Average Modified Harris Hip Score Research Articles

The Functional Outcome of Proximal Femoral Nail Antirotation-2 (PFNA-2) in Peritrochanteric Fractures of the Femur.

Introduction Peritrochanteric fractures are defined as extra-articular fractures involving the trochanter and frequent extension into the subtrochanteric region. These fractures exhibit a bimodal distribution in terms of age. These fractures commonly happen in young individuals who experience high-energy trauma, often in combination with other injuries. In contrast, elderly individuals with osteopenia are more prone to fractures caused by low-energy trauma. Methods This study is a prospective investigation that was carried out over 30 months. The study focused on peritrochanteric fractures that were treated using proximal femoral nail antirotation-2 (PFNA-2) as a fixation device. A range of criteria were examined and documented, encompassing the mean duration of surgical procedures, blood loss, the duration of hospitalization, mobility, and any potential post-operative problems. Subsequent assessments were conducted at fixed intervals of two weeks, six weeks, three months, six months, and two years. The functional outcome analysis for all patients involved the utilization of the modified Harris hip score (HHS). Results The study involved 60 cases of peritrochanteric fractures. The average age was 56 years.The most common mode of trauma was trivial fall/slip (46.66%), followed by road traffic accidents (RTA) (31.66%) and falls from height (21.66%). The average operating time was 53.03±5.66 minutes. The average modified Harris hip score was 84.78 with 26.66% excellent,70% good, and 3.33% fair results. Complications included superficial wound infection (5%), knee stiffness (11.66%), hip pain (8.33%), and shortening (1.66%). Conclusion PFNA-2 is a safe and easy implant option for treating peritrochanteric fractures as it preserves periosteal covering, minimizes blood loss, has a short operative time, and helps in early mobilization. PFNA-2 provides excellent outcomes in patients with peritrochanteric fractures with minimum complication rates compared to all other open methods and is highly recommendable.

Total Hip Arthroplasty with Extra-small Femoral Stems in Extremely Hypoplastic Femurs: A Case-Series Study.

Total hip arthroplasty (THA) in patients with hypoplastic femurs presents a significant challenge to orthopedic surgeons due to the limited space available for implant placement. Therefore, the extra-small femoral stems have been proposed as a solution to this problem, but there are limited data on the outcomes. We aimed to evaluate clinical and radiological outcomes of THA in patients with extremely hypoplastic femurs using the Bencox CM stem (Corentec), an extra-small femoral stem. We included 6 hips from 4 patients. The mean age of the patients was 41.2 years (range, 19.6-60.4 years). The mean height was 135.1 cm (range, 113.6-150.0 cm) with a mean body mass index of 25.7 kg/m2 (range, 21.3-31.1 kg/m2). The diagnoses for THA were sequelae of septic arthritis in childhood, pseudoachondroplasia, spondyloepiphyseal dysplasia, and juvenile rheumatoid arthritis. Preoperative computed tomography scans were conducted to assess the extent of proximal femoral hypoplasia. The clinical outcomes were assessed using the modified Harris Hip Score, while the radiological outcomes were evaluated using radiographs. The mean follow-up was 2.3 years (range, 1.0-5.9 years). The average modified Harris Hip Score improved to 88.8 at the final follow-up. Intraoperative femoral fractures occurred in 2 cases (33.3%). During the follow-up, 1 stem underwent varus tilting from postoperative 6 weeks to 6 months without subsidence. Otherwise, all stems showed good osteointegration at the latest follow-up. No hip dislocations, periprosthetic joint infection, or loosening of the prosthesis occurred. The use of extra-small femoral stems in THA for extremely hypoplastic femurs can provide reasonable clinical and radiological outcomes with minimal complications. We suggest that this femoral stem could be a viable option for patients with extremely hypoplastic femurs.

A long-term outcome (up to 29 years) of bilateral iliac wings “bayonet osteotomies” for closure of bladder exstrophy

BackgroundSeveral types of pelvic osteotomy techniques have been reported and employed by orthopedic surgeons to enhance the approximation of symphyseal diastasis in bladder exstrophy patients. However, there is limited evidence on a long-term follow-up to confirm which osteotomy techniques provide the most suitable and effective outcomes for correcting pelvic deformities. This study aimed to describe the surgical technique of bilateral iliac bayonet osteotomies for correcting pelvic bone without using fixation in bladder exstrophy and to report on the long-term clinical and radiographic outcomes following the bayonet osteotomies.MethodsWe retrospectively reviewed patients with bladder exstrophy who underwent bilateral iliac bayonet osteotomies with the closure of bladder exstrophy between 1993 and 2022. Clinical outcomes and radiographic pubic symphyseal diastasis measurements were evaluated. From a total of 28 operated cases, eleven were able to attend a special follow-up clinic or were interviewed by telephone by one of the authors with completed charts and recorded data.ResultsA total of 11 patients (9 female and 2 male) with an average age at operation of 9.14 ± 11.57 months. The average followed-up time was 14.67 ± 9.24 years (0.75–29), with the average modified Harris Hip score being 90.45 ± 1.21. All patients demonstrated decreased pubic symphyseal diastasis distance (2.05 ± 1.13 cm) compared to preoperative (4.58 ± 1.37 cm) without any evidence of nonunion. At the latest follow-up, the average foot progression angle was externally rotated 6.25° ± 4.79° with full hips ROM, and no patients reported abnormal gait, hip pain, limping, or leg length discrepancy.ConclusionsBilateral iliac wings bayonet osteotomies technique demonstrated a safe and successful pubic symphyseal diastasis closure with an improvement both clinically and radiographically. Moreover, it showed good long-term results and excellent patient’s reported outcome scores. Therefore, it would be another effective option for pelvic osteotomy in treating bladder exstrophy patients.

Midterm Results of Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Human Immunodeficiency Virus-Infected Patients in South Korea.

Studies have reported that osteonecrosis of the femoral head (ONFH) is more prevalent in patients with human immunodeficiency virus (HIV). Total hip arthroplasty (THA) is considered reasonable management of ONFH. However, only scarce data exist on the outcomes of THA for HIV-infected patients in South Korea. The purpose of this study was to evaluate the midterm results of HIV-positive patients who underwent THA for ONFH. We performed a retrospective review of HIV-infected patients with ONFH who underwent THA in our institution from 2005 to 2021. Twenty-two hips in 15 patients underwent THAs with cementless implants. The clinical and radiographic evaluation was performed at each follow-up, and any complication was recorded. The mean follow-up period was 5.2 years (range, 1.0-16.0 years). The mean age of the HIV infected patients with osteonecrosis at the time of surgery was 44.7 ± 11.6 years. ONFH occurred 9.8 ± 3.7 years after the initial diagnosis of HIV infection. The average modified Harris hip score improved from 58.3 ± 14.8 to 95.2 ± 11.3 at the latest follow-up. Surgical complications such as infection, nerve injury, or dislocation were not present. The radiographic evidence of stable fixation by bone ingrowth without migration was seen in all implants. Our data suggest that THA is a safe and valid option of treatment for ONFH in well-controlled HIV-infected patients in Korea. Further large-scale nationwide studies are warranted.

A combination of acetabular coverage and femoral head-neck measurements can help diagnose femoroacetabular impingement.

This study aimed to evaluate the relationship between the radiographical features of combination of the acetabular coverage and the femoral head-neck shape and the occurrence of femoroacetabular impingement (FAI). In this study, 114 patients who had FAI with or without labral tear and mild osteoarthritis were analyzed. Plain radiographs and computed tomography (CT) were taken for evaluation of acetabular coverage and femoral head-neck measurements. The relationship between the combination angle of acetabular coverage and femoral head-neck measurements and the occurrence of FAI was evaluated. The prevalence of FAI patients with the combination angle of CT-anterior CE + α angle ≥100° was 6.1% (7/114 patients). Receiver operator characteristic curve analysis demonstrated a higher area under the curve for combination of CT-anterior center edge angle (ACEA) with the α angle at 0.94 (CT-ACEA +α angle). A threshold for the occurrence of FAI was determined using the combination CT-ACEA + α angle at 100°. The frequency of FAI surgery was significantly higher in patients with a combination angle ≥100° than in those with a smaller angle. The average modified Harris hip score was significantly lower in patients with a combination angle ≥100° than in those with a smaller angle. We suggest that the combination of lateral center edge angle ≥40°, α angle ≥50° and combined angles of CT-ACEA and α angle ≥100° may help diagnosis of FAI. Level of evidence III: retrospective cohort study.

Minimally Invasive HEROS (Higher External ROtator Sparing) Posterior-lateral Approach for Total Hip Arthroplasty: Surgical Technique and Preliminary Results.

Minimally invasive approaches for Total Hip Arthroplasty (THA) are extremely popular among both patients and surgeons. Even though many surgical techniques have been described with overall satisfactory results, one of the most feared complications that still burdens THA is early dislocation, particularly for the most popular, posterior-lateral, approach. The purpose of this report is to describe an original, minimally invasive, posterior-lateral technique, which spares the proximal external rotator muscle tendons of the hip (Higher External ROtator-Sparing; HEROS), while presenting its preliminary clinical and radiographic results. From 2018 to 2020, 100 patients underwent THA, performed by the same surgeon using the HEROS technique. In all cases, the same cementless prosthesis was implanted. The Modified Harris Hip Score (MHHS) was obtained before surgery and at the last follow-up visit. The osteointegration and orientation of the prosthetic components were radiographically evaluated, and the restoration of the femoral offset was analyzed. Seventy-seven patients were assessed at a mean follow-up of 28 months. At the time of surgery, the average age of the patients was 72 years. There were 36 females and 41 males with a mean BMI of 27. The diagnoses were primary arthritis, avascular necrosis of the femoral head and fracture of the femoral neck. The mean surgical time was 76 minutes. The average MHHS score at follow-up was excellent. The mean offset variation was approximately 1 mm. There was an intra-operative fracture and an early infection of the wound. There were no dislocations. All patients returned to activities of daily living and were satisfied with the cosmetic appearance of the wound. The present study confirmed that this simple, minimally invasive approach is effective for restoring pain-free joint function and preventing implant dislocation with a low incidence of complications.

Bilateral synchronous total hip arthroplasty for end-stage arthropathy in hemophilia A patients: A retrospective study.

Total hip arthroplasty (THA) has been an effective tool of advanced hemophiliac hip arthritis. There are only limited data of bilateral synchronous THA for end-stage arthropathy in hemophilia A patients.The aim of this retrospective study was to analyze clinical outcome and complication rate of bilateral THA for hemophilia A patients with end-stage arthropathy of hip and review the operative strategy.From August 2012 to July 2016, 48 hips of 24 patients with hemophilia A patients underwent THA by a single experienced chief orthopedic surgeon. Clinical and radiological evaluations were included of operation time, blood loss, the quantity of blood transfusion, clotting factor consumption, duration of hospitalization, modified Harris hip score, complication rate, and radiographic assessment.All the 24 patients successfully completed the operation, followed up for 5 to 8 years, and the mean time was 6.5 years. The average operation time was 140 minutes (range, 120–180 minutes). The average total blood loss was 225 mL (range, 150–400 mL). The mean red blood cell transfusion amount was 2.4 U (range, 0–6 U). the mean hospitalization time was 24 days (range, 16–46 days). The mean amount of clotting factor VIII used in the perioperative period for management of hemophilia A was 30,600 U (range, 18,000–52,000 U). Average modified Harris hip score increased from 46.6 (range 28–70) points preoperatively to 90.2 (range 75–98) points at final follow-up, complications were few.With excellent operative techniques and hematological management, bilateral synchronous THA for end-stage arthropathy in hemophilia A patients can provide satisfactory outcomes.

Evaluation of Functional Outcome and Complications after Open Reduction and Internal Fixation of Acetabulum Fractures

Background: The present study was done to evaluate the functional outcome and complications after open reduction and internal fixation of acetabulum fractures. Material and methods: The present study was done in 44 patients of fracture acetabulum managed by open reduction internal fixation in the Department of Orthopaedic surgery, Indira Gandhi Medical College, Shimla. Results: There were 16 prospective (36.4%) and 28 retrospective (63.6%) cases. The mean age was 45.07 years with maximum number of 39 (88%) patients in the age group of 21- 60 years. Majority (77.3%) of the patients was males and 22.8 % were females. Modified Merle d’Aubigne and postel (MDA) score was excellent in 77%patients, good in 13%, fair in 10%. Matta’s radiological score at final follow up was excellent in 54.55%, good in 36.36%, fair in 4.55% and poor in 4.54% patients. The average Modified Harris Hip score was 94 at final follow up in 44 patients. Patients with anterior column fracture had HHS of 96 at final follow up; posterior wall fracture patients had average HHS of 92 at final follow up. Two patients had complications. One patient had femoral head fracture along with fracture of posterior wall developed AVN and also had subsequently Secondary OA with post-operative subluxation of femoral head. Thus three complications were seen in this patient. Another patient with fracture dislocation with fracture of posterior wall developed AVN and subsequently secondary OA 5 year after surgery. No patient developed sciatic nerve injury post operatively. None of patients developed postoperative sciatic nerve palsy. No patient died during treatment or follow up. Conclusion: Open reduction and internal fixation as a gold standard for acetabulum fractures which is indicated with excellent to good results in majority of the patients as assessed by Modified Merle d’Aubigne score, Modified Harris hip score and Matta Radiological score with minimal complications at final follow up.

Femoral Head Autograft Can Reliably Reconstruct Dysplastic Acetabula Through the Direct Anterior Approach for Total Hip Arthroplasty.

BackgroundBone deficiencies in dysplastic acetabula create technical difficulties during total hip arthroplasty (THA). Bulk femoral head autograft (FHA) is one method to increase cup coverage and bone stock of the true acetabulum; however, only limited data exist on its efficacy through a direct anterior approach (DAA). This study aimed to evaluate the outcomes of FHA during THA via a DAA in dysplastic hips.MethodsRetrospective review of 34 patients (41 hips) with hip dysplasia (Crowe I-III) who underwent primary THA via a DAA with FHA at a single institution was performed. Surgical procedures were performed on a traction table with intraoperative fluoroscopy and highly porous-coated cup placement in the true acetabulum. Patients were assessed clinically and radiographically at a minimum of 2 years postoperatively (range, 2 to 7).ResultsThe average modified Harris Hip Score improved from 31.9 ± 10.8 to 94.1 ± 5.8, Merle d'Aubigné Hip Score from 7.5 ± 2.8 to 16.6 ± 1.1, and visual analog pain score from 7.9 ± 2.7 to 1.4 ± 1.4 (all P < .001). All hips had an “anatomic” inferomedial cup position postoperatively, with an average increase in horizontal coverage of 43.4%. Mean postoperative limb-length discrepancy improved from 21.8 ± 16.1 mm to 1.6 ± 5.7 mm (P < .001). There were no cases of revision THA, nor complications such as dislocation, infection, or osteolysis.ConclusionReconstructing dysplastic acetabula (Crowe I-III) with FHA during THA can be successfully accomplished via the DAA with increased acetabular bone stock and accurate correction of limb-length discrepancy.

Osteosynthesis of Neck of Femur Fracture below 65 years of Age: does timing of surgery influence osteonecrosis, nonunion and functional outcome?

Background Influence of timing of injury surgery interval in outcome of osteosynthesis of neck of femur has always been a matter of debate. Patients in our set up have been surgically treated for neck of femur fracture with wide range of injury surgery interval which could have resulted in varied functional outcome and radiological outcome.&#x0D; Objective To evaluate the difference in functional outcome, femoral head osteonecrosis and non-union in fracture neck of femur fixed within and after twenty-four hours.&#x0D; Method All patients, who had undergone osteosynthesis for the neck of femur fractures via open or closed technique from 2010 to 2018 were analyzed retrospectively. The cases were examined and evaluated in terms of injury surgery interval, fracture union, functional status using Modified Harris Hip Score, complications like femoral head osteonecrosis and non-union.&#x0D; Result Fifty patients with an average injury surgery interval of 34±28 hours were evaluated. Twenty three (46%) cases were included in early surgery group (&lt; 24 hours) and 27 (54%) patients were included in delayed (&gt; 24 hours) surgery group. Incidence of femoral head osteonecrosis was reported in two (4%) cases, both being in delayed fixation group (p=0.49). Non-union was reported in four (8%) patients, one in early fixation group and three in delayed fixation group (p=0.61). The average Modified Harris Hip Score in early fixation group was 87 and in delayed fixation group was 84 (p=0.1). Forty two (84%) cases had a good quality of reduction and eight (16%) had a poor reduction. Non-union and functional outcome significantly differed between the good and poor reduction group (p=0.001 and 0.004 respectively).&#x0D; Conclusion There is no significant difference in the functional and radiological outcome of cases operated before and after 24 hours for osteosynthesis of neck of femur fractures in patients 16 to 65 years age group. However, poor reduction is significantly associated with the increased rate of non-union and poor functional outcome.

Gibson approach and surgical hip dislocation according to Ganz in the treatment of femoral head fractures

BackgroundThe purpose of the study is to evaluate clinical and radiological outcomes in those patients with femoral head fracture, treated with open reduction and internal fixation through Gibson approach and Ganz flip trochanter osteotomy. The treatment of Pipkin fractures is very challenging, especially for small trauma centers, because of the unusual fracture patterns and high-level surgical skills required.Case presentationBetween 2017 and 2020, nine cases of Pipkin fractures came to the Emergency Department at the Trauma Center of our Hospital in Rome. Inclusion criteria were the diagnosis of femoral head fracture, the open reduction and internal fixation as surgical choice and at least 24 months follow-up. Patients older than 65 years and those treated through total hip replacement or combined hip procedure (CHP) were excluded. Thus, five patients were included in our case series. The clinical outcome was evaluated according to Western Ontario and McMaster Universities Arthritis Index, Vail Hip score, modified Harris Hip score and Merle D’Aubignè Postel score. Radiographic assessment was scored according to Epstein-Thompson classification and heterotopic ossification was assessed through Brooker classification. The mean follow-up was 24 months (range 12-24). Average modified Harris Hip score was 92.1 points (range 75.9–100), and the average Vail score was 81.8 (range 55-95). WOMAC score was assessed in three different subscales, pain (A), stiffness (B) and physical condition (C), with the following results: 1.4 A (range 0-7), 1.2 B (range 0-6) and 6.4 C (range 0-22). Merle d’Aubignè Postel score resulted excellent for four patients and good for one patient. According to Epstein-Thompson score of the radiological outcome, four patients showed a good result and one a fair result. No mechanical or infective complications occurred in the five patients.ConclusionsGibson’s approach and surgical hip dislocation through Ganz trochanteric flip osteotomy allow a good exposure of the femoral head and acetabulum, giving us the possibility to perform an anatomical reduction of the fracture. In our case series, satisfactory clinical and radiological short-term results were obtained without significant complications.

A study to evaluate the functional and radiological outcome of proximal femoral nail Anti rotation 2 in inter trochanteric fractures of femur

Introduction: Fractures around the trochanteric area of the femur are among the most frequent fractures encountered in orthopaedics, especially in geriatric population and increasing life expectancy has resulted in increase in these type of fractures. Aim: The aim of this study was to analyze the functional and radiological outcome of patients treated with PFN A-II. Methods: Patients presenting with unstable intertrochanteric femur fracture (AO classification) and Singh’s index ≤ 3 were included. The study included 70 patients (30 males and 40 females), at our institution during the period of July 2019 to December 2020. Clinical outcome was measured in terms of procedure time, clinical function at each follow-up and mortality. Radiographic evaluation was measured by quality of reduction, Cleveland Index, tip-apex distance (TAD), and time for the union. Complications including delayed union, non-union, screw backing out , screw cut through into the joint, infection, osteonecrosis of the femoral head, and implant breakage were also investigated. Results: All the 70 patients included in the study were treated with PFN A-2. The average age of the patients included was 74.4 years . The TAD was more than 25mm in 8 patients. 11 patients has sub optimal position of the implant as per cleveland index. Outcome was excellent in 45, good in 15, fair in 7,poor in 3, and this is based on modified Harris hip score with the minimum follow-up period being 6 months. The difference between the neck shaft angle of the operated side when compared with the un-injured side is more than 10 * in 11 patients. The average union time was 5.6 weeks, average modified Harris hip score was 86.5. Conclusion: The result of our study shows that PFNA2 is an excellent device for osteosynthesis as it can be easily inserted. Moreover, it provides stable fixation in the osteoporotic patients , which allows early full weight bearing mobilization of the patient.

Evaluation of functional outcome of displaced fracture neck of femur in elderly treated with cemented bipolar prosthesis by modified Harris hip score

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The current research was conducted to determine the functional outcome of the displaced fracture neck of femur in elderly patients treated with cemented bipolar hip prosthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present research was a prospective study of 44 cases of displaced fracture neck of femur admitted to our institute between October 2017 and October 2019. Cases were chosen on the basis of inclusion and exclusion criteria. Cases were surgically treated with cemented bipolar hip hemiarthroplasty and functional findings were recorded with modified Harris hip score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our series of 44 cases there were 30 females and 14 males, with a maximum age of 92 years, minimum age of 65 years, and the average age was 72.72 years. At one-year follow-up, the average modified Harris hip score was 86.75% (maximum score of 95 and a minimum score of 66), overall, 20 patients (45.46%) achieved excellent, 16 patients (36.36%) achieved good, 5 patients (11.36%) achieved fair and 3 patients (6.82%) achieved poor results. 81.82% of the patients returned to the pre-fracture level of activity and independent ambulation. Patients had few complications like limb length discrepancy, 36.3% of patients had limb lengthening between 1 to 1.5 cm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In&lt;strong&gt; &lt;/strong&gt;elderly patients with displaced neck femur fractures, cemented bipolar hip prosthesis provides good functional outcome&lt;strong&gt;.&lt;/strong&gt; However further study for a longer period in a larger sample with a direct comparison between the cemented versus uncemented groups is required.&lt;/p&gt;

Clinical Outcomes after Arthroscopic Repair of Gluteus Medius with a Two-year Minimum Follow-up

Objectives:Hip arthroscopy has replaced the need for many open surgeries including repairs of gluteus medius tendon tear. There are only a few studies that have analyzed patient reported outcomes at 2 years for arthroscopic gluteus medius tendon repair. The purpose of the current study is to evaluate clinical outcomes in patients who underwent arthroscopic gluteus medius repair with at least 2 year follow-up.Methods:This was a single-center, retrospective IRB approved study. Between August 2010 and August 2016, patients who underwent hip arthroscopy with gluteus medius repair by a single surgeon were evaluated at baseline and two year follow-up via Modified Harris Hip Score (MHHS) and Non-arthritic Hip Score (NAHS). Inclusion criteria included all patients who received arthroscopic repair of the full or partial thickness tears of the gluteus medius tendon and had a minimum follow up of at least two years. Paired t-test was used for statistical comparison between baseline and follow-up for each respective outcome score and group.Results:20 hips were evaluated, met the inclusion criteria and separated based on partial (group one) or full thickness tear (group two). The study population comprised of 15 (79%) females and 4 (21%) males. Group one presented with a mean age of 54.8 ± 11.3 years and an average BMI of 25.1 ± 4.0. Group two presented with a mean age of 46 ± 11.4 and an average BMI of 25.5 ± 4.0. Patients in group one reported an average preoperative MHHS and NAHS of 33.6 ± 11.3 and 40.4 ± 14.9, respectively. At 2 year follow-up, an average MHHS and NAHS of 72.9 ± 22.9 and 77.2 ± 19.7 was reported, respectively. Patients in group two reported an average preoperative MHHS and NAHS of 43.8 ± 14.7 and 46.4 ± 8.3, respectively. At 2 year follow-up, an average MHHS and NAHS of 80.1 ± 8.5 and 79.5 ± 10.1, respectively. There was significant clinical improvement at the 2 year follow-up, relating to both outcome measures in each subject group (p<0.0004).Conclusions:After a minimum of two years for follow-up, arthroscopic repair of gluteus medius tears proves to be an effective approach and treatment. In the future, studies looking at longer follow-up time would help determine if the current approach maintains long-term clinical improvement.

Outcomes Following the Urgent Surgical Management of Displaced Femoral Neck Stress Fractures.

To review the clinical course, complication rates, and mid-term functional outcomes associated with the treatment of displaced femoral neck stress fractures (FNSFs). Retrospective Case Series. Military Tertiary Referral Center. Twenty-one operatively treated displaced FNSFs between 2002 and 2015. Urgent reduction and fixation was performed. If nonunion developed, an intertrochanteric osteotomy was performed. Nonunion, osteonecrosis (ON) of the femoral head, conversion to arthroplasty, modified Harris Hip Score, pain score, and Hip Outcome Score (HOS). Two (9.1%) patients developed nonunion. Both united after revision with intertrochanteric osteotomy. ON developed in one patient (4.8%) who was converted to arthroplasty. Average pain score at final follow-up was 2.0 (range 0-5). Average Modified Harris Hip Score was 84 (range 54-100). Average HOS Activities of Daily Living subscale was 80.9 (range 45.6-100). Average HOS Sport subscale was 69.8 (range 27.8-100). Larger displacement on injury films correlated with lower Modified Harris Hip Scores (P = 0.048) and lower HOS Sports Subscale Single Assessment Numeric Evaluation (P = 0.023). The need for an open reduction trended toward being a risk factor for nonunion (P = 0.081). This study represents the largest series of patients undergoing urgent surgery for displaced FNSFs. Nonunion and ON is found at a similar rate to what is reported in the young traumatic literature. Pain and outcome scores compare favorably to other hip pathology in young adults. Initial injury severity is variably correlated to final outcome scores. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Results of Unstable Intertrochanteric Femur Fracture Treated with Proximal Femoral Nail Antirotation-2 with respect to Different Greater Trochanteric Entry Points.

Background Proximal femoral nail antirotation-2 (PFNA-2) has been widely used to treat intertrochanteric fractures with varied outcomes in the previous studies. The entry point of the nail plays an important role in achieving acceptable reduction, stable fixation, and avoiding implant related complications. This study was proposed to determine the optimal greater trochanteric entry point for PFNA-2 in unstable intertrochanteric femur fractures. Methods We conducted an observational study on 40 patients with unstable intertrochanteric fracture treated with PFNA-2 implant in a tertiary care hospital. The patients were grouped into two based on the entry point: group L for lateral and group M for medial entry. Randomization was carried out by assigning the patients to the group by alternate allocation. The quality of reduction, tip apex distance, Cleveland index, and all the complications were noted. The final follow-up was conducted at six months. The functional outcome was evaluated using modified Harris hip score. The data analysis was performed using Student's t-test, chi square test, and Mann–Whitney test. A P value below 0.05 was considered significant. Results Forty patients with 20 patients treated with medial entry point were included in group M and 20 patients in group L with lateral entry point. The group L had an average tip apex distance of 20.53 and group M had 20.02 (P=0.8). The complication of screw back out was seen in 3 out of 4 patients with poor reduction in group L. As per the Cleveland index, 6 patients in each group had suboptimal position and 4 out of 6 patients in group L with suboptimal position had screw back out. The lateral cortex impingement was seen in 14 patients of group L and 6 patients in group M with significant comparison (P=0.01). Three patients in group L had varus collapse with screw back out. Also, none in group M (0.05). The average modified Harris hip score in group L at six months follow-up was 71.94 and 76.8 in group M (P=0.84). Conclusion Overall, to achieve good quality of fixation and reducing damage to gluteus medius entry point for PFNA-2 should be 5 mm medial to the greater trochanter tip.

Primary Total Hip Arthroplasty in Patients 20 Years Old and Younger

Historically, total hip arthroplasty (THA) performed in patients ≤20 years old has been associated with poor survivorship because of bearing-surface wear with conventional polyethylene, acetabular loosening with cemented sockets, and liner fracture in ceramic-on-ceramic (CoC) THA. For this population, there is a paucity of data regarding outcomes of THAs performed with use of modern implants and bearing surfaces. The purpose of the present study was to examine the mid- to long-term outcomes of modern THA in patients ≤20 years old. Utilizing a single-institution, prospectively collected total joint registry, we retrospectively identified 91 primary THAs performed in 78 patients ≤20 years old from 1998 to 2016. The average patient age was 17 years (range, 11 to 20 years), and the average body mass index was 26 kg/m (range, 16 to 49 kg/m). Forty-eight THAs (53%) were performed in male patients, and 47 (52%) were performed on the right hip. Bearing surfaces included CoC (53 THAs, 58%), metal-on-highly cross-linked polyethylene (MoP; 28 THAs, 31%), and ceramic-on-highly cross-linked polyethylene (CoP; 10 THAs, 11%). Outcome measures included reoperations, revisions, complications, clinical outcome scores, and bearing-surface wear. At an average follow-up of 8 years (range, 2 to 18 years), the average modified Harris hip score was 92 (range, 54 to 100), and 95% of patients reported feeling "much better" following the surgical procedure. Survivorship at 2, 5, and 10 years postoperatively was 96.7%, 96.7%, and 95.0% for reoperation; 98.9%, 98.9%, and 97.2% for revision; and 91.2%, 91.2%, and 89.5% for complications, respectively. The most common complications were instability (3 THAs, 3%), aseptic acetabular loosening (2 THAs, 2%), and postoperative foot drop (2 THAs, 2%). Linear articular wear averaged 0.019 mm/yr. There were no correlations between age, sex, body mass index, bearing surface, femoral head size, use of cement, or operative time and survivorship from complications, reoperations, or revisions. There were no differences in linear wear among CoC, CoP, and MoP bearing surfaces. In patients ≤20 years old, THAs performed with use of modern implants exhibit excellent clinical outcome scores and survivorship at mid- to long-term follow-up. CoC, CoP, and MoP bearing surfaces have similar survivorship, clinical outcomes, and bearing-surface wear in this population. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Results of primary THA using 36 mm femoral heads on first-generation highly cross-linked polyethylene in patients less than 60 years of age: Minimum 10-year follow-ups.

Long-term results of total hip arthroplasty (THA) using highly cross-linked polyethylene (HXLPE) and metal femoral head with more than 10 years of follow-up have already been reported. However, most studies included results with a head size of 28 mm that could affect wear rates. The aim of this study was to evaluate the results of 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age with a minimum follow-up of 10 years. Retrospective analysis included 54 cases from 47 patients. The mean age at the time of surgery was 47.22 years and the mean follow-up period was 131.04 months. Porous-coated cementless acetabular cups (Trilolgy®; Zimmer Inc., Warsaw, Indiana, USA) and HXLPE acetabular liners (Longevity®; Zimmer Inc.) were used for all cases. Acetabular cup abduction angles, anteversion angles, and wear rates of liner were measured using polyWare pro 3D distal version 5.10. The average modified Harris hip score at the final follow-up was 88.48 (range 80-96). Average Merle d'Aubigne and Postel score was 15.57 (range 14-18). There was no acetabular cup or femoral stem failing due to aseptic loosening. The average steady-state wear rate determined using radiographs taken at 1 year postoperatively and at the latest follow-up was 0.053 ± 0.025 mm/year. There were no statistically significant differences in liner wear rate with respect to age, variety of the femoral stem, or liner thickness. Results of THA with 36-mm metallic femoral heads on first-generation HXLPE in patients less than 60 years of age were satisfactory.

Evaluation of functional outcome of inter-trochanteric fractures treated with dynamic hip screw and locking compression plate

Dynamic Hip screw is the implant of choice for most inter-trochanteric fractures of the femur. But, its most common mode of failure is for the lag screw to cut out of the femoral head, the second is for the plate to be forced off the femur with the screws being pulled out of the osteoporotic bone. With the introduction of Locking plate osteosynthesis, in which fixed angle devices are used, which are not dependent on the holding power of screws alone, the bone-implant construct so formed is mechanically stable and fixation failure due to screw loosening in osteoporotic bone can be reduced. This study aims to evaluate DHS with a locking side-plate for fixation of inter-trochanteric fractures in elderly. Aim was to study the functional outcome of Locking Dynamic Hip Screw fixation in 30 patients admitted in MVJ Medical College and Research Hospital with trochanteric femur fractures in elderly age group. The clinical and radiological outcomes were evaluated with regular follow-up and the functional grading was done according to Modified Harris Hip Score. In our study, the mean time to radiological union was 19.73 weeks. There were two patients with superficial infection, one with screw cut-out and one with lateral cortex blowout. None of the patients in our study had varus collapse or side plate pull out. The average modified Harris hip score was calculated to be 83.73. Functionally, 26.67% had excellent, 50% had good, 16.67% had fair and 6.67% had poor results. The present study indicates that DHS with a locking side plate is a terrific treatment option for trochanteric fractures in elderly, with no major complications for fracture union. To accomplish the goal of early mobilisation and reduced failures, we need an implant which has an inherently stable construct independent of the bone quality, does minimal damage to the vascular supply of the bone and has a low complication rate. Locking DHS helps us achieve that goal.

A solution to z effect and lateral wall comminution in nailing of per trochanteric fractures: A retrospective study of 54 cases

Background: Pertrochanteric femur fractures are fractures which extends from extra capsular basilar neck of the femur to the lesser trochanter. Since this region bears the maximum mechanical stress as compared to other parts of the femur it’s a site for comminuted fractures, and accounts for 10% to 34% of all hip fractures with the incidence estimated to double by 2040. In the quest for perfect implant in pertrochanteric femur fractures we have been using hip fracture nail since past 2 years for all pertrochanteric fractures in our institution. Methods: This is a retrospective study of 54 cases of pertrochanteric femur fractures operated using hip fracture nail from 2017 to 2019 in our institute. All the patients were above 55 years of age with an average age group of 67 years. We analyzed rate of union, complications and functional outcome. All the patients were followed up at 3 months interval up to 1 year. Results: Average modified Harris hip score were satisfactory in 48 patients. Average time taken for fracture union was 9 months. Conclusion: We concluded that hip fracture nail solves many a problem of earlier generation nailing systems for unstable pertrochanteric femur fractures. Our study suggests that a twin screw integrated cephalo-medullary nail system effectively prevents the z effect and provides a solution to the lateral wall comminution which is the key predictor for a revision surgery after an unstable intertrochanteric femur fracture.