Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness.

The optimal treatment for displaced femoral neck fractures in elderly patients is a matter of controversy. Four surgical options are well supported in the orthopaedic literature: reduction with internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty. Based on a review of the outcomes literature regarding treatment of femoral neck fractures and a cost-effectiveness analysis, an algorithm for surgical treatment of displaced femoral neck fractures in elderly patients is presented. Cost-effectiveness analysis of these four surgical treatment options shows that arthroplasty is the most cost-effective treatment when complication rate, mortality, reoperation rate, and function are evaluated during a 2-year postoperative period. These data were strongly supported by a two-way sensitivity analysis that varied the effectiveness of the interventions and the costs. Literature derived outcome studies show that elderly patients with displaced femoral neck fractures achieve the best functional results with a well healed femoral neck without osteonecrosis after reduction and internal fixation. Achieving this result may be difficult, and it is not as cost effective as arthroplasty.

Medial reconstruction during total knee arthroplasty for severe valgus deformity.

A painful arthritic knee with severe valgus deformity may be treated successfully with total knee arthroplasty using several techniques: constrained implant with lateral release, nonconstrained implant with lateral release and a thick tibial insert, or nonconstrained implant with lateral release and medial reconstruction. Eight patients with Type II valgus deformity were treated with nonconstrained total knee arthroplasty implants, lateral ITB release at the level of the tibial osteotomy, and proximal medial collateral ligament advancement with bone plug recession. The reconstruction led to predictably successful outcomes in all patients at 4- to 9-years followup. All patients were satisfied with the operation. All knees were stable with a functional range of motion at the time of last followup.