Hip Fractures in Centenarians: Functional Outcomes, Mortality, and Risk Factors from a Multicenter Cohort Study

Background@#Increasing longevity has caused the very old population to become the fastest-growing segment. The number of centenarians (over 100 years old) is increasing rapidly. Fractures in the elderly lead to excessive medical costs and decreased quality of life with socioeconomic burdens. However, little research has thoroughly examined the functional outcomes and mortality of hip fractures in centenarians. @*Methods@#This is a retrospective observational study. Sixty-eight centenarian hip fracture patients were admitted to the 10 institutions from February 2004 to December 2019. Fifty-six patients with 1-year follow-up were finally included. The following data were obtained: sex, age, body mass index, Charlson comorbidity index value on the operation day, Koval’s classification for ambulatory ability, type of fracture, the time interval from trauma to surgery, American Society of Anesthesiologists grade, surgery-related complications, and duration of hospital stay. Postoperative Koval’s classification (at 1 year after surgery) and information about death were also collected. Multivariate analysis was performed to analyze the risk factors affecting mortality 1 year after surgery. @*Results@#Mortality rates were 26.8% at 6 months and 39.3% at 1 year. The 90-day mortality was 19.6%, and one of them (2.1%) died in the hospital. The 1-year mortality rates for the community ambulatory and non-community ambulatory groups were 29% and 52%, respectively. Only 9 (16.1%) were able to walk outdoors 1 year after surgery. The remaining 47 patients (83.9%) had to stay indoors after surgery. Multivariate analysis demonstrated that the pre-injury ambulatory level (adjusted hazard ratio, 2.884; p = 0.034) was associated with the risk of mortality. @*Conclusions@#We report a 1-year mortality rate of 39.3% in centenarian patients with hip fractures. The risk factor for mortality was the pre-injury ambulatory status. This could be an important consideration in the planning of treatment for centenarian hip fracture patients.

Mid-term Results of Revision Total Hip Arthroplasty Using Delta Ceramic-on-Ceramic Bearing

Background@#Delta ceramic-on-ceramic (CoC) articulation affords excellent outcomes in primary total hip arthroplasty (THA). However, the safety and reliability of this bearing in revision THA need more evidence. This study aimed to report complications, radiological changes, clinical results, and survivorship of revision THA using Delta CoC articulation at minimum 5-year follow-up. @*Methods@#We reviewed 118 revision THAs (113 patients: 68 men and 45 women) performed with use of Delta CoC bearing. Their mean age was 58.7 years (range, 30–90 years) and their mean body mass index was 24.6 kg/m 2 (range, 15.2–32.5 kg/m 2 ). These patients were followed up for 5–12 years (mean, 7.2 years). We evaluated squeak, grinding sensation, ceramic fracture, dislocation, periprosthetic joint infection (PJI), periprosthetic fracture, prosthetic loosening, ceramic wear, osteolysis, modified Harris hip score (mHHS), and survivorship with any reoperation after the revision as the endpoint. @*Results@#Two patients (1.7%) had grinding sensation, but no patient had ceramic fracture. Reoperations were necessary in 9 hips (7.6%) due to PJIs in 2, stem loosening in 2, cup loosening in 2, recurrent dislocation in 2, and periprosthetic fracture in 1. No hip had measurable wear or osteolysis. The average mHHS improved from 53.3 points before the revision to 82.3 points at the final follow-up. Survivorship was 91.6% (95% confidence interval, 86.3%–96.9%) at 12 years. @*Conclusions@#The Delta ceramic bearing appeared a reliable option for revision THA, showing encouraging mid-term results with acceptable survivorship and a low complication rate.

Perioperative Concerns and Complaints of Patients Undergoing Total Hip Arthroplasty

Background@#Preoperative concerns of patients undergoing total hip arthroplasty (THA) and their complaints during the initial postoperative period are not well investigated. We evaluated preoperative concerns of patients and patient-perceived problems during the operation and initial 5 days after the operation. @*Methods@#One hundred and thirty-two patients, who underwent primary THA at a tertiary referral hospital, were surveyed using a questionnaire and a face-to-face interview 1 day before the operation, operation day, and postoperative days 1, 2, 3, and 4. The severity of pain was assessed daily using a visual analog scale. @*Results@#The most common preoperative concern was the severity of pain after the surgery (65.2%), followed by the need of transfusion (34.8%) and postoperative rehabilitation (32.6%). Among 29 patients who could recall the experience during the operation, 12 (41.4%) suffered from shoulder pain on the contralateral side, and 6 (20.7%) answered that hammering sound had been annoying. After returning to the ward, 29 patients (22.0%) suffered from nausea, 8 (6.1%) complained of back pain, and 7 (5.3%) had ipsilateral knee pain. On postoperative day 1, 7 patients (5.3%) had persistent back pain, 8 (6.1%) had headache, and 5 (3.8%) suffered from nausea. On postoperative day 2, nine patients (6.8%) complained of radiating pain due to aggravation of preexisting spinal stenosis, 7 (5.3%) complained of weakness of the hip flexor due to periarticular injection of ropivacaine during the operation, and 5 (3.8%) had dressing-related skin problem at the wound. On postoperative days 3 and 4, patients had no problem other than hip pain. The mean pain score was the highest (3.1 ± 1.0) on postoperative day 1. @*Conclusions@#The results of this study might provide information needed to solve problems and improve satisfaction of patients undergoing THA.

The Early- to Mid-term Outcome of Novel Cementless Modular Femoral Stem in East Asian Patients

Background@#Early firm fixation of the femoral implant is crucial in total hip arthroplasty (THA) with unstable metaphysis or a large degree of femoral bone loss. This study aimed to evaluate the outcomes of THA using a novel cementless modular, fluted, tapered stem in such cases. @*Methods@#From 2015 to 2020, 105 hips (101 patients) had surgery performed by two surgeons at two tertiary hospitals using a cementless modular, fluted, tapered stem for periprosthetic fractures, massive bone loss, prosthetic joint infection sequelae, or tumorous condition. Clinical outcomes, radiographic results, and survivorship of the implant were evaluated. @*Results@#The average follow-up period was 2.8 years (range, 1–6.2 years). The Koval grade was 2.7 ± 1.7 preoperatively and maintained at 1.2 ± 0.8 at the latest follow-up. The plain radiograph showed bone ingrowth fixation in 89 hips (84.8%). The average stem subsidence at postoperative 1 year was 1.6 ± 3.2 mm (range, 0–11.0 mm). Five reoperations (4.8%) were needed, including 1 for acute periprosthetic fracture, 1 for recurrent dislocation, and 3 for chronic periprosthetic joint infection. Kaplan-Meier survivorship with reoperation for any reason as the endpoint was 94.1%. @*Conclusions@#The early- to mid-term results of THA with the novel cementless modular, fluted, tapered THA stem system were satisfactory clinically and radiologically. The shortcomings inherent to its modularity were not identified. This modular femoral system may provide adequate fixation and be a practical option in the setting of complicated THA.

Effect of Total Hip Arthroplasty on Ipsilateral Lower Limb Alignment and Knee Joint Space Width: Minimum 5-Year Follow-up

Background@#This study aimed to 1) assess the effect of total hip arthroplasty (THA) on coronal limb alignment, namely, the hip–knee–ankle angle (HKA), 2) identify factors that determine changes in the HKA, and 3) determine whether alignment changes influence the knee joint space width. @*Methods@#We retrospectively evaluated 266 limbs of patients who underwent THA. Three types of prostheses with neck shaft angles (NSAs) of 132°, 135°, and 138° were used. Several radiographic parameters were measured in the preoperative and final radiographs (at least 5 years after THA). A paired t-test was used to confirm the effect of THA on HKA change.Multiple regression analysis was performed to identify radiographic parameters related to HKA changes following THA and changes in knee joint space width. Subgroup analyses were performed to reveal the effect of NSA change on the HKA change, and the proportion of total knee arthroplasty usage and changes in radiographic parameters between maintained joint space and narrowed joint space groups were compared. @*Results@#The preoperative mean HKA was 1.4° varus and increased to 2.7° varus after THA.This change was related to changes in the NSA, lateral distal femoral angle, and femoral bowing angle. In particular, in the group with a decrease in NSA of > 5°, the preoperative mean HKA was largely changed from 1.4° varus to 4.6° varus after THA. The prostheses with NSA of 132° and 135° also led to greater varus HKA changes than those with an NSA of 138°. Narrowing of the medial knee joint space was related to changes in the varus direction of the HKA, decrease in NSA, increase in femoral offset. @*Conclusion@#A large reduction in NSA can lead to considerable varus limb alignment after THA, which can have adverse effects on the medial compartment of the ipsilateral knee.

Incidence and Risk Factors of Short Axial Length of the Proximal Femur: A Caution in the Use of Femoral Neck System in Patients with Garden Type I/II Femoral Neck Fractures

Background@#In 2018, Femoral Neck System (FNS), a dedicated fixator for femoral neck fractures, was introduced. This device has been in increasing use because it provides excellent rotational and angular stability. However, the shortest bolt of FNS is 75 mm long. Thus, it is not usable when the axial length of the proximal femur (ALPF), the distance between the innominate tubercle and the surface of the femoral head, is less than 80 mm. In this study, we investigated the incidence and associated factors of small ALPF (< 80 mm) in femoral neck fracture patients. @*Methods@#We measured the ALPF on preoperative computed tomography (CT) scans of 261 patients (166 women and 55 men), who were operated due to nondisplaced or impacted femoral neck fractures. The ALPF was measured on reconstructed oblique coronal images along the femoral neck. We evaluated the distribution of ALPF, calculated the incidence of small ALPF (< 80 mm), and correlated it with patient’s height, weight, body mass index, age, bone mineral density (T-score), and caput-column-diaphysis angle. @*Results@#The ALPF ranged from 67.4 mm to 107.1 mm (mean, 88.4 mm; standard deviation, 7.2 mm). In 19 patients (8.6%, 19 / 221), the length was < 80 mm. The ALPF was strongly correlated with height (correlation coefficient = 0.707, R2 = 0.500, p < 0.001) and moderately correlated with weight (correlation coefficient = 0.551, R2 = 0.304, p < 0.001). The T-score was moderately correlated with the ALPF (correlation coefficient = 0.433, R2 = 0.187, p < 0.001). The age was moderately correlated with the ALPF (correlation coefficient = –0.353, R2 = 0.123, p < 0.001). @*Conclusions@#A considerable percentage of femoral neck fracture patients (8.6%) had small proximal femurs (ALPF < 80 mm), which cannot be operated with FNS. We recommend measuring the ALPF using reconstructed oblique coronal CT images or scaled hip radiographs: en face view of the femoral neck prior to surgery in patients with short stature and/or low body weight. If the ALPF is < 80 mm, the surgeon should prepare other fixation devices.

Osteoporotic Fractures among Selective Estrogen Receptor Modulator Users in South Korea: Analysis Using National Claims Database

Background@#We evaluated (1) compliance with selective estrogen receptor modulator (SERM) use in postmenopausal women; and (2) the risk of osteoporotic fractures according to compliance and other patient characteristics. @*Methods@#National claims data of postmenopausal women from January 2013 to December 2014 were reviewed. Demographics, comorbidities, type of medical institution, and patient compliance were investigated. Compliance was measured according to medication possession ratio (MPR) and the patients were classified into compliant (MPR ≥80%) or non-compliant (MPR <80%) groups. Osteoporotic fractures were followed up for 2 years after prescription. @*Results@#Among 15,166 postmenopausal women, 4,130 were categorized as compliant. Osteoporotic fractures were confirmed in 669 patients. The hip fracture rate in the non-compliant group (0.39%) was marginally higher than that in the compliant group (0.36%; P=0.06). Compared to age 50 to 54 years, age 55 to 59 years showed protection against fractures (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.379–0.857; P=0.007), while those over 70 years showed a higher risk of fractures (HR, 2.035; 95% CI, 1.485–2.789; P<0.0001 for age 70–74 years; HR, 2.197; 94% CI, 1.588–3.041; P<0.0001 for age 75–79 years; and HR, 3.53; 95% CI, 2.493–4.999; P<0.0001 for age ≥80 years). Patients with mild (HR, 1.29; 95% CI, 1.088-1.530; P=0.0034) and moderate (HR, 1.286; 95% CI, 1.002–1.652; P=0.0486) comorbidities were associated with higher risks of fractures compared to those without comorbidities. @*Conclusions@#Among postmenopausal women with osteoporosis, only 27.2% complied with SERM therapy. A marginal difference in hip fracture rate was observed between the compliant and non-compliant groups. Older age and severe comorbidities were associated with higher risks of osteoporotic fractures.

Effectiveness of Online Video Instruction on Time to Start Ambulation and Duration of Hospital Stay, Satisfaction and Functional Recovery in Patients Undergoing Total Hip Arthroplasty

Background@#At the end of 2014, we implemented an online video to inform patients of the entire process from admission to rehabilitation after total hip arthroplasty (THA). In this study, we investigated the effectiveness of online video instruction in THA patients. @*Methods@#Electronic medical records of 184 patients undergoing THA in 2014 (pre-video group) and 182 patients in 2015 (post-video group) were reviewed. We compared 1) the time to start wheelchair ambulation, 2) walker or crutch ambulation, 3) the length of hospital stay, 4) postoperative satisfaction using visual analogue scale (0–10 points), and 5) modified Harris Hip Score (mHHS) at postoperative 6 weeks. @*Results@#In the post-video group, the time to start wheelchair ambulation (1.8 ± 0.6 vs. 2.4 ± 3.2 days, P = 0.021) and walker/crutch ambulation were faster (2.9 ± 1.2 vs. 3.8 ± 1.0 days, P = 0.016), and the hospital stay was shorter (8.2 ± 4.7 vs. 9.9 ± 7.8 days, P = 0.001) compared to the pre-video group. The visual analogue scale for satisfaction (7.84 ± 1.62 vs. 7.68 ± 1.85 points) and mHHS (89.59 ± 9.47 vs. 89.58 ± 8.59) were similar. @*Conclusion@#Online video instruction is an effective tool to expedite ambulation and reduce the hospital stay without compromising the clinical outcome and postoperative complications after THA.

Prevalence, Clinical Implication, and Cause of Spine Hip Discordance in Elderly Patients with Fragility Hip Fracture

Background@#Spine-hip discordance (SHD) increases fracture risk. However, its prevalence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and investigated the cause of SHD in patients with hip fractures. @*Methods@#This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients underwent dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Society of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to determine the cause of discordance. @*Results@#Among 1,220 eligible patients, 130 were excluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. @*Conclusions@#Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.

Surgeons’ Awareness and Impaction Technique of a Ceramic Liner into a Metal Shell

Background@#In ceramic-on-ceramic total hip arthroplasty, firm locking is necessary between a ceramic liner and an acetabular metal shell to prevent dissociation of the liner from the metal shell. We evaluated surgeons’ awareness of the technique for inserting the ceramic liner and measured the impaction force applied by surgeons during the insertion of the ceramic liner. @*Methods@#To evaluate the awareness, we conducted a survey using a questionnaire including techniques for ceramic liner insertion. The impaction force was measured using an impaction simulator in 224 surgeons. @*Results@#Most surgeons answered that they cleaned and dried up the inner surface of the metal shell before inserting a ceramic liner (96.4% and 86.2%, respectively), and 74.6% checked the correct seating of the ceramic liner. However, only 23.2% correctly answered that a minimum of 2kN (a light strike) was necessary to obtain a sufficient fit between the metal shell and the ceramic liner. The impaction force was weaker than 2 kN in 9.4% of the surgeons. @*Conclusions@#Education about the adequate impaction force to obtain a firm fit of the ceramic liner is necessary for surgeons who perform total hip arthroplasty using ceramic-on-ceramic bearings

Hip Fracture Management during the COVID-19 Pandemic in South Korea

Background@#The purpose of this study was to introduce a screening system for coronavirus disease 2019 (COVID-19), to evaluate the overall orthopedic management in hip fracture patients during the COVID-19 pandemic in South Korea, and to compare the surgical results in hip fracture patients during the COVID-19 pandemic with those of the previous year. @*Methods@#Hip fracture patients who visited emergency rooms were screened at the screening clinics before admission. The medical management was carried out with the medical staff wearing surgical masks, meticulous hand hygiene observed, and a minimum distance of 2 m between patients maintained. The demographics, operative parameters, and surgical results of patients treated during the pandemic were compared with those from the previous year. @*Results@#From January 2020 to July 21, 2020, 119 patients with hip fractures (33 men and 86 women) were admitted to our institution for surgical treatment. Five patients showed symptoms of pneumonia, but no patient was positive for COVID-19. The mortality rate during the study period was 4.2%, and none of the patients died due to COVID-19. The interval between admission and surgery and the length of hospital stay were significantly shorter (p = 0.008, p = 0.002) and the proportion of spinal anesthesia was greater in hip fracture patients during the COVID-19 pandemic compared to those from the previous year (p = 0.011). @*Conclusions@#The COVID-19 screening system for hip fracture patients has proven to be effective in preventing intrahospital spread of the disease. Hip fracture surgery performed during the COVID-19 pandemic has shown comparable results without any COVID-19 infection and COVID-19-related mortality.

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.

Vitamin D Deficiency and Sarcopenia in Hip Fracture Patients

Background@#Vitamin D plays a critical role in the proliferation and differentiation of skeletal muscle and bone metabolism. We compared the prevalence of vitamin D deficiency in elderly patients undergoing hip fracture surgery (HFS) with those undergoing elective primary total hip arthroplasty (THA). We also evaluated the association between vitamin D deficiency and sarcopenia. @*Methods@#This prospective study included 70 patients in the HFS group, and 100 patients in the elective THA group. The HFS group included 42 women, while the elective THA group included 74 women. The mean age in the HFS and elective THA groups was 79.8 and 75.4 years, respectively, and the mean preoperative Koval score was 2.1 and 2.3, respectively. Serum 25-hydroxy-vitamin D3 levels were measured by I125 radioimmunoassay. Bone mineral density and appendicular skeletal muscle mass (ASM) were measured using dual X-ray absorptiometry. Sarcopenia index was calculated by dividing ASM (kg) by the body mass index (kg/m2). Sarcopenia was diagnosed when the sarcopenia index was <0.789 in men and <0.512 in women. @*Results@#Serum vitamin D levels were lower, and the percentages of patients with vitamin D insufficiency and deficiency were higher in the HFS group than in the elective THA group. In the HFS group, the prevalence of sarcopenia was higher in men (57%, 16/28) than in women (29%, 12/42; P=0.025). @*Conclusions@#Vitamin D deficiency was more prevalent in patients undergoing HFS than in patients undergoing elective THA. Among patients undergoing HFS, vitamin D deficiency was more prevalent in sarcopenic than in non-sarcopenic patients.

Current and Future Burden of Periprosthetic Joint Infection from National Claim Database

Background@#Periprosthetic joint infection (PJI) is the most serious complication after total joint arthroplasty. The incidence and burden of PJI in North America have been reported.There might be potential differences according to ethnics and regional practices between western countries and East Asia. Nevertheless, its incidence in East Asia remains unknown.We aimed to evaluate the incidence and economic burden of PJI in Korea and to project the future burden. @*Methods@#We identified numbers of total hip arthroplasties, total knee arthroplasties and PJIs in Korea from 2010 to 2018 using medical claim data of Korean Health Insurance and Review and Assessment. Annual incidence and medical cost of PJI were calculated. We projected future burden of PJI through 2030 using Quasi-poisson regression model. @*Results@#The annual incidence of PJI ranged from 2.3% to 2.8% and the average cost per each PJI patient ranged from $4,361 to $6,016. Total annual cost of PJI increased from $8.0 million in 2010 to $18.0 million in 2018 and was projected to exceed $57.0 million by 2030. @*Conclusion@#The incidence of PJI in Korea is comparable with reported PJI incidence of 2.0%–2.7% in the United States. Our findings would be used for worldwide comparison of PJI epidemiology and establishment of healthcare policies for PJI in East Asia.

Current and Future Burden of Periprosthetic Joint Infection from National Claim Database

Background@#Periprosthetic joint infection (PJI) is the most serious complication after total joint arthroplasty. The incidence and burden of PJI in North America have been reported.There might be potential differences according to ethnics and regional practices between western countries and East Asia. Nevertheless, its incidence in East Asia remains unknown.We aimed to evaluate the incidence and economic burden of PJI in Korea and to project the future burden. @*Methods@#We identified numbers of total hip arthroplasties, total knee arthroplasties and PJIs in Korea from 2010 to 2018 using medical claim data of Korean Health Insurance and Review and Assessment. Annual incidence and medical cost of PJI were calculated. We projected future burden of PJI through 2030 using Quasi-poisson regression model. @*Results@#The annual incidence of PJI ranged from 2.3% to 2.8% and the average cost per each PJI patient ranged from $4,361 to $6,016. Total annual cost of PJI increased from $8.0 million in 2010 to $18.0 million in 2018 and was projected to exceed $57.0 million by 2030. @*Conclusion@#The incidence of PJI in Korea is comparable with reported PJI incidence of 2.0%–2.7% in the United States. Our findings would be used for worldwide comparison of PJI epidemiology and establishment of healthcare policies for PJI in East Asia.

Hip and Subtrochanteric or Femoral Shaft Fractures after Bisphosphonate Use in Korean Women, Using Korean National Sample Cohort

Background@#Concern about bisphosphonate-associated subtrochanteric and femoral shaft (ST/FS) fractures has been raised. However, its real risk is still debatable, because there is no study to estimate risk and benefit of bisphosphonate. The objective of this study was to evaluate the risk of typical hip fractures and ST/FS fractures among bisphosphonate users using nationwide database. @*Methods@#We performed a retrospective cohort study using National Health Insurance Service-National Sample Cohort. We evaluated occurrence of the ST/FS and femoral neck and intertrochanteric (FN/IT) fractures among female bisphosphonate new users. Incidence rate of ST/FS and FN/IT fractures were compared between long-term users (≥ 1 year) and short-term users (< 1 year). Number needed to harm (NNH) for ST/FS and number needed to treat (NNT) for typical hip fracture were analyzed. @*Results@#Among 46,420 bisphosphonate users, we identified 14,689 long-term users and 21,840 short-term users. During the study period, 61 long-term users and 36 short-term users had ST/FS fractures, while 204 long-term users and 511 short-term users had FN/IT fractures. The long-term user showed higher incidence rate of ST/FS fractures (67.1/100,000 person-years; 95% confidence interval [CI], 50.3–83.9) comparing with 31.2/100,000 person-years (95% CI, 21.0–41.4) in the short-term users. The incidence rate of FN/IT fractures was 225.5/100,000 person-years (95% CI, 194.6–256.5) in the long-term users and 448.6/100,000 person-years (95% CI, 409.7–487.5) in the short-term users. The NNH for ST/FS was 400, while the NNT for typical hip fracture was 105. @*Conclusion@#Our study suggested that physicians keep the significant benefit of bisphosphonate to prevent typical hip fracture in mind, even the concerns about bisphosphonate-associated ST/FS fractures.

Risk of Osteoporotic Fracture in Patients with Breast Cancer: Meta-Analysis

BACKGROUND: The fracture risk induced by anti-estrogen therapy in patients with breast cancer remains controversial. The aim of this study was to perform a meta-analysis and systematic review to evaluate the risk of osteoporotic fracture in patients with breast cancer.METHODS: A systematic search was performed to identify studies that included any osteoporotic fracture (hip fracture and vertebral fracture) in patients breast cancer. Main outcome measures were occurrence and risk of osteoporotic fractures including hip and vertebral fractures in patients and controls.RESULTS: A systematic search yielded a total of 4 studies that included osteoporotic fracture outcomes in patients with breast cancer. Meta-analysis showed a higher risk of osteoporotic fracture in patients with breast cancer. Analysis of these 4 studies involving a total of 127,722 (23,821 cases and 103,901 controls) patients showed that the incidence of osteoporotic fractures was higher in the breast cancer group than in the control group. The pooled estimate of crude relative risk for osteoporotic fracture was 1.35 (95% confidence interval, 1.29–1.42; P<0.001).CONCLUSIONS: Although studies were limited by a small number, results suggested a possible association between anti-estrogen therapy and increased risk of osteoporotic fractures in patients with breast cancer.

Anterior Cortical Window Technique Instead of Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: A Minimum 10-Year Follow-up

BACKGROUND: The anterior cortical window technique was developed to facilitate stem removal in revision total hip arthroplasty (THA). In this technique, only the anterior cortex of the proximal femur is osteomized; the trochanter, lateral cortex, and medial cortex remain intact. Therefore, a new stem can be press-fitted into the femur and mediolateral stability can be obtained. However, the long-term results of revision THA using this technique are unknown. We report the outcome and survivorship at a minimum of 10-year follow-up. METHODS: From May 2003 to April 2006, 69 patients (75 hips) underwent revision THA using an anterior cortical window and a cementless distal interlocking stem. Of these, 50 patients (56 hips) were followed up for 10 to 13 years (mean, 11.5 years). There were 26 men (29 hips) and 24 women (27 hips) with a mean age of 51.2 years (range, 29 to 82 years) at the time of revision arthroplasty. We evaluated radiographs, Harris hip score, University of California at Los Angeles (UCLA) activity score, Koval category, and survivorship. RESULTS: Nonunion of the osteotomy occurred in one hip (2%). Five stems (8.9%) subsided 5 mm or more. At the final evaluation, the mean Harris hip score, UCLA activity score, and the Koval category were 82.5, 4.6, and 1.5, respectively. Survivorship with any operations as the end point was 80.4% and that with stem-revision as the end point was 91.1%. CONCLUSIONS: With use of an anterior cortical window, a well-fixed stem can be easily removed, and a new stem can be inserted with firm mediolateral stability in the proximal femur in revision THA. We recommend using this technique instead of the extended trochanteric osteotomy in revision THA.

Validity, Reliability and Responsiveness of the Korean Version of Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire in Patients with Carpal Tunnel Syndrome

BACKGROUND: The Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) is one of the most widely used questionnaires for assessing functional ability of the patients with upper extremity diseases. Carpal tunnel syndrome (CTS) is the most common neuropathic disease in the upper extremities. The aim of this study was to verify the validity, reliability, and responsiveness of Korean version of QuickDASH questionnaire (K-QuickDASH) in the patients with CTS. METHODS: In total, 83 subjects who underwent open carpal tunnel release (CTR) operation were selected. They fulfilled Korean version of Disabilities of the Arm, Shoulder and Hand questionnaire (K-DASH) and K-QuickDASH at two different time points: before and six months after the surgery. Both criterion-related and construct validities were evaluated using Pearson's correlation coefficient and factor analysis. Internal consistency was estimated using Cronbach's alpha, and test-retest reliability was assessed to verify the reliability of K-QuickDASH using intraclass correlation coefficient (ICC). The standardized response mean and the effect size were analyzed to confirm the responsiveness of the K-QuickDASH in CTS patients. RESULTS: Significant positive correlation was found between K-QuickDASH and K-DASH. All the questionnaire items were categorized into three factors. Acceptable internal consistency was confirmed in three categories of K-QuickDASH. A high test-retest reliability and responsiveness of K-QuickDASH were detected. CONCLUSION: K-QuickDASH in Korean patients with CTS was confirmed to have high degree of validity and reliability, and responsiveness after CTR. Therefore, the K-QuickDASH would be a good evaluation tool for evaluating clinical symptoms and determination of treatment outcomes in the patients with CTS.