Artificial Femoral Head Replacement Research Articles

Effects of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fractures.

To investigate the effect of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fractures. 102 elderly male patients with femoral neck fractures hospitalized in the Beijing Hospital from January 2017 to January 2019 were included. The patients with femoral neck fractures were divided into the depression group and the control group. The observation indicators included: bone mineral density, serum alkaline phosphatase, serum calcium, serum phosphorus, 25-hydroxy-vitamin D, osteocalcin, Type I procollagen amino-terminal propeptide, serum β-isomer of C-terminal telopeptide of type I collagen, hip function scores, and pain visual analogue scale at pre- and post-operative examinations. The BMD was significantly lower in the depressed group than in the control group [either for lumbar spine or hip, P<0.05]. Serum 25-(OH)-D levels and serum OC levels were lower (both P<0.05) in the depression group, while serum -CTX levels were higher in the depression group than in the control group (P<0.05). Depression severity (GDS score) was negatively correlated with BMD (r=-0.456, P<0.05), 25(OH)D (r=-0.546, P<0.05), and OC (r=-0.215, P<0.05), while positively correlated with β-CTX (r=0.372, P<0.05). The Harris scores of the depression group were lower than the control group (P<0.001). In the control group, VAS scores decrease at 12 months postoperatively while in the depressed group, VAS scores increased (P<0.001). Depression is a risk factor for low bone mineral density and fracture, and adversely affects functional recovery and pain relief after artificial femoral head replacement. Special care should be taken for those patients with depressive symptoms in orthopedic practice.

Novel screw fixation placement configuration for the treatment of Pauwels type III femoral neck fractures: a finite element analysis.

Verticality of transcervical hip fractures in young patients is usually connected with typically high-energy fractures which are known as Pauwels type III. Artificial femoral head replacement surgery is mostly not considered for treating femoral neck fractures in such patients. The commonly used devices for the fixation of vertical femoral neck fractures are multiple screws or a sliding hip screw with or without an antirotation screw. Size, location and length of the screws are the most effective parameters in terms of the structural performance of internal fixation implants, but the optimal configuration of the screws is necessary to be investigated to direct the clinical practice. The aim of this study is to compare the biomechanical stability of the standard inverted triangle configuration with the various newly proposed x-crossed screw configurations. FEA simulations carried out in this study demonstrated that using an x-crossed-right assembly in treating Pauwels type III femoral neck fractures satisfies the biomechanical stability in terms of maximum von Mises stresses and maximum femoral head displacement. However, in terms of maximum relative neck fracture displacement, the x-crossed-right assembly would not entirely suffice the desired biomechanical stability. Therefore, using an x-crossed screw assembly in treating femoral neck fractures would provide the needed biomechanical stability.

Treatment of femoral head replacement in elderly patients with femoral neck fracture complicated with uremia

To investigate the treatment method and effect of artificial femoral head replacement for elderly patients with femoral neck fracture complicated with uremia. From January 2016 to December 2020, 21 elderly patients with femoral neck fracture complicated with uremia were treated with artificial femoral head replacement. There were 3 males and 18 females, aged 65 to 83 years old with an average of (77.2±1.9) years. All patients were complicated with uremia and required long-term maintenance of hemodialysis. The age of dialysis was 2 to 11 years with an average of (6.3±1.6) years, 2 to 3 times per week. The time from injury to admission to operation was 3 to 7 days with an average of (4.0±2.1) days. The anemia and hypoproteinemia of the patients were corrected preoperatively, and the serum potassium and creatinine indexes of the patients were adjusted by hemodialysis. All the incisions were healed in the first stage, and there were no complications of wound infection, prosthesis loosening, dislocation and deep vein thrombosis. All patients resumed routine hemodialysis in time to maintain the stability of serum creatinine and potassium levels. All 21 patients were followed up for 5 to 23 months with an average of (16.8±2.6) months. Harris scores changed from (24.8±2.5) scores preoperatively to (87.2±3.1) scores postoperatively. Elderly patients with femoral neck fracture combined with uremia underwent artificial femoral head replacement surgery, as long as the perioperative treatment is appropriate, with active postoperative rehabilitation treatment, can obtain a good clinical effect.

Timing of artificial femoral head replacement in the treatment of femoral intertrochanteric fracture with intramedullary nail failure in elderly patients

To analyze the timing of artificial femoral head replacement in elderly patients with femoral intertrochanteric fracture after intramedullary nail failure. From July 2013 to September 2019, 17 elderly patients with femoral intertrochanteric fracture after intramedullary nail fixation failure were treated with artificial femoral head replacement. According to the interval from diagnosis of internal fixation failure to pedestrian femoral head replacement, the patients were divided into early operation and delayed operation groups. Among them, there were 8 cases of early operation, 5 males and 3 females;the age ranged from 80 to 89 years old with an average of (84.88±2.79) years old;the interval was 1 to 7 days with an average of(4.13±1.73) d. There were 9 cases of delayed operation, 4 males and 5 females;the age ranged from 80 to 89 year old with an average of(84.22±3.03) years old;The interval was 15 to 30 with days an average of (25.56±4.36) d. The operation time, intraoperative blood loss, the first postoperative weight-bearing time, postoperative hospital stay, the number of complications and deaths were compared between two groups. Harris score was used to evaluate hip function at 1 and 12 months after operation. The incision healed well after operation. There was 1 case of urinary tract infection in the early operation group;in the delayed operation group, there were 2 cases of intermuscular venous thrombosis, 1 case of pulmonary infection, 3 cases of urinary tract infection and 1 case of prosthesis dislocation. All 17 patients were followed up for 12 to 16 months with an average of (14.76±1.86) months. There was no significant difference in operation time, intraoperative blood loss and the number of deaths between two groups(P>0.05). There were significant differences in the first weight-bearing time, postoperative hospital stay and the number of complications between two groups(P<0.05). One month after operation, there was significant difference in Harris score between two groups(P<0.05). There was no significant difference in Harris score between two groups 12 months after operation(P>0.05). After the failure of intramedullary nail fixation of femoral intertrochanteric fracture in elderly patients, there is no significant difference in mortality and final hip function between early operation and delayed operation. However, early pedestrian femoral head replacement can make patients go down to the ground earlier, shorten the length of hospital stay, effectively reduce the complication rate and restore hip function as soon as possible.

Value of Rapid Rehabilitation Model in the Perioperative Period of Artificial Femoral Head Replacement for Senile Femoral Neck Fracture

Value of Rapid Rehabilitation Model in the Perioperative Period of Artificial Femoral Head Replacement for Senile Femoral Neck Fracture

Comparative study of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly

To compare the clinical efficacy of femoral head replacement and internal fixation in the treatment of unstable intertrochanteric fractures in the elderly. Retrospective analysis of 70 cases of unstable intertrochanteric fractures treated from January 2016 to January 2019 and meeting the inclusion and exclusion criteria, 39 cases were fixed with closed reduction and new proximal femoral intramedullary nail(InterTAN), and 31 cases were treated with open trochanter reconstruction and artificial femoral head replacement. The operation time, intraoperative bleeding, hospital stay, weight bearing time, postoperative complication rate and hip function recovery (Harris score) were compared between two groups. All cases were followed up for 12 to 24 months. There were no significant differences in intraoperative bleeding and hospital stay between the two groups (P>0.05). The operation time in replacement group was longer than that in internal fixation group (P< 0.05). The postoperative weight-bearing time in replacement group was significantly earlier than that in internal fixation group (P<0.05). In the replacement group, there were 1 case of pulmonary infection, 1 case of deep venous thrombosis and 1 case of periprosthetic fracture;in the internal fixation group, there were 4 cases of pulmonary infection, 3 cases of internal fixation failure, 3 cases of cerebral infarction and 2 cases of urinary infection;there was significant difference between two groups (P< 0.05). The Harris score in replacement group was higher than that in internal fixation group one month after operation (P< 0.05), but there was no significant difference between two groups at 12 months after operation(P>0.05). InterTAN and femoral head replacement can treat unstable intertrochanteric fractures in the elderly, but femoral head replacement can move down early, improve the quality of life at the end of life, reduce postoperative complications and facilitate the treatment of coexisting diseases in internal medicine.

Effect and complications of proximal femoral anti-rotation intramedullary nail in the treatment of femoral intertrochanteric fracture in the elderly

To study the prognosis and complications of proximal femoral nail antirotation(PFNA) in the treatment of elderly intertrochanteric fracture. From January 2016 to November 2019, 127 cases of femoral intertrochanteric fracture were treated with PFNA, including 51 males and 76 females. The average age was 81.39±8.16 (range from 60 to 98). According to Evans classification, the numbers of cases of typeⅠa, typeⅠb, typeⅠc, typeⅠd and typeⅡwere 10, 46, 48, 16 and 7, respectively. Based on the AO /OTA classification, there were 10 cases of type 31-A1.2, 84 of type 31- A1.3, 17 of type 31-A2.2, 9 of type 31-A2.3, and 7 of type 31-A3. Preoperative and the final follow up, function of hip joint of patients treatedwith the PFNA were evaluated by harris hip score, and the postoperative complications were observed. No incision infection occurred in all patients after PFNA. In this research, 4 cases failed in internal fixation, three of them underwent artificial femoral head replacement;5 cases died within one year after operation;2 cases had multiple embolizations of pulmonary artery branches, which recovered after anticoagulation treatment. There were 48 cases complicated with pneumonia, among which 9 cases had pulmonary inflammation before operation;27 cases with pleural effusion, 3 cases with acute heart failure, 3 cases with acute renal insufficiency, except one case died of pneumonia, pleural effusion, hypoproteinemia and respiratory failure during hospitalization, the other patients recovered after treatment. All 119 patients were followed up for 6 to 36 months, with an average of (17.01±6.03) months, Harris hip score increased from 8.96±5.40 preoperation to 83.57±8.92 at the final follow-up (t=75.86, P<0.01). PFNA is a recommended option for the treatment of senile patients with intertrochanteric fracture. However, there were a lot of complications when femoral intertrochanteric fractures happened in aged patients, especially prevention and treatment of pulmonary embolism, promptly corrected low hemoglobin and low albumin, and reduce complications.

Application of head-neck ratio in the treatment of femoral neck fracture in aged patients with artificial femoral head replacement

Application of head-neck ratio in the treatment of femoral neck fracture in aged patients with artificial femoral head replacement

Analysis of short-term effect of artificial femoral head replacement in the treatment of femoral intertrochanteric fracture in the elderly.

article: Analysis of short-term effect of artificial femoral head replacement in the treatment of femoral intertrochanteric fracture in the elderly - Panminerva Medica 2021 Apr 21 - Minerva Medica - Journals

Comparison of clinical efficacy of artificial femoral head replacement and total hip replacement in the treatment of femoral neck fracture in the elderly.

article: Comparison of clinical efficacy of artificial femoral head replacement and total hip replacement in the treatment of femoral neck fracture in the elderly - Minerva Surgery 2021 October;76(5):484-5 - Minerva Medica - Journals

The Effect of Total Hip Replacement and Artificial Femoral Head Replacement in the Treatment of Elderly Femoral Neck Fractures

The Effect of Total Hip Replacement and Artificial Femoral Head Replacement in the Treatment of Elderly Femoral Neck Fractures

Finite element analysis of different diameter prosthesis ball head in artificial femoral head replacement

In order to select the proper size of prosthesis ball head, the biomechanical changes of hip joint using different diameter prosthesis ball head was studied by three-dimensional finite element analysis. The thin-layer CT data and related parameters of artificial femoral head prosthesis were used to establish the finite element model of hip joint after artificial femoral head replacement with different ball diameter of prosthesis(M0:preoperative model;M1:ball head diameter=original femoral head diameter;M2:ball head diameter=original femoral head diameter+1 mm;M3:Ball head diameter= Original femoral head diameter -1 mm;M4:ball head diameter =original femoral head diameter -2 mm). Loading the joint forces and related muscle loads were loaded, and the stress distribution and change of bone and cartilage around acetabulum were analyzed by simulating the standing state of one foot when walking slowly. (1) In M1 to M4, the stress concentration in pelvis was different. The peak value of Von Mises stress in the pelvis of M3 was 44.8 MPa, which was the closest to that before operation, with an increment of 13.4%. The displacement of the pelvis of M3 was the smallest in the four groups after operation, with an increment of 1.40 mm. The next was M1, with a peak value of 47.3 MPa, with an increment of 19.7%, and a pelvic displacement of 1.59 mm. (2) In acetabulum area, the peak value of Von Mises stress in M3 was 23.3 MPa, which was the closest to that before operation, with an increment of about 6.3%, followed by M1, with a peak value of 24.0 MPa and an increment of about 8.1%. (3) On the acetabulum cartilage, the stress distribution of M1 and M3 was similar to that before operation, and the peak value of Von Mises stress of M3 was 18.5 MPa, which was the closest to that before operation, followed by M1, which was 22.5 MPa. (4) M1 to M4 showed different degree of stress concentration in the outer upper quadrant of the artificial femoral head, but showed stress shielding under it;among them, the von Mises stress distribution of M3 was more uniform than that of other models, and its peak value (70.8 MPa) was the lowest in each group, followed by M1 (80.7 MPa). When femoral head replacement is performed, it is suggested that the prosthesis ball head with the diameter less than 1 mm and the prosthesis ball head with the same diameter as the original femoral head should be used first, so as to obtain the closest natural mechanical characteristics of the hip joint before the replacement and reduce the risk of complications caused by size differences.

An Experimental Analysis of Composite Nursing Material of Degradable Magnesium/Polylactic Acid in the Treatment of Postoperative Pain After Orthopedic Surgery

In this study, magnesium is used as the modified material of polylactic acid (PLA). In the process of combining magnesium and PLA, the magnesium powder is pre-treated with fluorine conversion, that is, the surface of the magnesium powder would form a fluoride membrane, and then it is compounded with PLA to form Mg-F-PA. In the experiment, the morphology of the material is analyzed first. Magnesium powder and magnesium fluoride powder are evenly dispersed on the surface of the composite material, and the surface of the composite material is relatively flat. At the same time, it is found in the mechanical analysis that the mechanical strength of composite Mg-F-PA decreases compared with that of single PLA, but the binding force of magnesium fluoride powder + PLA is stronger than that of magnesium powder + PLA. 120 patients with lower extremity fractures of ASA I∼III are selected and divided into 4 groups, with 30 cases in each group. These patients are treated with hip replacement (group 1), artificial femoral head replacement (group 2), open reduction and internal fixation for lower limb fractures (group 3), open reduction and internal fixation for lower limb fractures + Mg-F-PA (group 4). Then, postoperative evaluation is conducted. The clinical results show that the group 4 is better than the other 3 groups in terms of the sedation degree score, the number of pain pump presses and the incidence of postoperative adverse reactions (P &lt; 0.05). Therefore, the orthopedic material that proposed in this study can reduce postoperative pain.

Comparative Analysis of Three Internal Fixation Methods for Intertrochanteric Fracture of Femur in the Elder

As the average life span of the Chinese prolongs, the number of intertrochanteric fractures of the femur in elderly patients has increased all the time, and gradually becomes a more common type of fracture in elderly patients. From January 2011 to December 2016, 137 elderly patients with intertrochanteric fractures were treated with 3 mehhods, including locking plate, proximal femoral nail (PFNA) and artificial femoral head replacement. The mean age was 79.16±3.45 years. The mean follow-up time was 17.20±1.30 months. The operative time, intraoperative bleeding volume, postoperative complications, and Harris score of the hip joint at 1 month and 1 year after surgery were compared among the three groups. Statistical analysis by SPSS 22.0 software showed that the operation time of group C was the shortest, followed by group B and group A. The difference was statistically significant (p<0.05). There was no significant difference in operation time between group A and group B (p>0.05); There was no significant difference in bleeding volume between the three groups (p>0.05). Group A had the lowest complication rate, followed by group C and group B. But there was no significant difference between the three groups (X2=0.0618, p>0.05). All the patients were cured and discharged after active symptomatic treatment. Among the patients, the mean Harris score of group A was 38.52±6.51 at 1-month follow up postoperatively; the mean Harris score of group B was 44.28±5.97 at 1-month follow up postoperatively; the mean Harris score of group C was 70.59±6.99 at 1-month follow up postoperatively, the C group was the best and the B group was the second. There was a significant difference between the three groups (p<0.05). The mean Harris score of group A was 84.40±9.34 at 1-year follow up postoperatively; the mean Harris score of group B was 83.12±8.76 at 1-year follow up postoperatively; the mean Harris score of group C was 85.25±8.07 at 1-year follow up postoperatively. There was no significant difference between the three groups (p>0.05). During the follow-up period, there was no loosening or breakage in the internal fixation, and the fracture healed well. This study concluded that locking plate, PFNA or artificial femoral head replacement can achieve satisfactory clinical results in elderly patients with intertrochanteric fractures, but artificial femoral head replacement can achieve early functional recovery, more conducive to elderly patients.

Therapeutic Effect of Artificial Femoral Head Replacement and Proximal Femoral Nail Antirotation on Elderly Unstable Intertrochanteric Fractures

Objective: To compare the clinical efficacy of artificial femoral head replacement and Proximal femoral nail antirotation (PFNA) in the treatment of unstable femoral intertrochanteric fractures in the elderly. Methods: This study retrospectively analyzed 60 elderly patients with unstable intertrochanteric fractures treated with PFNA and artificial femoral head replacement from 2015.06 to 2018.06, of which 34 were in the PFNA group (Group A) and 26 in the artificial femoral head replacement group (Group B). Statistical analysis of relevant surgical indicators such as surgical time, intraoperative blood loss, postoperative blood transfusion, postoperative time to landing, postoperative infection rate, hospital stay, number of secondary operations, postoperative VAS score, and postoperative Hip function score comparison. Results: All 60 patients were followed up for 1 - 24 months. Compared with the artificial femoral head replacement group, the operation time of PFNA group was shorter, the blood loss during operation was less, and the difference was statistically significant (P 0.05). Conclusion: The hip joint function and pain scores of the artificial femoral head replacement group in the early and follow-up periods are better than those of the PFNA group. The artificial femoral head replacement is more suitable for the treatment of elderly unstable intertrochanteric fractures.

Hip hemiarthroplasty for senile femoral neck fractures: Minimally invasive SuperPath approach versus traditional posterior approach

BackgroundThe supercapsular percutaneously-assisted total hip (SuperPATH®) approach was created by combining the percutaneous preparation of the acetabulum using the percutaneously-assisted total hip (PATH), femoral reaming, and broaching of superior capsulotomy (SuperCap) approach. This technique reported a low complication rate, excellent gait kinematics, low transfusion rate, a shorter length of hospital stay, and a high proportion of discharge from the hospital. As minimally invasive SuperPath approach is designed for both trauma and end-stage degenerative joint disease, we investigated if this technique and standard surgical tools can replace artificial femoral head in elderly patients with femoral neck fracture. We also tested if it has advantages over the traditional posterior approach. MethodsA prospective study was performed in 100 cases of eligible femoral neck fractures from May 01, 2015 to October 31, 2016. They were randomly divided into SuperPath and traditional group. The outcomes were evaluated using preoperative index, intraoperative data, and postoperative function data. ResultsNo significant difference was detected in the operation time between the two groups. Compared with the traditional group, SuperPath group had smaller incision length, less intraoperative bleeding, lower transfusion rate, and a shorter starting time of weight-bearing activity. Harris Hip Score, Barthel Index, and VAS for pain-level scores in the SuperPath group at 1-week follow-up intervals were significantly lower than the conventional group, but not significantly different at 3-month and 2-year follow-up post-operation. ConclusionsSuperPath approach for artificial femoral head replacement can reduce surgical injury due to smaller size of incision and accelerate weight-bearing activities post-operation to treat senile femoral neck fractures compared with traditional posterior approach surgeries.

Efficacy of artificial femoral head replacement for femoral head avascular necrosis.

Background: Femoral head avascular necrosis (FHAN) is one of the most common progressive orthopedic disorders. Previous studies have reported that artificial femoral head replacement (AFHR) can effectively treat patients with FHAN. However, no systematic review has investigated the efficacy of AFHR for FHAN. This study will assess the efficacy of AFHR for patients with FHAN.Methods: We will search MEDLINE, EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure up to March 1, 2019 without any restrictions. Any randomized controlled trials for assessing the efficacy of AFHR for patients with FHAN. The methodological quality for each eligible study will be assessed by using Cochrane risk of bias tool. Statistical analysis will be conducted by using RevMan 5.3.Results: This study will provide current evidence of AFHR for patients with FHAN from several aspects, including pain intensity, function, and limitation of femoral head, health-related quality of life, and safety.Conclusion: This study will provide latest evidence on assessing the efficacy and safety of AFHR for FHAN.PROSPERO registration number: PROSPERO CRD42019126249.

The application value in bi-directional quality control module of surgical package in artificial femoral head replacement

Objective To explore the application value and clinical effect of the bi-directional quality control module for Surgical Package in artificial femoral head replacement. Methods A total of 360 patients undergoing artificial femoral head replacement in our hospital from June 2015 to June 2017 were selected and divided into observation group and control group, 180 cases in each group. The observation group,used bi-directional quality control module of surgical bag, while the control group used conventional management model of surgical bag. The operation time, the incidence of surgical bag, postoperative complications and postoperative satisfaction were compared. Results The average operation time in the observation group was (69.2 ± 11.6)min, the average operation time in the control group was (76.8 ± 14.5)min, P <0.01. The total defect rate in the observation group was 2.2%. The total defect rate in the control group was 22.2%, P <0.01; the observation group had less severe pain, incision split, fever, postoperative bleeding, incision infection than the control group, P <0.05. Patient satisfaction score was (89.38±7.83) points in the observation group, (79.18±5.55) points in the control group, P <0.01. Conclusions The bi-directional quality control module of surgical package can shorten the operation time, reduce the defect surgical packages, reduce the incidence of postoperative complications, improve the quality of operation, and improve patient satisfaction in the application of artificial femoral head replacement. It is worthy of clinical application. Key words: Surgical package; Bi-directional quality control module; Artificial femoral head replacement

Curative effect of artificial femoral head replacement and its effect on hip joint function and complications of senile patients with femoral intertrochanteric fracture.

Curative effect of artificial femoral head replacement on hip joint function and complications of elderly patients with femoral intertrochanteric fracture were investigated. Eighty patients who were operated for femoral intertrochanteric fractures operation were randomly divided into observation group (n=40) and control group (n=40). The observation group was treated with artificial femoral head replacement, while the control group received internal proximal femur locking plate fixation. In the observation group, the operation time was shorter than that in the control group (P<0.05). The intraoperative bleeding was less than that in the control group (P<0.05). The postoperative indwelling drainage time was shorter than that in the control group (P<0.05). Besides, at 3, 6 and 12 months after operation, 10 m walking speed in the observation group was significantly higher than that in the control group (P<0.05). The 5-time sit-stand time was shorter than that in the control group (P<0.05). At 1 week, 1 month, 3, 6 and 12 months after operation, Harris hip joint scores and visual analogue scale scores in the observation group were both superior to those in the control group (P<0.05). Moreover, the total hospitalization time in the observation group was shorter than that in the control group. Time of walking on crutches and walking without crutches was earlier than that in the control group (P<0.05). The overall proportion of postoperative chronic pain, thrombosis and failed surgery in the observation group was significantly lower than that in the control group (P<0.05). Finally, physical and psychological scores in the observation group after intervention were obviously higher than those in the observation group before intervention and the control group after intervention (P<0.05). Artificial femoral head replacement is characterized by the short operation time, less intraoperative bleeding, fast postoperative recovery of joint function, low degree of pain and fewer complications in the treatment of senile femoral intertrochanteric fracture, which can improve the postoperative life quality of patients.

Predictors of Gait Recovery after Artificial Femoral Head Replacement in Patients with Femoral Neck Fracture: A Retrospective Study Focusing on Acute Postoperative Pain and Lower-limb Muscle Strength

Predictors of Gait Recovery after Artificial Femoral Head Replacement in Patients with Femoral Neck Fracture: A Retrospective Study Focusing on Acute Postoperative Pain and Lower-limb Muscle Strength