Artificial Hip Replacement Research Articles

Risk factors for periprosthetic joint infection after primary artificial hip and knee joint replacements.

We aimed to explore the risk factors for periprosthetic joint infection (PJI) after primary artificial hip and knee joint replacements by performing a case-control study. The clinical data of patients receiving primary hip and knee joint replacements were retrospectively analyzed. The case group included 96 patients who suffered from PJI, comprising 42 cases of hip joint replacement and 54 cases of knee joint replacement. Another 192 patients who received joint replacement at the ratio of 1:2 in the same period and did not suffer from PJI were selected as the control group. Differences between the two groups were compared in regard to etiology, pathogen, blood type, urine culture, body mass index (BMI), surgical time, intraoperative blood loss, postoperative 1st day and total drainage volumes, length of hospitalization stay, and history of surgery at the affected sites. Gram-positive bacteria were the main pathogens for PJI. The most common infection after hip joint replacement was caused by Staphylococcus epidermidis, which accounted for 38.10%, while Staphylococcus aureus was mainly responsible for the infection of knee joint (40.74%). High BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were independent risk factors (p < 0.05). PJI after primary replacement was mainly caused by gram-positive bacteria, and patients with high BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were more vulnerable.

Mapping Tribo-Corrosion Behaviour of TI-6AL-4V Eli in Laboratory Simulated Hip Joint Environments

Wear and corrosion in artificial hip replacements are known to result in metal ion release and wear debris induced osteolysis. This may lead to pain and sensitivity for patients. This infers that pre-clinical testing is critical in determining the long-term performance, safety, and reliability of the implant materials. For this purpose, micro-abrasion-corrosion tests were carried out on a biocompatible material, Ti-6Al-4V ELI, using a T-66, Plint micro-abrasion test rig in conjunction with Gill Ac corrosion testing apparatus for the range of applied loads and electrical potentials in the hip joint simulated environment. A Ringer’s solution, with and without an abrasive particle (silicon carbide), was used to enable the interactions between abrasion and corrosion. In this paper, the effects of applied load and electrochemical potential on the tribo-corrosion behaviour of Ti-6Al-4V in a bio-simulated environment are presented. The wastage, micro-abrasion-corrosion mechanisms, and synergy behaviour were identified and mapped. A significant difference in corrosion current densities was observed in the presence of abrasive particles, suggesting the removal of the protective oxide layer. The results also indicate that Ti-6Al-4V had significant abrasive wear loss when coupled with a ceramic counterpart. According to the mechanism, micro-abrasion plays a predominant role in the abrasion-corrosion behaviour of this material and the material losses by mechanical processes are substantially larger than losses, due to electrochemical processes.

Measurement of Self-Supporting Ability among Patients with Hip Replacement

Total hip arthroplasty (THA) is an effective treatment for patients with end-stage arthritic hip condition. It provides pain relief, enhances mobility, and restores function (Liu, Zi, Xiang, & Wang, 2015). Arthroplasty, or joint replacement, comes from the Greek words ‘arthron’, that is meaning joint, and ‘plassein’, is meaning mould (Palareti et al., 2016).total hip replacement (THR) in patients with symptomatic osteoarthritis (OA) were succeed up to one-quarter of patients report suboptimal recovery. Osteoarthritis (OA) which cause pain and functional disability and most common form of arthritis and major structural changes of the joint and contains inflammation. Moderate to severe OA is the most common indication for total hip replacement (THR) (Brembo, Kapstad, Van Dulmen, & Eide, 2017).THR is a cost-effective treatment for hip OA and offers relief of pain and improved function and quality of life (Ethgen, Richy, & Reginster, 2004). In 2006, among 230,144 people who operated THR in USA, 86% of them had diagnosis of OA. According to the expectations in 2030, the number of surgeries for primary THR will reach to 572,000 per year in USA. Also, it was reported in Taiwan 6519 new cases in 2004 with increasing its number to 15,000 in 2008. It’s shows 2.1% growth per year in (of a total population of 23 million). The main task of rehabilitation is strengthening the muscles around the replaced hip joint to keep joint stability (Chang et al., 2017). For THR rehabilitation, hydrotherapy, stationary bike, motion’s range and walking programs are correlated (Nelson, Bourke, Crossley, & Russell, 2018). In the successful THR operation, gait alterations will stay in patients for 10 months after surgery. Also, immobilization after surgery will be remained due to the muscular weakness. To reduce immobilization effects and speed up discharging and increasing recovery, starting the rehabilitation of THR will be usually recommended on the day of operation. Furthermore, to improve balance, stability, safety and self-confidence using a crutch is proposed. Nevertheless, incorrect using of a crutch can effect on improving recovery time (Esposito, Freddolini, Marcucci, Latella, & Corvi, 2018). According to World Health Organization (WHO) almost 25% of the population will have bone and joint problems until 2050. With promoting the positive self-efficacy and instigating suitable medical treatment, the condition of patients can be highly improved. In the USA the number of patients with OA will be double in the population with aged >65 years old according to research conducted by the Centers for Disease Control and 4 Prevention (CDC) by 2030 (Wu, Lee, Chou, Chen, & Huang, 2018). Recently, the most common used treatment for hip disorders became the artificial hip replacement in old patients (Kutzner, Donner, Schneider, Pfeil, & Rehbein, 2017). The aim of the research: Our study was aimed at measuring the self-supporting ability including quality of life, walking distance, range of movement, muscle strengthening and balance among patients after operation of hip replacement. Hypothesis: We suppose the patient’s physical functioning will be improved after the physiotherapy program. After training, we assume the muscle strengthening will be also increased. We hypothesize the range of movement will be developed. Quality of life will be enhanced after three weeks of physiotherapy training, we presume. Furthermore, we believe during the physiotherapy program the walking distance will be extended. We assume standing balance will be improved after the above-mentioned training period.

Finite Element Analysis of Different Artificial Hip Stem Designs Based on Fenestration under Static Loading

Permanent hip joint damage caused by calcification, aging, or accidents requires replacement using artificial hip joint replacement surgery. Among the biomaterial applications, the Total Hip Replacement (THR) method is the most successful. Many types of artificial hip joints are available in the commercial market. Various types of material and design can be selected to suit the needs of the patients. One of which is the design with fenestration type on the hip stem. In terms of materials, Titanium and stainless steel are the ones commonly used in hip joint replacement. In this paper, the effects of fenestration hip stem on mechanical behavior have been studied using the finite element analysis. Several hip designs, i.e., the hip joint without fenestration, hip joint with fenestration slot, hip joint with fenestration big loop, and hip joint with fenestration multi-loop, were considered in this study. All models were applied using Autodesk inventor model. Static structural analysis was performed using ANSYS to conclude at the best fenestration. Results showed that for Ti-6Al-4V material, design with many loop fenestration has the lowest stress than others, with the result obtained is 495.46 MPa. However, the artificial hip stem with slot fenestration has the smallest deformation with the least difference in value compared to other designs with distortion 0.54808 mm. In addition, the design that produced the higher stress von-Misses was big loop fenestration 526,28 MPa. In conclusion, it was found that all four designs indicated lesser stress values than the yield strength.

A Test to Evaluate the Mobility of Trochanter over Acetabulum during Performing Artificial Hip Replacement

A Test to Evaluate the Mobility of Trochanter over Acetabulum during Performing Artificial Hip Replacement

Modified Ilizarov hip reconstruction in treatment of adolescent hip instability

To evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability. The clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness. All 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient's hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one ( t=－10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation ( t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%. Modified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.

Efficacy comparison between operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism

Objective To investigate efficacy of operation and non-operation treatment for hip fractures patients complicated with pulmonary embolism. Methods A retrospective case control study was conducted to analyze the clinical data of 18 hip fracture patients complicated with pulmonary embolism admitted to Dongyang People's Hospital from May 2017 to January 2019. There were 11 males and seven females, aged 59 to 96 years[(80.0±9.3)years]. There were 10 patients with intertrochanteric fractures, one with femoral subtrochanteric fracture and seven with femoral neck fractures. After diagnosis of pulmonary embolism, the patients were given anticoagulant therapy with low molecular weight heparin for at least one week. The re-examination showed that pulmonary embolism absorption improved and D-dimer did not increase. Eleven patients chose surgical treatment (operation group) with intramedullary nail internal fixation or artificial hip replacement. Seven patients chose non-surgical treatment (non-operation group) with skin traction. The Harris score of hip function was compared between the two groups. Visual analogue scale (VAS) was used to evaluate hip joint pain. At the last follow-up, fracture healing, prognosis of pulmonary embolism and mortality within 3 months were recorded. Results All the patients were followed up for 3-22 months [(11.2±6.0)months]. At last follow-up, the Harris score was (92.1±2.2)points in the operation group and (28.8±18.8)points in the non-operation group (P<0.01); the VAS was 0 point (0-1 point) in the operation group and 3 points (1-3 points) in the non-operation group (P<0.01). At the last follow-up in the operation group, five patients obtained fracture healing after internal fixation, and among the six patients receiving artificial joint replacement, five patients recovered well except for one deceased patient. At the last follow-up, pulmonary embolism was absorbed and no recurrence of pulmonary embolism was found. None of the patients died within 3 months in operation group, while 14% of the patients (1/7) in the non-operation group died within 3 months. Conclusions For hip fracture patients complicated with pulmonary embolism, compared with non-operation treatment, operation treatment is more beneficial to restore hip function and relieve pain, with lower mortality rate within 3 months. Operation treatment is feasible for patients who showed improved absorption of pulmonary embolism and no secondary increase of D-dimer after one to two weeks of full anticoagulation treatment before operation. Key words: Hip fractures; Pulmonary embolism; Operation

Clinical study of Jiawei Xiaoyao Powder(JWXYP) on preventing delirium in elderly patients with hip fracture after operation

To study the effect of soothing liver, relieving depression, invigorating spleen and reinforcing blood on reducing delirium in elderly patients with hip fracture. From December 2014 to June 2018, 180 elderly patients with hip fracture admitted were divided into treatment group and placebo group according to the order of admission:90 patients in treatment group were treated with Jiawei Xiaoyao Powder(JWXYP), including 32 males and 58 females, with an average age of(72.12±4.92), involving 67 cases of femoral trochanter fractures and 23 cases of femoral neck fractures; 35 cases underwent dynamic hip screw fixation, 31 cases underwent intramedullary fixation and 24 cases underwent artificial hip replacement. In the placebo group, 90 patients were treated with placebo, including 37 males and 53 females, with an average age of(72.91±5.43) years old, involving 69 cases of femoral trochanteric fractures and 21 cases of femoral neck fractures, including 37 cases underwent dynamic hip screw fixation, 30 cases underwent intramedullary fixation and 23 cases underwent artificial hip replacement. The age, sex, injury site, intraoperative bleeding volume, postoperative drainage, operation time, anesthesia time, post-operative pain score, post-operative hemoglobin, post-operative CRP, delirium severity(DRS) score and delirium occurrence were observed and compared between the two groups. All patients were followed up until delirium returned to normal, postoperative delirium was found in 12 cases (13.33%) in the treatment group and in 39 cases(43.33%) in the placebo group, the treatment group was significantly better than the placebo group. The monitoring indexes of the two groups were compared:post-operative pain score(P=0.002), post-operative hemoglobin(P=0.012), post-operative CRP(P=0.042). JWXYP can relieve liver depression, invigorate spleen and invigorate blood circulation, reduce pain, inflammatory stimulation and supplement blood volume after operation, and significantly reduce the incidence of delirium after operation.

Effect of home visit intervention on joint function and life ability of patients after hip arthroplasty

Objective To observe the effect of home visit on joint function and complications of patients undergoing hip replacement. Methods Ninety cases of patients with artificial hip replacement who were admitted to our hospital from January to December 2017 were randomly divided into two groups by random Number Table Method.45 patients in the control group were given routine nursing after discharge, and 45 patients in the observation group were treated with home visit nursing. The hip function and living ability of the two groups were evaluated 8, 12, 16 weeks after discharge,and the complication rate was compared. Results The self-care ability scores of the observation group at 8, 12 and 16 weeks after discharge were 102.23±11.20, 108.36±10.41, 116.25±10.36 higher than those of the control group at 97.86±10.35), 100.21±14.26, 104.23±15.6, with significant differences (t=1.922, 3.097, 4.294, P < 0.05 or 0.01). The Harris scores of the observation group at 8, 12 and 16 weeks after discharge were 82.31±11.27, 87.38±10.05, 95.10±11.23 higher than those of the control group at 78.02±10.23, 83.41±11.74, 89.43±11.62, with significant differences (t=1.891, 1.723, 2.343, P < 0.05). The incidence of complications in the observation group at 16 weeks after discharge was 0 lower than 13.33% (6/45) in the control group (χ2=6.429, P=0.011). Conclusions Home visit intervention can improve the self-nursing ability of the patients after hip joint operation, promote the recovery of hip function and life ability, and reduce the complications. Key words: Home visit; Artificial hip joint replacement; Joint function; Complication

Research progress of cannulated screw internal fixation in the treatment of femoral neck fracture

Femoral neck fracture refers to the destruction of the continuity of the femoral neck bone. Due to the special anatomical structure of femoral neck, the supply of blood vessels is often destructed after the fracture, which may result in fracture nonunion, femoral head necrosis, etc. How to choose a therapeutic method which can effectively avoid these consequences has been the focus of study in the treatment of femoral neck fracture. The therapeutic methods of femoral neck fracture include conservative treatment, internal fixation surgery, artificial hip replacement, etc. With the constant updating of internal fixtures and the application of artificial hip replacement, surgical treatment of femoral neck fractures has gradually replaced conservative treatment. To repair femoral neck fractures by internal fixation and try every means to keep the femoral heads is the mainstream of current surgical treatments. Hollow compression nail fixation is currently a well-recognized method of internal fixation. In recent years, further achievement has been scored on the basis of three hollow compression nails for the treatment of femoral neck fractures. In particular, the application of cannulated screw F technology has highlighted its advantages. It is expected to be applied in the future to treat displaced and osteoporotic femoral neck fractures. This article aims to review the new applications and related advances in the treatment of femoral neck fractures with three hollow compression nails. Key words: Femoral neck fractures; Internal fixators; Bone screws; Review

Biodegradable Electrosprayed NPs as Drug Carriers for Optimal Treatment of Orthopaedic Infections

Abstract The possibility of replacing the damaged joint by an artificial (hip replacement) is one of the most important achievements of the orthopaedic science because it enables the person suffering from osteoarthritis to regain a normal life. However, infections that can be created after an implantation are one of the major complications that can lead to implant failure. Therefore, a preliminary study of vancomycin drug loaded Polycaprolactone (PCL) nanoparticles were created via Electrospraying Process, making it a promising nanovehicle to prevent and treat orthopedic implant-associated infections. Scanning Electron Microscopy (SEM) measurements confirmed the successful fabrication of these structures. Finally, drug release kinetics was established to observe the sustained release of the drug and degradation studies were performed in order to evaluate the mass loss of polymers.

Curcumin Inhibits Polyethylene-Induced Osteolysis via Repressing NF-κB Signaling Pathway Activation

Background/Aims: Aseptic loosening is a common reason for failed artificial hip replacement after total hip arthroplasty. Aseptic loosening is mostly the result of wear debris that causes osteolysis and weakens the structures that support the prosthesis. Wear debris plays a crucial role in osteolysis during the loosening process, and polyethylene (PE) particles are found as wear debris more frequently than any other type of particle. In the absence of effective therapeutic agents, osteolysis has been hard to treat. Previous studies have demonstrated that curcumin influences signalosome-associated kinases and the proteasome-ubiquitin system during osteoclastogenesis. The aims of this study were to explore the anti-osteolysis effect of curcumin and if possible to identify the signaling pathway involved in a model of PE-induced osteolysis. Methods: Differentiation of osteoclasts was induced in vitro by PE particles in RAW264.7 (monocyte/macrophage) cells and in vivo by calvarial and air pouch models of osteolysis established by PE stimulation in mice. We performed a set of TRAP staining, realtime polymerase chain reaction (PCR), and Western blot experiments to evaluate the anti-osteolytic effect of curcumin by comparing specimens that were exposed and not exposed to curcumin. Results: Curcumin had a promising inhibitory effect on osteolysis induced by wear debris and suppressed the RANK/c-Fos/NFATc1 signaling pathway. Conclusion: Curcumin can prevent PE-induced osteolysis and bone loss. An inhibitory effect on the RANK/c-Fos/NFATc1 signaling pathway may explain the anti-osteolysis activity of curcumin.

Pelvic Tilt Displacement Before and After Artificial Hip Joint Replacement Surgery

BackgroundPrediction of pelvic displacement before total hip arthroplasty (THA) is important for accurate acetabular implant placement. This study aimed to evaluate the effect of contralateral joint conditions on pelvic displacement after THA. MethodsA total of 355 cases that underwent computed tomography before and after THA for osteoarthritis due to developmental dysplasia were assessed. The pelvic plane was based on preoperative and postoperative day 1 computed tomography images. The displacement in the anteversion direction was expressed as +. Subjects with a minimal joint space <2 mm in the contralateral hip joint were in group N; subjects with ≥2 mm were in group W; subjects with THA were in group P; and subjects who underwent THA simultaneously on both sides were in group B. The Bartlett test was used when conducting the equal variance test among the groups. The F test was used for pairwise comparison. A P value <.01 was considered statistically significant. ResultsGroups N, W, P, and B had 49, 227, 55, and 24 cases, respectively, and their displacements were −0.2° ± 2.7°, 0.8° ± 3.9°, 0.5° ± 2.6°, and 1.1° ± 4.0°, respectively; the variance between the groups was significantly different (P = .0001). The differences between groups W and N (P = .0020), between groups W and P (P = .0003), and between groups P and B (P = .0086) were statistically significant. ConclusionWhen the contralateral joint space is wide, the variance of the displacement is high. The contralateral joint affects pelvic displacement.

An international comparison of the regional variation in clinical interventions: Germany and Austria

In previous international comparisons of regional differences in the utilisation of selected therapies, individual countries have mostly been described in isolation. In the present study, an attempt is made for the first time to systematically compare the utilisation of selected surgical interventions in Germany and Austria at the small-scale level. Comparative analyses were carried out for three surgical procedures: artificial hip and knee replacements and cardiopulmonary bypass surgery (CPB) using a heart-lung machine. Data were drawn from the German and Austrian diagnosis related groups (DRG) statistics. The regional variation in hospital admission rates was age-standardised and linked to the patients’ domicile before being analysed statistically and cartographically, both as a regional cross-section and as a longitudinal survey. At the county level, the quotients between the highest and the lowest rates in Germany were 2.1 and 3.1 for hip and knee joint replacements respectively, and 2.8 for both in Austria; for CPB interventions the regional variation is somewhat greater, namely 3.7 in Germany and 3.2 in Austria. In recent years, the interquartile distance for the hospital admission rates in individual regions has fluctuated in both countries, so there is no clear indication of a reduction in the regional differences in age-standardised hospital utilisation. The regional variation in selected surgical procedures can be analysed not only within each country separately, but also for Germany and Austria as a single unit, ignoring the border between them. In both countries, the regional cross-sectional analysis at the county level highlights regional distribution patterns whose causes merit further investigation.

A systematic review of hip fractures in elderly people

Objective To study the age peak of incidence, pathologic sites, therapeutic effect and complications of different treatment for hip fractures in the elderly. Methods Hip fractures, therapy, were used as key words to search articles both in English and Chinese from 1979 to 2017. The articles were filtrated by title, abstract and full text and 32 of them were left. All the patients were objects of this study, but the repeated cases were excluded. The patients’ data such as age of onset, gender, fracture type, operation method, follow-up time, and complications were collected and analyzed by systematic analysis. Results Data of 2 758 patients in 32 papers had been collected for analysis. There were 1791 femoral neck fractures and 967 intertrochanteric fractures, with a ratio of 1.85∶1. The patients’ age of onset was ranging from 54 to 92 years old, with an average of 76.7 years old, and the age peak of incidence was from 70 to 79 years old. The sex ratio was 1∶1.66 (1 037 males: 1721 females). All the patients had been followed up for 0.5 to 18 years, (average, 7.8 years). Among 927 femoral neck fractures who were treated by 3 lag screws, there were 278 cases of non-union (29.9%), 139 femoral head necrosis(15.1%) and 19 internal fixation loosening (2.0%); but for 183 femoral neck fractures who were treated by dynamic hip screws (DHS), there were 51 cases of non-union (28.1%), 31 femoral head necrosis(17.0%), 3 internal fixation losening(1.8%), and 27 cutting effect (15%). Then for 400 femoral neck fractures who were treated by hemiarthroplasty, there were 6 cases of dislocation(1.5%), 14 shaft fracture (3.5%), 8 deep infection (2.0%); while for 281 femoral neck fractures who were treated by total hip arthroplasty, there were 14 cases of dislocation (5.0%), 11 shaft fracture (4.0%), and 10 deep infection (3.5%). On the other hand, for 354 intertrochanteric fractures who were treated by proximal femoral nail or proximal femoral nail antirotation internal fixation (PFN or PFNA), there were 18 cases of trochanter fracture (5.0%), 28 hip varus (8.1%), 32 displacement (9.0%); and for 210 intertrochanteric fractures who were treated by Gamma nail, there were 17 cases of trochanter fracture (7.9%), 11 cutting effect (5.0%), 6 displacement (3.0%); and for 135 intertrochanteric fractures who were treated by DHS, there were 8 cases of cutting effect (6.1%), 7 displacement (5.2%); and for 101 intertrochanteric who were treated by proximal femoral locking plate, there were 5 cases of displacement (5.0%); Also for 89 intertrochanteric fractures who were treated by hemiarthroplasty, there were 2 cases of dislocation(1.8%), 3 shaft fracture (3.0%), 1 deep infection(1.5%); and for 78 intertrochanteric fractures who were treated by total hip arthroplasty, there were 4 cases of dislocation (4.8%), 3 shaft fracture (4.0%), 2 deep infection (2.5%). Conclusion The elderly hip fractures’ age peak of incidence is from 70 to 79 years old, and femoral neck fracture takes up a majority of it. Female patients are more than male patients. The femoral neck fractures are mainly treated by 3 lag screws internal fixation; non-union and femoral head necrosis are the common complications postoperation. While the intertrochanteric fractures are mainly treated by proximal femoral nails; displacement, hip varus and trochanter fractures are the common complications postoperation. The artificial hip replacement is the effective remedy measure for secondary femoral head necrosis after hip fractures. Key words: Aged; Hip; Fractures, bone; Review

Supercapsular percutaneously-assisted total hip approach for the elderly with femoral neck fractures: study protocol for a prospective, open-label, randomized, controlled clinical trial

Background: Artificial hip replacement by the posterolateral approach is generally introduced as a treatment for femoral neck fracture in the elderly, but it is limited by the need for a large incision, cutting off the extortor, and postoperative hip dislocation. The supercapsular percutaneously-assisted total hip (SuperPATH) approach was developed based on the original lateral approach. The SuperPATH approach for hip replacement is characterized by the reduced chance of damaging blood vessels and nerves, reducing intraoperative blood loss, retaining all the joint capsules and supinator, and significantly reducing the incidence of postoperative hip dislocation. Given these advantages, we hypothesized that the SuperPATH approach for hip replacement can achieve better efficacy in the elderly with femoral neck fractures and promote the recovery of postoperative hip function compared with the posterolateral approach. Methods/Design: This is a prospective, single-center, open-label, randomized controlled clinical trial that will be completed at the Pudong Hospital of Fudan University, Shanghai, China. Forty patients with femoral neck fractures were randomly divided into two groups to undergo femoral head replacement by the SuperPATH approach in the experimental group, and by the conventional posterior approach in the control group. The follow-up period is 1 week and 6 months. The primary outcome measure is Harris hip scores at baseline, and at 1 week and 6 months postoperatively to assess functional recovery of the hip. Secondary outcome measures to evaluate the advantages of the SuperPATH approach include the length of surgical incision, intraoperative blood loss, operative time, 24-hour postoperative drainage, and hospital stay. Other outcome measures include the incidence of adverse events at 1 week and 6 months after surgery. Discussion: The aim of this trial is to test our hypothesis that the SuperPATH approach is safer and more reliable for hip functional recovery compared with the posterolateral approach for the artificial hip replacement in femoral neck fractures of the elderly. Trial registration: ClinicalTrials.gov identifier: NCT03134664. Ethics: The study protocol was approved by the Ethics Committee of the Pudong Hospital of Fudan University, China, and performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Written informed consent was obtained from all participants prior to the trial commencement.

Motivational Interviewing affect rehabilitation and the quality of life for patients undergoing artificial unilateral total hip replacement

Objective To evaluate the influence of Motivational Interview on function restore and life quality after artificial unilateral total hip replacement surgery. Methods A convenient sampling method was used for collecting 103 patients underwent artificial unilateral total hip replacement surgery for the study. Lottery method was used to divide these patients in to treatment group 53 cases and control group 50 cases. Intervention of both joint exercise and motivational interview was used for the treatment group, and routine health education was used for the control group in a large general hospital in Hangzhou. Results 1 month later, patients' joint function assessed with Harris score of the intervention group and control group were 62.40 ± 8.95 and 54.06 ± 9.61; 3 months later, intervention group was 82.25 ± 7.09 while control group was 74.60 ± 9.97, the difference was statistically significant (t= -4.559 and -4.451, P= 0.000). Patients' life quality after 1 month was 485.54 ± 86.85 in intervention group and 400.69 ± 72.36 in control group; 3 months later, the scores were 601.54 ± 73.49 and 543.08 ± 81.77, the difference was statistically significant (t=-5.370 and -3.821, P=0.000). Conclusions Motivational Interview was capable of improving joint function restore and quality of life through changing patients' motivation, helping patients establishing and adhering to joint exercise. Key words: Joint replacement, hip; Behavior change; Motivational interviewing.

Comparison of effects of surgical versus non-surgical treatment for femoral neck fractures in patients aged 70 years and over

Objective To compare the effects of surgical versus non-surgical treatment for femoral neck fractures in elderly patients, in order to provide guidance on treatment options. Methods The clinical effects and complications of different approaches from 42 patients with femoral neck fractures who had received treatment at our department from February 2006 to August 2011 were retrospectively analyzed. Results Of the 42 cases, 13 cases were treated with artificial hip replacement, 18 cases with hollow lag screw fixation, and 11 cases with tibial traction. No death occurred in patients treated with surgery, and 4 patients who had received non-surgical treatment died within 6 months of the followed-up. Conclusions Very elderly patients with femoral neck fractures generally perform well under appropriate perioperative care. Surgical treatment can produce good therapeutic effects, shorten the time for bed rest, improve the quality of life and reduce the mortality rate. Key words: Femoral neck fractures; Treatment outame

Progress in diagnosis and care of fractures of the femoral head

Fractures of the femoral head (FFH) are mainly seen in young adults, and the majority mechanism is due to dashboard injury in crushing vehicles. FFH can be present with or without posterior dislocation of the hip joint. Except for periarticular pain and hip dysfunction, the typical signs include flexion, adduction and internal rotation of the hip and shortening of involved limb. CT and MRI get their popularity as diagnostic methods for FFH. An emergency open reduction should be indicated in the scenario of failed closed reduction in FFH with posterior dislocation, of FFH with femoral neck fractures, of unmatched head and acetabulum following closed reduction and of deteriorating sciatic nerve damage. Pipkin as well as Brumback classification is still the most popularly used methods, which have great significance for establishment of surgical strategy and prediction of prognosis. More and more clinical evidences show conservative care of FFH should only be indicated for non-displaced fractures or displacement less than 2 mm. These cases must meet the following criteria simultaneously, including stable hip joint, concentric head and acetabulum, no free fractured fragments in the joint space and no labrum entrapment. Operative care is naturally the treatment of choice. Surgical approaches for FFH are hot topics in recent years. In previous control studies to compare Kocher-Langenbeck (K-L) and Smith-Peterson (S-P) approach, it is revealed less operative time, less blood loss and better operative field you can get in S-P approach, however, the incidence of ectopic ossification is higher. Ganz approach, which is characterized by osteotomy of great trochanter, hip capsulotomy and surgical dislocation of the hip, is a novel pattern for operative care of FFH. Ganz approach can show the entire femoral head, while can not damage medial femoral circumflex artery (MFCA) and induce iatrogenic osteonecrosis of the femoral head (ONFH). Various screws are the main implants for the fixation of fractured femoral head. Osteoarthritis and ONFH are two principal complications following FFH, which not only closely associate with severity and mechanism of primary injury, but also correlate with reduction quality and iatrogenic factors. Artificial hip joint replacement is a rational choice for extremely comminuted femoral head and these FFH in the elderly.

Emergent Embolectomy for Massive Intraoperative Thromboembolism During Total Artificial Hip Replacement

Emergent Embolectomy for Massive Intraoperative Thromboembolism During Total Artificial Hip Replacement