Less than one-third of hip fracture patients return to their prefracture level of instrumental activities of daily living in a prospective cohort study of 480 patients.

AIM: A significant loss of instrumental activities of daily living (IADL) after a hip fracture has been reported. The aim of the present study was to identify specific predictors for low IADL after a hip fracture, in order to target better postoperative care for these patients. METHODS: A prospective observational cohort study of 480 hip fracture patients was carried out. IADL was measured at baseline, and after 3 and 12 months using the Groningen Activity Restriction Scale. Multivariable logistic regression analysis was carried out using age, sex, American Society of Anesthesiologists classification, prefracture living with a partner, prefracture living situation, prefracture use of walking aids, type of fracture, type of anesthesia, length of hospital stay, postoperative complications and prefracture IADL as potential predictors for low IADL after a hip fracture. The correlation between IADL, mobility and living situation, both at admission, and 3 and 12 months postoperatively, were measured. RESULTS: Three months after hip fracture treatment, 24% of patients returned to their baseline IADL level, at 12 months postoperative this was 29%. Factors associated with a larger loss in IADL after a hip fracture were older age, prefracture living with a partner, prefracture living at home, prefracture use of walking aids and longer length of hospital stay. The correlation between IADL and living situation was 0.69, and between IADL and use of walking aids was 0.80. CONCLUSIONS: A return to prefracture IADL level was low. Healthier patients have a steeper decline in postoperative IADL. Geriatr Gerontol Int 2018; 18: 1244-1248.

A retrospective review of a series of interposition arthroplasties of the elbow.

BACKGROUND: Interposition arthroplasty (IA) is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. The outcome and complications of an IA were evaluated. METHODS: We retrospectively reviewed 18 consecutive cases of interposition arthroplasty (IA) (one case was excluded as a result of incomplete records). Pre- and postoperative pain and function were evaluated. Complications, re-operations and revisions were recorded. RESULTS: The mean age was 41 years (range 19 years to 59 years) at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 12 cases and inflammatory arthritis in five cases. The median follow-up was 54 months (range 8 months to 120 months). In 15 cases, at least one re-operation was performed. Seven cases were revised, with four of these to a total elbow replacement, an arthrodesis was performed in two cases and a re-do interposition was carried out in one case. The median interval from the interposition to revision was 23 months (range 8 months to 88 months). In 10 patients with the interposition currently in situ, mean visual analogue scale score for pain improved from 7.4 to 2.4 and mean Mayo Elbow Performance Score improved from 42 to 76 points. CONCLUSIONS: IA offered an improvement in pain and function but at a high cost. It is associated with a high complication rate the need for revision surgery.

Femoroacetabular impingement and its implications on range of motion: a case report.

INTRODUCTION: Femoroacetabular impingement leads to limited hip motion, pain and progressive damage to the labrum. Assessment of the amount and location of excessive ossification can be difficult, and removal does not always lead to pain relief and an increase of function. One of the challenges ahead is to discover why certain cases have poor outcomes. CASE PRESENTATION: The technical and clinical results of two consecutive arthroscopic shavings of an osseous cam protrusion are described in our patient, a 50-year-old Caucasian man with complaints of femoroacetabular impingement. At 12 weeks after the first arthroscopic shaving, our patient still experienced pain. Using a range of motion simulation system based on computed tomography images the kinematics of his hip joint were analyzed. Bone that limited range of motion was removed in a second arthroscopic procedure. At six months post-operatively our patient is almost pain free and has regained a range of motion to a functional level. CONCLUSION: This case demonstrates the relevance of range of motion simulation when the outcome of primary arthroscopic management is unsatisfactory. Such simulations may aid clinicians in determining the gain of a second operation. This claim is supported by the correlation of the simulations with clinical outcome, as shown in this case report.