Primary total hip arthroplasty versus hemiarthroplasty for displaced neck femur fractures in older patients

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. Objectives: To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Materials and methods: We prospectively as well as retrospectively studied 46 patients treated with total hip replacement or hemiarthroplasty. Pain, range of motion, hip function, haris hip score and complications were assessed clinically while hip stability, femoral anteversion, acetabular cup inclination and acetabular erosions were assessed radiographically. Results: In our study according to Harris hip score, group A (hemiarthroplasty group) showed 58.33% excellent to good result whereas 33.34% shows fair to poor result. In group B (total hip replacement group) 90.91% showed excellent to good result and 9.08% showed fair to poor result. In this study, the overall Harris hip score was 76.33 with SD±19.091 in hemiarthroplasty group and 86.45 with SD±6.363 in Total hip replacement group with p-value 0.0224(<0.05). Nitin Kumar Singh, Himanshu Jain, Sonal Garg, Sachin Yadav. Primary total hip arthroplasty versus hemiarthroplasty for displaced neck femur fractures in older patients. IAIM, 2017; 4(10): 209-215. Page 210 Conclusion: So we concluded in our one year of study that total hip replacement had better functional outcome in fracture neck of femur in elderly treated by either hemiarthroplasty or total hip replacement and total hip replacement is less painful than hemiarthroplasty.

Preservación ósea femoral con tallos cortos de fijación cervicometafisaria. Estudio radiográfico comparativo con tallos no cementados de fijación metafisaria / Femoral bone presevation using short stems with metaphyseal fixation

Introducción: Los tallos no cementados recubiertos con hidroxiapatita de fijación metafisaria han logrado excelentes resultados a largo plazo. La segunda generación de tallos cortos de fijación cervicometafisaria ha surgido a principios de la década de 1990, con el objetivo de preservar capital óseo femoral. Sin embargo, la preservación ósea femoral teóricamente propuesta no ha sido comprobada. El objetivo de este trabajo es determinar radiográficamente la preservación del capital óseo femoral cuando se utilizó un tallo corto de fijación cervicometafisaria, comparando las radiografías posoperatorias con la programación del tallo que se debería haber utilizado en caso de ser un diseño convencional con fijación metafisaria. Materiales y Métodos: Los primeros 50 tallos cortos de fijación cervicometafisaria (MiniHip TM, Corin, Cirencester, Reino Unido) fueron analizados por dos observadores independientes, con radiografías de frente, en cuanto a nivel de resección cervical y longitud del tallo, comparándolos con las filminas de un tallo convencional de fijación metafisodiafisaria (MetaFix TM, Corin, Cirencester, Reino Unido). Resultados: Según el análisis radiográfico, los tallos cortos de fijación cervicometafisaria ocuparon una longitud femoral promedio de 79 mm (rango 68-102). Los tallos convencionales de fijación metafisaria hubiesen ocupado, en promedio, 73 mm más que los tallos cortos (rango 47-94). Esta distribución se observó en el corte de cuello (promedio 10 mm más distal) y en la longitud del implante (promedio 66 mm mayor longitud) (p <0,001). Esta diferencia permite preservar un 42% el capital óseo femoral. Conclusión: La preservación ósea relacionada con el uso de tallos cortos de fijación cervicometafisaria podría traer beneficios a largo plazo en pacientes jóvenes con alta demanda funcional.

Background: Uncemented hydroxyapatite-coated stems with methaphyseal fixation have demonstrated excellent long-term results. Second generation of short stems has been developed in the 90’s with the purpose to preserve femoral bone at the femoral neck and diaphysis. However, the amount of bone that would be theoretically saved has not been well-established. To radiographically determine femoral bone preservation in a series of patients operated on with a short, neck preserving stem, we compared these results with the length of a templated conventional length, uncemented hydroxyapatite-coated stem. Methods: The first 50 short hydroxyapatite-coated uncemented stems (MiniHip TM, Corin, Cirencester, UK) were radiographically analyzed by two independent observers measuring the level of neck cut and the stem length. Then, these results were compared with the level of neck cut and stem length when a conventional, metaphysodiaphyseal stem (MetaFix TM, Corin, Cirencester, UK) was implanted using templates. Results: According to the radiographic results, short stems measured an average length of 79 mm (range 68-102). Conventional stems would have required 78 mm (range 47-94) more bone for fixation than short stems. This difference was observed in the neck cut (average 10 mm more distal with a conventional stems), as well as in the diaphysis (average 66 mm more distal with a conventional stems) (p <0.001). Conclusion: Femoral bone preservation may be related to long-term benefits especially in young patients.

Primary Total Hip Arthroplasty Using Third Generation Ceramic-Ceramic Articulation: Results after a Minimum of Three-years of Follow-up / 대한고관절학회지

PURPOSE: This study assessed the short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems. MATERIALS AND METHODS: Two hundred and seventy two patients (294 hips) with primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems who had been followed-up for a minimum of 3 years were included. Clinicoradiological results were analyzed and postoperative complications were observed. RESULTS: At final follow-up, mean Harris hip score was increased from 52 to 94 points. On radiogical evaluation, the average acetabular inclination was 42 degrees and the average acetabular anteversion was 15 degrees. Neither osteolysis nor loosening were observed around the acetabulum or proximal femur. Among 294 acetabular cups, 293 cups (99.66%) achieved stable fixation. Regarding the 294 femoral stems, 286 (97.28%) had bony fixation, 7 (2.38%) had fibrous fixation, and none were found to have unstable stem fixation. Proximal bone resorption was observed in 17 hips (5.78%; only Grade 1) and radiolucent lines were observed in 88 hips (29.93%), however, all were around the distal smooth portion of the stems. Postoperative complications included dislocation in 6 hips (2.04%), heterotopic ossification in 3 hips (1.02%), ceramic fractures in 4 hips (1.36%), superficial infection in 1 hip (0.34%), and squeaking in 8 hips (2.72%). CONCLUSION: The short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation and Accolade TMZF femoral stems together with Secur-Fit acetabular cups were satisfactory. However, problems such as ceramic fractures and squeaking after arthroplasty were observed. Additional studies are necessary in order to develop methods that may reduce or eliminate these complications.

Seven-year Results of a Tapered, Titanium, Hydroxyapatite-Coated Cementless Femoral Stem in Primary Total Hip Arthroplasty

BACKGROUND: Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. METHODS: Seventy-eight patients and 86 hips were included in the study. There were 35 men and 43 women; the mean age at the time of the operation was 59 years (range, 41 to 81 years). We used a tapered, titanium (Ti6Al4V), HA-coated femoral implant. We evaluated the patients at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty. Clinical evaluation was performed using the scoring system and the hip scores were assigned according to the level of pain, the functional status and the range of motion. The patients who refused to return, but who did forward X-rays for review after being contacted were questioned by phone about the functional status of their hip. Radiographic follow-up was performed at six weeks, at three, six and twelve months and yearly thereafter. All the available radiographs were collected and assessed for implant stability, subsidence, osseointegration, osteolysis, stress shielding and evidence of periprosthetic lucency. RESULTS: Eighty-six hips (78 patients) were available for review at follow-up of greater than 7 years. In 11 of the 86 cases, acetabular failure required revision of the acetabular component, but the femoral stem survived and it was available for long-term evaluation. The radiographs were obtained at 7-year follow-up for another 20 hips, but the patients would not come in for the 7-year clinical evaluation. Therefore, a phone interview was conducted to assess any change in the functional status at a minimum of 7 years. CONCLUSIONS: The mechanical fixation of a tapered, titanium, HA-coated femoral implant was excellent in this study. This femoral design provided reliable osseointegration that was durable at a mean of 7 years follow-up.