New scoring system at admission to predict walking ability at discharge for patients with hip fracture.

INTRODUCTION: A reliable scoring system that predicts the walking ability of hip fracture patients would be useful for clinicians. Here we developed a scoring system for hip fracture patients and evaluated its predictive ability. HYPOTHESIS: We hypothesized that age, sex, presence of dementia, walking ability before the injury, fracture type, serum hemoglobin level, serum albumin level and interval in days between admission and surgery would be the predictive factors of the walking ability at discharge. MATERIAL AND METHODS: Data from 409 patients who underwent hip fracture surgery were included. We analyzed factors that affected walking ability and developed a scoring system that predicts the probability of walking unaided or with a cane at discharge. RESULTS: The mean age of the patients was 81.3 years. A total of 164 (40%) patients could walk unaided or with a cane at discharge. Multivariate logistic regression analysis showed that the obstructive factors for the ability to walk unaided or with a cane at discharge were older age (odds ratio [OR]=0.962, p=0.002), dementia (OR=0.126, p<0.001), use of a cane before injury (OR=0.396, p<0.001), trochanteric fracture (OR=0.571, p=0.027) and low serum albumin level (OR=4.15, p<0.001) at admission. The scoring system used the following formula: Score=5-0.04×age+albumin-2(with dementia)- 1(with use of a cane before injury)-1(with trochanteric fracture). The C-statistics for the scoring system was 0.81 (95% confidence interval, 0.77-0.85). DISCUSSION: This newly developed scoring system of information at admission predicted the discharge mobility of hip fracture patients. In addition to the previously known risk factors, serum albumin level at admission was detected as a new predictor for mobility at discharge. LEVEL OF PROOF: IV, retrospective study.

Revision Total Hip Arthroplasty Using the Kerboull Acetabular Reinforcement Device and Structural Allograft for Severe Defects of the Acetabulum.

BACKGROUND: The purpose of this study is to review our experience with Kerboull reinforcement device combined with bulk allograft for management of severe acetabular defects. METHODS: We investigated the results of revision total hip arthroplasty (THA) in 65 hips of 59 patients (10 male, 49 female) with Paprosky type 3A or 3B acetabular bone defects. Functional outcome was assessed using the Merle d'Aubigne hip score. Post-operative radiographs were examined for evidence of cup loosening. The mean age at revision THA was 59.1 years (23-85) and mean follow-up duration was 11.2 years (2-15). RESULTS: The Merle d'Aubigne hip score improved from 10.6 points (5-15) before surgery to 17.1 points (15-18) (P < .05) at the time of last investigation. In this series, mean coverage of the bone graft was 83.0% (34.6-100) of the loading portion in the horizontal plane on radiography immediately after revision. However, consolidation of the bone graft was completed within 12 months for all cases. There were 4 radiological failures due to acetabular aseptic loosening at a mean of 10.8 years (8-13) after index surgery; all 4 cases demonstrated massive bone loss that no part of the rounded plate could be placed on the host bone. Kaplan-Meier analysis showed that the 15.2-year survival rate was 85.1% (95% confidence interval 71-99) with re-revision surgery for any reason as the end point. CONCLUSION: Despite massive bone defects, we achieved favorable results for revision THA using bulk allograft and the Kerboull reinforcement device.

Results on total hip arthroplasties with femoral shortening for Crowe's group IV dislocated hips.

We performed total hip arthroplasties in 11 women with Crowe's group IV completely dislocated hips, with a mean age at surgery of 59.6 years and a mean follow-up of 65 months. In all cases, femoral shortening was achieved using step-cut osteotomy. All acetabular cups were placed in their anatomical locations. The mean Merle d'Aubigne hip score improved from 10.9 points to 16.9. There was no case of nonunion or malunion in the osteotomized site. Temporary numbness was observed in 2 hips, which subsided within 3 weeks without any treatment. One hip had to be revised 8 years after surgery because of aseptic loosening of the stem. Our study shows that total hip arthroplasty, incorporating step-cut femoral shortening, provides acceptable results for completely dislocated hip.