Coste de la fractura de cadera osteoporótica en España por comunidad autónoma / Cost of osteoporotic hip fracture in Spain per Autonomous Region

Objetivo: Se estimó la utilización de recursos sanitarios (URS) y costes asociados durante los 12 meses posteriores a una primera fractura de cadera osteoporótica (FCO) por comunidad autónoma (CC.AA.). Métodos: Estudio observacional, prospectivo, que incluyó pacientes ≥65años hospitalizados por una primera FCO en Andalucía, Cataluña, Comunidad Valenciana, Galicia, Madrid y País Vasco. Se registró la URS relacionada con la FCO, la calidad de vida y la autonomía del paciente, y se estimaron los costes asociados. Resultados: Participaron 487 pacientes (edad media: 83,1años, 77% mujeres), con características demográficas similares entre CC.AA. La duración media del ingreso fue más prolongada en Madrid y en Galicia (mujeres/hombres: 15,0/18,6 y 16,9/12,6 días) y menor en Andalucía y en la Comunidad Valenciana (8,2/7,2 y 8,4/9,4días). Las sesiones de rehabilitación y días de asistencia domiciliaria formal fueron más numerosos en Cataluña y en Madrid (mujeres/hombres: 16/21 y 17/29 sesiones; 19/20 y 30/27días) comparado con Andalucía y Galicia (4/1 y 3/0 sesiones; 3/1 y 1/0días). Los costes medios fueron más altos en Madrid y menores en Andalucía (mujeres/hombres: 12.321/12.297€ y 7.031/6.115€, respectivamente). Conclusiones: Las FCO implican un coste elevado para los sistemas sanitarios autonómicos, observándose diferencias notables entre CC.AA., derivadas principalmente de la duración diferencial de la primera estancia hospitalaria, así como al cuidado ambulatorio durante los meses posteriores. Estas diferencias podrían estar relacionadas con diferencias en la demora quirúrgica. Es deseable un abordaje y consenso a nivel nacional de este problema sanitario, con pautas de actuación comunes, ya que podría suponer grandes beneficios socioeconómicos y sanitarios globales

Objective: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. Methods: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. Results: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). Conclusions: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits

Cost of osteoporotic hip fracture in Spain per Autonomous Region. / Coste de la fractura de cadera osteoporótica en España por comunidad autónoma.

OBJECTIVE: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. METHODS: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. RESULTS: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). CONCLUSIONS: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits.

Bilateral Rapidly Destructive Osteoarthritis of the Hip: Could We be Misdiagnosing? A Case Report.

INTRODUCTION: Rapidly destructive osteoarthritis (RDO) of the hip is characterized by rapid joint destruction with no specific underlying diagnosis. Diagnostic protocols and algorithms to rule out other possible causes of the rapid destruction of the hip have not been described. Furthermore, microbiological diagnostic procedures in the medical field have dramatically changed since RDO was first described. CASE REPORT: We report the case of bilateral RDO in a Caucasian 84-year-old female treated with a bilateral total hip replacement and propose an etiology for this condition. This is the first case that specifically mentions obtaining cultures intraoperatively as a definitive diagnostic method. It is also a rare case as it describes a patient with the bilateral rapid destruction of the hip joints. CONCLUSION: Total hip arthroplasty remains as the gold-standard for treatment of RDO due to clinical severity and radiographic findings. All current clinical guidelines do not recommend using a one stage total hip replacement in an active infected site due to high risk of early prosthetic joint infection. The evidence of an infectious etiology in all or some cases of RDO would have large-scale implications regarding diagnosis and treatment of this condition.

El bloqueo iliofascial en el tratamiento analgésico de la fractura de cadera del anciano / Fascia iliaca block for pain control in hip fracture patients

Introducción. La analgesia en pacientes con fractura de cadera se ha basado en la utilización de antiinflamatorios no esteroideos y opiáceos, que se asocian a múltiples efectos secundarios. El bloqueo iliofascial es una alternativa analgésica relativamente novedosa en el tratamiento del dolor de estos pacientes. Nuestro objetivo es evaluar la eficacia analgésica del bloqueo iliofascial realizado en Urgencias a pacientes mayores de 65años con fractura de cadera. Material y métodos. Entre enero y diciembre de 2016 fueron estudiados prospectivamente 216 pacientes. Las variables analizadas fueron: dolor al llegar a Urgencias y después del bloqueo, necesidad de rescate, cumplimiento del protocolo, demora en la administración de la analgesia y demora para la cirugía. Resultados. Se observaron diferencias estadísticamente significativas entre los valores de EVA antes y después del bloqueo (p<0,001). La puntuación EVA media pre-bloqueo fue de 6,16 (DE=2,82). Tras el bloqueo, la disminución media de la EVA fue de 2,99 (IC95%: 2,45-3,53%). El 26% de los pacientes recibieron morfina de rescate en las primeras 8h. La tasa de cumplimiento del protocolo analgésico fue del 84%. El bloqueo se administró en 16mins de media (DE=10,33). La mediana de demora para intervención quirúrgica fue de 1día (RIQ 25-75%: 1-2). Conclusión. El bloqueo iliofascial es una técnica analgésica reproducible, efectiva y segura. Constituye un pilar fundamental en la estrategia analgésica de los pacientes con fractura de cadera en nuestro centro. Los otros dos pilares incluyen la analgesia precoz y la disminución de la demora para la intervención quirúrgica (AU)

Introduction. Pain treatment for patients with hip fracture has been based on the use of nonsteroidal anti-inflammatories and opioid derived drugs. These medications have been associated with multiple adverse effects. Fascia iliaca block is a recent pain management alternative for these patients. The objective of this study was to evaluate the effectiveness of fascia iliaca block performed in the emergency room (ER) for patients over 65years of age with hip fracture. Materials and methods. A cohort of 216 patients, from January to December 2016, was studied prospectively. Analyzed variables were: pain upon arrival at ER, pain after fascia iliaca block, need for rescue medication, protocol compliance, delay in analgesia administration and delay for surgery. Results. Differences between visual analogue scale (VAS), before and after the fascia iliaca block, were statistically significant (P<.001). Pre-block VAS recorded was 6.16 (SD=2.82). The mean VAS reduction after the block was 2.99 (95%CI: 2.45-3.53%). Twenty-six percent of patients required morphine as rescue medication in the first 8hours after diagnosis. Compliance with protocol administration was of 84%. Fascia iliaca block was performed in a mean time of 16minutes (SD=10.33) after diagnosis. The median delay for surgery was 1 day (RIQ 25-75%: 1-2). Conclusion. Fascia iliaca block is a reproducible, safe and effective technique for pain management. It is a keystone in pain treatment for patients with a proximal femur fracture at our institution. Other objectives in our pain management protocol include early analgesia administration and reduction of time to surgery (AU)

Fascia iliaca block for pain control in hip fracture patients. / El bloqueo iliofascial en el tratamiento analgésico de la fractura de cadera del anciano.

INTRODUCTION: Pain treatment for patients with hip fracture has been based on the use of nonsteroidal anti-inflammatories and opioid derived drugs. These medications have been associated with multiple adverse effects. Fascia iliaca block is a recent pain management alternative for these patients. The objective of this study was to evaluate the effectiveness of fascia iliaca block performed in the emergency room (ER) for patients over 65years of age with hip fracture. MATERIALS AND METHODS: A cohort of 216 patients, from January to December 2016, was studied prospectively. Analyzed variables were: pain upon arrival at ER, pain after fascia iliaca block, need for rescue medication, protocol compliance, delay in analgesia administration and delay for surgery. RESULTS: Differences between visual analogue scale (VAS), before and after the fascia iliaca block, were statistically significant (P<.001). Pre-block VAS recorded was 6.16 (SD=2.82). The mean VAS reduction after the block was 2.99 (95%CI: 2.45-3.53%). Twenty-six percent of patients required morphine as rescue medication in the first 8hours after diagnosis. Compliance with protocol administration was of 84%. Fascia iliaca block was performed in a mean time of 16minutes (SD=10.33) after diagnosis. The median delay for surgery was 1 day (RIQ 25-75%: 1-2). CONCLUSION: Fascia iliaca block is a reproducible, safe and effective technique for pain management. It is a keystone in pain treatment for patients with a proximal femur fracture at our institution. Other objectives in our pain management protocol include early analgesia administration and reduction of time to surgery.

[Hip arthroplasty with conventional stem as rescue treatment after failed treatment of intertrochanteric hip fractures]. / Artroplastia de cadera con vástago convencional en fracasos de osteosíntesis de fracturas del fémur proximal.

OBJECTIVE: The purpose of this study is to evaluate the results and complications of hip arthroplasty with conventional stem performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. MATERIAL AND METHODS: Between 1997 and 2011, 17 patients with a mean age of 76 years were treated with hip arthroplasty for failed treatment of intertrochanteric hip fracture. In all cases a conventional stem was used. The mean follow-up was 6 years (range 1-14 years). Pain, range of motion (Merle d'Aubigné) and functional results (Barthel), as well as implant fixation (Harris and Engh), were evaluated during the follow-up. RESULTS: Except for one case of death (6%) and one case of infection (Girdlestone arthroplasty), all patients were able to walk independently at 6 months. The majority of the patients (87%) had no or mild pain. After 2 surgeries (osteosynthesis and hip arthroplasty) the mean Barthel Score had decreased from 81 to 66 points. Just one case (6%) of stem loosening has been observed. DISCUSSION: In older patients, prosthetic replacement after failed proximal femoral fixation is a reliable salvage option. Most patients have good pain relief and functional improvement, although the rate of perioperative medical complications is high. Surgery is less demanding and the operating time is shorter when conventional femoral stems are used.

Artroplastia de cadera con vástago convencional en fracasos de osteosíntesis de fracturas del fémur proximal / Hip arthroplasty with conventional stem as rescue treatment after failed treatment of intertrochanteric hip fractures

Objetivo. El objetivo de este estudio es evaluar los resultados del tratamiento del fracaso de la osteosíntesis en fracturas del fémur proximal mediante artroplastia de cadera con vástago convencional. Material y métodos. Estudio retrospectivo de 17 pacientes (edad media 76 años), en las que se implantó una prótesis de cadera tras haber fracasado la osteosíntesis de una fractura pertrocantérica, entre 1997 y 2011. En todos los casos se implantó un vástago femoral convencional. El seguimiento medio fue de 6 años (1-14 años). Se ha evaluado el dolor, la movilidad y la marcha (Merle d’Aubigné) y el resultado funcional (Barthel), así como la estabilidad radiológica del implante según los criterios de Harris y de Engh. Resultados. Excluyendo un caso de exitus (6%) y una infección tratada mediante artroplastia de resección tipo Girdlestone, a los 6 meses de la cirugía protésica todos los pacientes habían recuperado la deambulación autónoma. El 87% presentaban dolor leve en su cadera o no tenían dolor. Tras las 2 cirugías el Barthel medio había disminuido en 15 puntos (de 81 a 66). Únicamente se ha observado un caso de aflojamiento aséptico del vástago femoral (6%). Discusión. La artroplastia de cadera es un procedimiento efectivo en el rescate del fracaso de la osteosíntesis de fracturas proximales de fémur. Permite un rápido alivio del dolor y una eficaz recuperación funcional, aunque la morbimortalidad asociada es elevada. La utilización de vástagos convencionales y no vástagos largos de revisión permite simplificar la cirugía y disminuir el tiempo quirúrgico (AU)

Objective. The purpose of this study is to evaluate the results and complications of hip arthroplasty with conventional stem performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. Material and methods. Between 1997 and 2011, 17 patients with a mean age of 76 years were treated with hip arthroplasty for failed treatment of intertrochanteric hip fracture. In all cases a conventional stem was used. The mean follow-up was 6 years (range 1-14 years). Pain, range of motion (Merle d’Aubigné) and functional results (Barthel), as well as implant fixation (Harris and Engh), were evaluated during the follow-up. Results. Except for one case of death (6%) and one case of infection (Girdlestone arthroplasty), all patients were able to walk independently at 6 months. The majority of the patients (87%) had no or mild pain. After 2 surgeries (osteosynthesis and hip arthroplasty) the mean Barthel Score had decreased from 81 to 66 points. Just one case (6%) of stem loosening has been observed. Discussion. In older patients, prosthetic replacement after failed proximal femoral fixation is a reliable salvage option. Most patients have good pain relief and functional improvement, although the rate of perioperative medical complications is high. Surgery is less demanding and the operating time is shorter when conventional femoral stems are used (AU)