ABSTRACT
PURPOSE: Patients with chronic kidney disease (CKD) have a higher risk of complications when undergoing hip hemiarthroplasty. The primary aim is to test the null hypothesis that there is no difference between cemented and uncemented stem loosening rates in patients with CKD who receive a hip hemiarthroplasty for femoral neck fractures. The secondary aim is to determine the effect of increasing severity of renal disease on the rate of stem loosening in this CKD patient subset. MATERIALS AND METHODS: A retrospective study of all patients with CKD who underwent a hip hemiarthroplasty for a traumatic femoral-neck fracture between 2003 and 2013 was performed. Patients with a minimum of two-year follow-up were included; those with pathological fractures or loosening due to infection were excluded. The outcome measure was radiographic aseptic loosening of the stem, defined as progressive radiolucency of more than 2 mm, progressive subsidence or migration of the implant. RESULTS: One-hundred and nineteen cases were included in this study. Loosening occurred in 11 cases (9.24%). A comparison between cemented and uncemented groups revealed no difference in the rate of loosening (P=0.079). In all cases, worsening renal function did not increase the rate of loosening (P=0.311). The rate of loosening did not increase with worsening renal function in either the cemented (P=0.678) or uncemented groups (P=0.307). CONCLUSION: There is no difference in the rate of loosening between cemented and uncemented hemiarthroplasty for femoral neck fractures in the elderly with CKD. The rate of loosening did not increase with worsening renal function. All patients with renal impairment, not just those with end-stage renal failure, warrant close follow-up as early loosening can occur throughout the entire spectrum of renal disease.
ABSTRACT
BACKGROUND:: Preoperative mental health status as a predictor of operative outcome has been a growing area of interest. In this paper, the correlation between preoperative mental health status and postoperative functional outcome following scarf osteotomy for hallux valgus correction was explored. METHODS:: Parameters were tabulated preoperatively and postoperatively at a minimum of 1-year follow-up. They included the Short Form 36 (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) measurements and the visual analog score (VAS) to quantify pain. SF-36 mental component summary (MCS) score was used as a surrogate for patient's mental health status. Seventy-six consecutive cases were analyzed at a minimum of 1-year follow-up. RESULTS:: There were significant improvements in all 8 domains of the SF-36, with the mean MCS score increasing from 52.3 ± 7.6 preoperatively to 55.7 ± 6.8 postoperatively. Preoperative MCS scores were not correlated to changes in AOFAS score, PCS score, VAS pain score, HVA or IMA. Preoperative MCS was observed to be correlated to postoperative AOFAS ( r = 0.381, P = .001) and PCS score ( r = 0.315, P = .006). Patients with a preoperative MCS score ⩾50 had a statistically higher postoperative AOFAS and PCS score than patients with MCS score <50. There was no correlation between preoperative MCS scores and improvements in radiologic parameters. There was also no correlation between the improvements in radiologic parameters and improvements in both the AOFAS and VAS pain scores. CONCLUSION:: Preoperative mental health (as measured by the MCS score) was only correlated to postoperative functional outcome (as measured by the postoperative AOFAS and PCS score), but not other postoperative outcomes (VAS pain score, radiologic parameters). LEVEL OF EVIDENCE:: Level III, comparative study.
