Total hip replacement after hip fracture: primary or secondary surgery? a comparison of clinical and radiological results

To compare clinical and radiological results of primary and secondary total hip replacement [THR] after displaced fracture of the femoral neck. Retrospective review of a cohort of 47 patients. All surgeries were performed by the senior author in Al Razi Hospital, Kuwait between 2002 and 2007. Follow- up assessment was done in Al Razi and in Farwaniya Hospital, Kuwait by all authors. Twenty-nine cases of primary THR compared with 18 cases of secondary THR. Cementless, cemented and hybrid implants were used for total hip replacements. Clinical assessment was done using Merle D' Aubigne hip score and radiological assessment was done using standard criteria of geometry of the implant and its stability. Clinical results were better in the primary THR group but radiological results were equivocal. There was tendency to position the cup horizontally in the secondary surgery group. Cementless, cemented and hybrid implants did equally well in our cohort. Primary THR seems to be a better option in displaced fracture of the femoral neck. Cemented cementless and hybrid hip can be used in these cases

Periprosthetic fractures of the femur after hip and knee replacement

To present the clinical and radiological results of treatment of periprosthetic fractures of the femur after hip and knee replacements. Thirty-four patients [8 males and 26 females] with 34 fractures of the femur complicating hip and knee replacements are the subjects of this report. In 21 cases, the fracture affected the femur after hip replacement, and in 13 cases after knee replacement. Fractures around the hip replacement were classified according to Vancouver classification, and those around the knee replacement were classified according to Rorabeck. Location of fracture was defined as metaphyseal or diaphyseal. Arbitrary classification of fracture union was used. Fractures were considered to be either united or to have delayed union, after radiology. Conservative treatment and different methods of fixation were used. Clinical correlations between location of fracture and outcome were analyzed. All 21 metaphyseal fractures after hip and knee replacements united. Eight diaphyseal fractures [6 after hip replacement and 2 after knee replacement] united. Five diaphyseal fractures after hip replacement had delayed union, and 4 fractures united after bone graft. In 1 case, fracture did not unite, the treatment was discontinued and the patient was lost to follow-up. Our data show that metaphyseal fractures, regardless of type of implant, had better healing potential and did not require additional surgery. Diaphyseal fractures of the femoral shaft around the stem of femoral component of the hip or knee prosthesis required a bone graft and had less favorable outcomes. Women were more frequently affected by periprosthetic femoral fractures

Hackethal bundle nailing with intramedullary elastic nails in the treatment of two- and three-part fractures of the proximal humerus: initial experience at Al Razi Hospital, Kuwait

To present the clinical and radiological results of a minimally invasive technique, the fixation of two- and three-part fractures of the proximal humerus according to the Neer Classification System, using the intramedullary bundle-wiring Hackethal technique.The operations were performed with the Hackethal technique [use of elastic titanium nails, Synthes] on 17 patients [8 males and 9 females] with two- and three-part fractures of the proximal humerus. In cases of two-part fracture only, intramedullary titanium nails were used while for three-part fractures, percutaneous cannulated screws were used to fix the greater tuberosity, followed by intramedullary insertion of titanium elastic nails. The clinical results were assessed using the Constant score and radiological assessment including the union and alignment of the proximal humerus. Preoperative and postoperative CT scans were performed along with 3D reconstruction in all cases for diagnostic and prognostic significance. All fractures united in an average period of 12 weeks [range 10-17 weeks]. In all patients, a good to excellent range of motion of the shoulder, and good to excellent muscular power and alignment were noted. The Constant score amounted to 81 points [range 64-98 points]. There was no secondary loss of fixation and migration of implants. In cases of two-part fracture of the proximal humerus, the minimally invasive Hackethal technique alone and in cases of three-part fracture, the same technique with percutaneous cannulated screws provided excellent clinical and radiological results with a minimal risk of complication. It is an important alternative to open reduction and internal fixation of these difficult fractures

Cemented and cementless total Hip replacement. critical analysis and comparison of clinical and radiological results of 182 cases operated in Al Razi Hospital, Kuwait

In this study we present the results of a series of cemented Exeter and cementless Zweymuller implants. Subject and Methods: Eighty-seven cemented and 95 cementless hip replacements for different hip pathologies were followed for an average period of 36 months for cementless and 60 months for cemented cases. Clinical results were calculated using the Merle d'Aubigne score. The orientation of the prosthetic components and the fixation of the cup and stem were analyzed. The clinical and radiological results were compared using statistical methods. In the average period of 36 months in cementless and 60 months in cemented hip replacements the clinical results improved significantly when compared with the preoperative score [p < 0.05]. Sixty-seven cemented acetabular cups [77.1%] were in the desired position [30-50°] and 20 cemented cups [22.9%] were outside this range. Seventy-six cups [80%] were in the desired degree of abduction and 19 [20%] were outside this range. All cups except 1 were anteverted or neutral. Of the femoral stems, 173 were in the neutral position, 5 in the valgus and 4 in the varus position. Cemented cups were more commonly loose and cemented and cementless stems did equally well. No significant differences in rate of complications were found. Cementless acetabular implants had better clinical results and a lower loosening rate at 3 years of follow-up compared to cemented implants at 5 years of follow-up. The cemented femoral implants were equally stable compared to the cementless ones

Total hip arthroplasty in acetabular deficiency: experience in Al Razi Hospital, Kuwait

To report clinical and radiological outcomes of cemented and cementless total hip arthroplasty for primary and secondary osteoarthritis with a deficiency of acetabular bone stock. Subject and Thirty-seven patients [16 male and 21 female] having 41 hips affected by primary and secondary acetabular bone stock defect that were operated using cemented [n = 25] and cementless [n = 16] hip replacement were followed for an average period of 37 [range 12-100] months. Bone defect was classified according to American Academy of Orthopedic Surgery criteria. Different types of bone graft techniques and metal reinforcements were used. Merle d'Aubign‚ clinical score was used to calculate clinical outcomes. Geometrical position of the acetabular component, cup integration, hip center and graft integration were assessed. The mean clinical score improved significantly from 10.6 patients preoperatively to 16.7 patients postoperatively; 95% of the cups were in the desired position and were considered integrated and the bone graft remodeled in most cases. There were 2 deep infections, 1 dislocation and 2 cases of transient neurological deficit. No significant differences in final clinical and radiological outcomes, rate of loosening and rate of complications were found between cemented and cementless acetabular replacements. The results show that reconstruction of acetabular bone deficiency can be accomplished with few complications using either a cemented or cementless acetabular component with or without grafting according to the clinical situation

Percutaneous fixation of comminuted fractures of the humerus: initial experience at Al Razi Hospital, Kuwait

To present initial experience of 12 cases of percutaneous plating of the comminuted fractures of the humerus using minimal access surgery and standard low-contact dynamic compression plate. Twelve patients [11 males and 1 female] with an average age of 29.8 years [range 17-46 years] with comminuted diaphyseal fractures of the humerus were treated by minimal access surgery using standard AO/ASIF implants. Fracture was reduced indirectly either by manipulation or by a femoral distractor. Image intensifier was used to monitor the reduction and fixation. The plate was fixed on the anterior surface of the humerus using proximal and distal minimal incision on the anterior aspect of the upper arm. All fractures were united, and all patients had a good range of motion in the adjacent joints. In 1 patient, there was a transient neurological deficit. Percutaneous fixation of comminuted fractures of the humeral shaft is an alternative to standard open surgery, reducing the surgical impact and giving an excellent functional result