Treatment of displaced intracapsular fractures of the femoral neck with total hip arthroplasty or hemiarthroplasty.

AIMS: Despite few good-quality studies on the subject, total hip arthroplasty (THA) is increasingly being performed for displaced intracapsular fractures of the neck of femur. We compared outcomes of all patients with displacement of these fractures treated surgically over a ten-year period in one institution. METHODS: A total of 2,721 patients with intracapsular fractures of the femoral neck treated with either a cemented hemiarthroplasty or a THA at a single centre were retrospectively reviewed. The primary outcomes analyzed were readmission for any reason and revision surgery. We secondarily looked at mortality rates. RESULTS: We found no difference in the overall revision rate or rate of infection. However, the rates of readmission due to dislocation, pain, and trochanteric bursitis were significantly higher in the THA group (p = 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). CONCLUSION: Our study, comparing the outcomes of neck of femur fractures treated with a cemented hemiarthroplasty and THA, revealed the perceived superiority of THA was not borne out by our results. This should be carefully considered before any radical change in practice regarding the use of THA for displaced intracapsular fractures of the femoral neck. Cite this article: Bone Joint J 2020;102-B(6):693-698.

Revision of medial Oxford unicompartmental knee replacement to a total knee replacement: similar to a primary?

Unicompartmental knee replacement (UKR) is an option for the treatment of isolated medial compartment osteoarthritis. A commonly perceived potential advantage is that revision of a UKR is straightforward. The purpose of this study was to determine the early outcomes and the level of complexity of revisions of Oxford UKRs performed at our hospital. A retrospective review of a prospective database of all phase III Oxford UKRs was undertaken. This identified 89 Oxford UKRs which were revised at our institution between 2002 and 2008. The median time from the primary procedure to revision was 19 months (interquartile range 2-73 months). Nine were revised to another UKR. Eighty were revised to a total knee replacement (TKR). Fifty-three were revised with primary TKR components. Twenty-seven were revised using stems and/or augments. The median overall tibial component thickness (including augments) was 15 mm. Forty-five knees had an overall tibial component thickness greater than 15 mm. A primary Oxford UKR bearing thickness of greater than 6mm was associated with an increased likelihood of requiring revision components. On the basis of this review, tibial bone defects were commonly encountered when revising UKRs. Reconstruction with either an augment and a stem, or thick polyethylene component was often required. We recommend that the potential complexity of revision for UKR failure should be borne in mind when considering a primary Oxford UKR.

Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report.

We present a case of an ipsilateral tibial shaft fracture and a distal tibial triplane fracture with an intact fibula in a 14-year-old boy. Computed tomography revealed the distal tibial triplane fracture with a 2.6-mm displaced Tillaux fragment and a posterior malleolar shear fragment. Open reduction and internal fixation was performed to optimise healing and outcome. This is a rare injury, for which a high index of suspicion is needed for diagnosis. Missing the intra-articular distal tibial triplane fracture could result in a disabling angular deformity (mostly varus) or limb-length discrepancy secondary to premature partial closure of the distal physis.

Patient-perceived outcomes and return to sport and work: TKA versus mini-incision unicompartmental knee arthroplasty.

Few reports have been published about patient-perceived outcomes and return to sport following total knee arthroplasty (TKA) compared with unicompartmental knee arthroplasty (UKA). This article compares the two procedures using self-assessment questionnaires to determine whether there was a difference in patient-perceived Oxford scores, return to sport, and return to work. Patient-perceived outcomes of mini-incision UKA (Oxford; Biomet Inc, Warsaw, Ind) and TKA were retrospectively reviewed at a minimum of 12 months after surgery. A total of 150 patients underwent 183 UKAs (mean age: 71.5 years; standard deviation [SD]: 9.85) and 120 patients underwent 142 TKAs (mean age: 71.53 years; SD: 9.87). Oxford knee questionnaires were used assessing modified Grimby score, sports, and work activities. Mean Oxford knee score (22.17; SD: 9.03) for UKA was superior to TKA (24.5; SD: 9.68) (P=.04) scores. Mean modified Grimby score for UKA (3.89; SD:1.27) was superior to TKA (2.76; SD:1.12) (P<.0001). More patients returned to or increased sports following UKA (P=.0003), but no sooner than TKA patients. Patient-perceived Oxford and modified Grimby scores were better and sporting activity was greater following mini-incision UKA compared to TKA.