with the primary outcome. Results: The mean femoral stem subsidence was 2.16 ±3.4 mm. The mean post-operative Visual Analog Score (VAS) on follow-up was 1.38 ± 1. Mean HHS on follow-up was 85.28±10.3. American Society Anaesthesiologist score 3 (p = 0.011, OR = 2.77) and varus alignment (p=0.039, OR = 6.963) were related to worse stem subsidence. Otherwise, neutral alignment (p = 0.045 and OR = 0.405) gave protection against femoral stem subsidence. The female gender (p = 0.014, OR 2.53) was associated with postoperative pain onset. Neutral alignment had significant relationship with functional outcomes (p = 0.01; OR 0.33). Conclusion: A higher ASA score and varus stem alignment were related to a higher risk of femoral stem subsidence. Meanwhile, neutral stem alignment had a protective effect on the femoral stem subsidence and outcome.

Functional outcomes among geriatric fragility hip fracture patients in a developing country: A comparative study between complete and incomplete post-operative rehabilitation

@#<p style="text-align: justify;"><strong>Objective.</strong> The study compared functional outcomes among post-operative geriatric fragility hip fracture patients who received complete and incomplete rehabilitation.</p><p style="text-align: justify;"><strong>Methods.</strong> This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were contacted and interviewed through Telemedicine. They were asked to answer two questionnaires - the Modified Harris Hip Score (MHHS) and the EuroQol-5D-5L (EQ-5D-5L). The scores were tallied and used to describe and compare the post-operative functional outcomes between the two rehabilitation pathways.</p><p style="text-align: justify;"><strong>Results.</strong> Among the 50 patients included in this study, twenty-three (46%) patients underwent complete rehabilitation, while 27 (54%) underwent incomplete rehabilitation. The average corrected MHHS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent complete rehabilitation, and an outcome of 75.9 among patients who underwent incomplete rehabilitation. Results to the EQ-5D--5L survey showed that a majority of patients who underwent complete rehabilitation reported having 'no problems' in terms of self-care, and anxiety or depression. However, the same group had more patients reporting 'any problems' in terms of mobility. On the other hand, a bigger proportion of patients from the incomplete rehabilitation group presented with 'any problems' in terms of usual activities. Proportions were similar for both groups in terms of pain or discomfort, with neither group having patients who reported extreme pain or discomfort.</p><p style="text-align: justify;"><strong>Conclusion.</strong> In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive complete rehabilitation from those who undergo incomplete rehabilitation. Continuing this study may better describe and differentiate the functional outcomes in order to pave the way for evidence-based protocols dedicated to providing the highest quality of care for acute fragility fracture patients.</p>

Open reduction for neglected traumatic hip dislocation in children and adolescents

Background: Neglected traumatic dislocation of the hip is extremely rare in children, and the preferred treatment remains unclear. In this study we studied the role of open reduction in neglected traumatic hip dislocation in children and adolescents as a modality of treatment.Methods: Eight patients with a neglected, traumatic dislocation of the hip received in the emergency department of GMC, Jammu were managed by open reduction. Types of dislocations, associated lesions, treatment methods, complications, and clinical and radiological outcomes were reviewed in the study.Results: All patients presented with limp and pain. Six patients had minimal difficulty in squatting while two had marked difficulty. Leg lengths were within 2 cm in 7 of 8 cases at follow-up, and only 1 patient had a discrepancy greater than 2 cm.Conclusions: Open reduction is a satisfactory treatment for neglected hip dislocation. It restores joint stability, range of motion and limb length.

A Prospective Study of the Functional Outcome of Intertrochanteric Femoral Fracture Managed with Short Proximal Femoral Nail

Introduction: Fractures through the intertrochanteric lineof the upper end of the femur, and peritrochanteric fractures,unite readily no matter what treatment is used because thebroad fractured surfaces are richly supplied with blood andthere is seldom wide displacement. But at the same time,unless suitable precautions are taken, the fracture may unitein a position of coxavara with shortening of the limb andlimitation of hip movements. Hence we conducted a studyin our set up to know the functional result of short proximalfemoral nail (PFN) in treatment of these fractures.Material and Methods: We included all intertrochantericfracture of femur in skeletally mature patient who are fit forsurgery in our study. Fifty patients treated with short PFNwere included in the study.Results: Majority of the patient in our study were between61-80 years with a mean age of 74.46 ± 12.04 years. About 52percent of the patients were female and 48 percent male. Fallat home was the most common mode of injury. Right hip wasinvolved in 48% of the patient and left hip was 52%. The shortPFN required shorter incisions, less blood loss and operativetimes. Average time for operation was 42.30±10.01. Postoperative complications included revision surgery 2 (4.0%)patients, superficial infection in 2 (4.0%), Z effect in 1 (2.0%)patient, inadequate reduction in 1 (2.0%) patient, difficultyin distal locking in 1 (2.0%) patient and varus in 1 (2.0%)patient. The average harris hip score came out to be 87.37at 24 weeks and 90% of the patients belonged to the ‘good’group and 6% of the patients belonged to the ‘excellent’group intertrochanteric fractures, treated with short PFN, hadsignificantly better outcomes with all patients having goodresults in 24 weeks which is very short time. Conclusion:Intra operative technical difficulties associated with short PFNcan be reduced by thorough knowledge and understanding ofboth the anatomy and implant. By using some technical tipsdifficult closed reduction can be done and internal fixationwith PFN can be attempted.

Outcomes and metal ion levels of birmingham hip resurfacing versus total hip Arthroplasty: A systematic review and meta-analysis / 中国组织工程研究

BACKGROUND: Total hip arthroplasty is the gold standard for the end stage of elderly hip disease, but Birmingham hip resurfacing has become an effective alternative to total hip arthroplasty for young people with high levels of exercise. Whether Birmingham hip resurfacing has an advantage over total hip arthroplasty is still inconclusive. OBJECTIVE: To systematically review the efficacy and metal ion level of Birmingham hip resurfacing and total hip arthroplasty. METHODS: The electronic databases of PubMed, EMBASE, Cochrane library, and Web of Science, which last updated on November 30, 2018, were searched for clinical control study of Birmingham hip resurfacing and total hip arthroplasty. Literature data were extracted and literature quality was evaluated. Meta-analyses were performed with RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Twelve studies were identified with a total of 2 317 patients (n=1 279 in Birmingham hip resurfacing group and n=1 038 in total hip arthroplasty group). (2) Meta-analysis results demonstrated that in the primary outcome measures, the Birmingham hip resurfacing group did not differ from the total hip arthroplasty group during short-term follow-up (RR=0.13, 95% CI [0.02, 1.01], P=0.05), but Birmingham hip resurfacing had a lower revision rate during long-term follow-up (RR=0.27, 95% CI [0.15, 0.50], P 0.05). (4) Finally, in the metal ion level, whether it was short-term follow-up or long-term follow-up, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty (P < 0.05). While at the Cr ion level, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty in short-term follow-up (P=0.55), but long-term follow-up showed that Birmingham hip resurfacing released more Cr ions than total hip arthroplasty after surgery, and the difference between the groups was statistically significant (P=0.03). (5) In conclusion, compared with total hip arthroplasty, Birmingham hip resurfacing has a smaller revision rate and overall complication, a better hip function score, but its Cr ion level is higher. This conclusion still needs further a great amount of large-sample, multi-center, high-quality randomized controlled trials to verify its correctness.

Staged Revision of Infected-hip Arthroplasty Using an Antibiotics-loaded Intra-articular Cement Spacer: Impact on Cemented and Cementless Stem Retention / 대한고관절학회지

PURPOSE: Currently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems.MATERIALS AND METHODS: Between December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibiotics-loaded cement spacer were analyzed in this study.RESULTS: Peri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems.CONCLUSION: In cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.

Free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of os-teonecrosis of the femoral head / 中华显微外科杂志

To investigate the feasibility and clinical efficacy of free graft of vascularized iliac bone flap based on deep iliac circumflex vessels for the treatment of osteonecrosis of femoral head (ONFH). Methods Twelve cases of ONFH(13 hips) received free graft of vascularized iliac bone flap based on deep iliac circumflex ves-sels from April, 2016 to July, 2017.The average Harris score was (74.7±6.9) in the second stage and (68.6±9.2) in the third stage. After debriding the necrosis bone of the femoral head, the contralateral vascularized iliac bone flap had been harvested, and then implanted into the femoral head. The deep iliac circumflex artery and its accompanying vein were anastomosed with the transverse branch (or ascending branch) of the lateral circumflex femoral artery and con-comitant vein respectively. The herringbone brace was used for hip fixation for 3 weeks after operation. X-ray exami-nation (1, 3, 6, 9 and 12 months after operation, respectively) and Harris hip score (6 and 12 months after operation, respectively) were performed to evaluate the recovery results of the femoral head. Scores were recorded and analyzed by paired t-test.The difference was considered to statistically significant if P＜0.05. Results The patients were fol-lowed-up for 15(12-20)months. The iliac bone flap of 12 patients (13 hips) healed well. There was no necrosis and collapse in 12 hips, except 1 femoral head collapsed slightly because of weight loading too early. The average Harris score was (91.6±4.5) of the second stage and (84.8±6.1) of the third stage. Compared with scores before the operation, the difference was statistically significant (P＜0.05). Conclusion Free vascularized iliac bone grafting based on deep iliac circumflex vessels is an ideal treatment for ONFH head in middle and advanced stage.

Gait variability and symmetry assessment with inertial sensors for quantitative discrimination of Trendelenburg sign in total hip arthroplasty patients: a pilot study based on convenience sampling

Abstract Introduction The aim of this pilot study based on convenience sampling was to analyze the feasibility to quantitatively discriminate Trendelenburg sign (TS), a characteristic drop in pelvic position during gait in hip disfunctions, in patients with total hip arthroplasty (THA), by assessing gait variability and symmetry using inertial sensors. Methods Thirteen patients with right THA, divided into two groups with (GTS, n=4) and without TS (GnTS, n=9) assessed by experienced physician, were enrolled in the study. Harris Hip Score was applied for specific evaluation of THA. The protocol consisted in walking on a level treadmill during 3 minutes with two inertial sensors attached at anterior superior iliac spine of both sides. For each left and right step, features were extracted from the Y-axis gyroscope signals: peak value, mean absolute value, standard deviation and range. For each feature, a symmetry ratio was calculated as the ratio between left and right side. Results No significant differences were found in Harris Hip Score between groups. The variability assessed by standard deviation for left step, contralateral to the replaced side, was significantly larger for GTS group (p<0.001). Significant differences in the symmetry ratios were found between GTS and GnTS for all features extracted from gyroscopes Y-axis (W=144, p<0.001). The symmetry ratios for GnTS group were approximately equal one (except for range), whereas for the GTS group they exceed the 10% criterion. Conclusion The variability and symmetry ratios of gait features extracted from inertial sensors were successful to discriminate TS in THA patients.

A study of management of intracapsular fracture neck femur using bipolar prosthesis

Introduction: Problems of the hip joint, whether due to trauma or arthritis need surgical skill and judgement often requiring multiple surgical procedures and prolonged rehabilitation. Bipolar hip replacement offers a durable and versatile solution for many problems of the hip in which replacement of the head and neck of the femur in a hemiarthroplasty offers advantages of rapid return to function with a pain free hip. Replacements cannot last forever and this becomes a concern particularly in relatively younger individuals. Aim of the study: To evaluate the efficacy of Biploar hip prosthesis, in management of intracapsular fracture neck femur in physiologically younger patients where replacement of the head and neck of the femur offers the advantage of rapid return of joint function. Materials and Methods: This was a prospective study done in the department of Orthopedics, Government General Hospital, Kurnool, where 30 patients with intracapsular fracture neck femur underwent bipolar prosthesis procedure. Post-operative clinical and radiological follow up was done at 6 weeks, 3 months, 6 months and 1 year. The outcome was graded as poor, fair, good and excellent. Complications were looked for. Results: Good to excellent results were seen in 96% of the patients. Infection was seen in 4% of cases. None of the cases had dislocation or loosening of prosthesis. No mortality or major complications, revision surgery or mortality were seen.

A Non-Randomized Prospective Study of Management of Intracapsular Fracture Neck of Femur with Bipolar Hemiarthroplasty.

Background: The fracture neck of femur is one of the commonest fractures in elderly. With life expectancy increasing with each decade, our society is becoming increasingly an active geriatric society, with significant number of hospitalized and nursing home patients with femoral neck fractures and their sequelae. Selection of the type of prosthesis is very important in hemiarthroplasty as different types are available. Since the last two decades, bipolar replacements of the femoral head have gained popularity for treating femoral neck fractures. Aim & Objective – To assess and analyse the results of management of fracture neck of femur with bipolar hemiarthroplasty. Methods: After obtaining ethical committee approval and informed consent from patient, detailed history of patient was taken with particular emphasize on mode of injury and associated medical illness. On the day of surgery , under anesthesia and patient in lateral position, following strict aseptic precautions, either lateral (Hardinge) or Posterior (Southern-Moore) approach incision made, tissues dissected, joint capsule incised and femoral head extracted with the help of cork screw. Then the appropriate size of prosthesis with cement was seated. The wound was closed meticulously in layers. Knee flexion, isotonic quadriceps exercises were started from 1st or 2nd post op day and patients were mobilized with walker as tolerated. Patients are educated on different position of legs that should be avoided in the postoperative period. Follow up was done after 6 weeks and for further at 3 months, 6 months & 1 year .Result: In our series, at the end of final follow-up, there was no evidence of loosening, radiolucent zones, distal migration or subsidence of prosthesis. The patient with Periprosthetic fracture healed and is weight bearing fully with no pain. One patient who had moderate heterotopic ossification had still has some mild pain occasionally. Conclusion: we conclude that bipolar hemiarthroplasty produces good functional outcomes with minimal complications for displaced intracapsular femoral neck fractures and has several advantages; these results are comparable to the other studies.

Total hip arthroplasty in octogenarians: A local retrospective case series

@#<p>With improving healthcare, the number of Filipino octogenarians is increasing. Projected population of octogenarians as reported by the Philippine National Statistics Office will increase by 28% to 3,227,253 by year 2040 (from 2015: 912,817). This is a multicenter retrospective case series involving 24 patients (1 patient with surgery on 2 hips), with an average age at the time of surgery of 82 years old (range: 80-88 years old) who underwent total hip arthroplasty during the period 2007-2016. Indications for total hip arthroplasty included 12 cases of degenerative osteoarthritis, 8 cases of displaced femoral neck fractures, 4 cases of untreated femoral neck fractures, and 1 case of subtrochanteric fracture with hip arthritis. Of the 24 patients, 21 were females and 3 were males. Of the 25 hips, 19 were treated with cemented total hip, 5 with hybrid implants, and 1 with calcar replacing cemented femoral stem. Average follow-up was 36 months (range: 6-87 months). All patients were able to ambulate and return to premorbid function. There were no intraoperative or postoperative complications encountered. Revision rate was zero percent as of last follow-up. Clinical/functional results were assessed using the Harris Hip Scoring system. The results of this study affirm that primary total hip arthroplasty is a viable treatment option for active octogenarians with end-stage arthritis and hip fractures.</p>

Comparison of Fixation Techniques in Young Patients with Fracture Neck of Femur: Multiple Hip Screws with Fibular Graft or Multiple Hip Screws Alone.

Background: Fracture neck of femur occurs infrequently in young patients compared to geriatric age groups. The occurrence in the younger age group is associated with high-energy trauma and more complications. The study was conducted to compare the results of two fixation techniques in management of fracture neck of femur in young age group patients. Methods: A total of 60 patients included in this prospective randomized trial were divided into two groups. Group I includes patients managed by multiple hip screws with fibular graft and group II includes patients managed by multiple hip screws alone. Assessment of fixation was done on basis of Harris Hip score at 6 week and 3 monthly intervals. Results: According to Garden's classification, a total of 40 (66.67%) cases were of type III, out of which 24 patients were in group I and 16 were in group II. The rest 20 (33.33%) patients were of type IV with 6 cases ingroup I and 14 cases in group II. In our study, functional outcome was calculated according to Harris hip score. In Group I we got 21 patients (70%) with excellent result, 7 patients (23.33%) with good result and 2 patients were failure cases. In Group II 17 patients (56.67%) got excellent outcome, 9 patients (30%) good outcome and 4 were failure cases.Conclusion: The study showed that there was no significant difference in any of the procedures and either of the technique could be employed depending on user experience and skills.

Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital / 대한고관절학회지

PURPOSE: Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. MATERIALS AND METHODS: Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. RESULTS: There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. CONCLUSION: Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome.

Osteonecrosis of Femoral Head Treated with Extracorporeal Shock Wave Therapy: Analysis of Short-term Clinical Outcomes of Treatment with Radiologic Staging / 대한고관절학회지

PURPOSE: To evaluate clinical results of extracorporeal shock wave therapy (ESWT) with radiographic staging on patients with avascular necrosis of femoral head (AVNFH). MATERIALS AND METHODS: We evaluated 24 patients diagnosed with AVNFH (32 hip joints) who were treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and the average age of patients was 47.8 years. The Association Research Circulation Osseous (ARCO) system was used to grade radiographic stage prior to treatment. For this study patients were divided into two groups based on their ARCO stage, group 1 (ARCO stages I and II) and group 2 (ARCO stage III). Comparative analyses were done between the two groups using the visual analogue scale (VAS) score and the Harris hip score (HHS) at pre-treatment and 3, 6, 12, and 24 months after treatment. Failure was defined when radiographic stage progressed or arthroplasty surgery was needed due to clinical exacerbation. RESULTS: Both groups showed clinical improvements with VAS scoring at final follow-up (group 1: median 7 to 1.5, P<0.001; group 2: mean 7 to 4, P=0.056). Using HHS, group 1 showed a significant improvement (from 65.5 to 95 [P<0.001]), while no significance was observed for group 2 (P=0.280). At final follow-up, 3 hips from group 1 and one hip from group 2 showed radiographic improvement; however, two patients underwent total hip arthroplasty due to persistent pain and dysfunction. CONCLUSION: ESWT can be considered as an interventional option before surgical treatment in patients with not only early stage AVNFH but also with mid stage.