Final Harris Hip Score Research Articles

Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study

BackgroundRobots are being used in a wide range of surgical procedures. However, in clinical practice, the efficacy of orthopedic robotic-assisted treatment of femoral neck fractures is still poorly reported, particularly in terms of screw placement accuracy, femoral neck fracture healing rates and postoperative functional recovery. Moreover, there is a lack of comparative analysis between robot-assisted surgery and traditional surgical approaches.PurposeThe purpose of this study was to compare the clinical outcomes of patients with femoral neck fractures treated with TiRobot-assisted hollow screw fixation with those of patients with femoral neck fractures treated with traditional surgical approaches.MethodsThis study included 112 patients with femoral neck fracture who were treated from March 2017 to October 2021 with percutaneous hollow screw internal fixation. These included 56 cases in the TiRobot-assisted surgery group and 56 cases in the standard surgery group. After at least 1 year of follow-up, the treatment outcomes of the two groups were compared, including the amount of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, the length of hospital stay, the accuracy rate of screw placement, the final Harris Hip Score, the fracture healing rate, and the rate of femoral head necrosis. Statistical analysis software was used to process and analyze the result.ResultsThe TiRobot-assisted group had a statistically significant improvement over the control group in terms of intraoperative bleeding, the duration of intraoperative fluoroscopy, the number of guide pin positioning adjustments, length of hospital stay, accuracy of screw placement and incidence of femoral head necrosis (P < 0.05). There was no statistically significant difference in time to surgery, final Harris hip score and fracture healing rate (P > 0.05).ConclusionThis study shows that TiRobot-assisted surgery has the advantages of short hospital stay, high safety, minimally invasive, high success rate of nail placement, and can reduce the amount of intraoperative radiation and the incidence of femoral head necrosis, thus achieving satisfactory clinical outcomes, and is worthy of clinical promotion.

The Impact of Metabolic Syndrome on Reoperations and Complications After Primary Total Hip Arthroplasty.

Metabolic syndrome (MetS) represents a constellation of interrelated conditions including insulin resistance, abdominal obesity, hypertension, and dyslipidemia. The goals of this study are to determine the impact of MetS on implant survivorship, complications, and clinical outcomes after primary total hip arthroplasty (THA). Utilizing our institutional total joint registry, 1,268 patients undergoing primary THA were identified with MetS based on the World Health Organization definition and matched 1:1 to those without MetS based on age, gender, and surgical year. MetS patients were further stratified according to the World Health Organization body mass index (BMI) classification to contextualize obesity. Kaplan-Meier analyses were utilized to compare survivorship free of any reoperation, revision, and complications. Clinical outcomes were assessed with Harris hip scores. Mean follow-up after THA was 5 years. MetS patients had significantly worse 5-year survivorship free from any reoperation compared to those without MetS (93.5% vs 96.1%, respectively; hazard ratio [HR] 1.4, P= .04). When stratifying MetS and BMI classification, the BMI >40 kg/m2 had significantly decreased 5-year implant survivorship free from any reoperation (85.9% vs 96.1%, HR 3.4, P < .001), any revision (91.7% vs 97.3%, HR 2.7, P < .001), and reoperation for periprosthetic joint infection (95% vs 99%, HR 5.1, P < .001). Both groups experienced significant and similar improvement in final Harris hip scores (P < .001). Patients with MetS had a 1.4-fold increased risk of reoperation after primary THA compared to a matched cohort without the condition. MetS patients with a BMI >40 kg/m2 had the highest risk of reoperation, and had a significantly higher revision and periprosthetic joint infection rates, suggesting that morbid obesity remains a critical, independent risk factor beyond MetS. Level 3, Case-control study.

Combined acetabular and femoral neck fractures with intrapelvic femoral head dislocation: Successful staged management of a rare injury in two cases.

Combined central acetabular and femoral neck fractures with intrapelvic femoral head dislocation is an infrequent situation that provides a problematic condition for surgeons attempting to reconstruct the hip joint. Herein, we report two cases involving central acetabular fracture-dislocation combined with intrapelvic dislocation of a fractured femoral neck. Each case involved associated injuries that made primary total hip arthroplasty (THA) impossible and necessitated using the fewest skin incisions possible. As a result, we first attempted a posterior acetabular fixation of both the anterior and posterior columns with intra-articular plating of the anterior column. Finally, a cementless acetabular cup was implanted. There were no complications identified during the stages of reconstruction up to and including THA. The two patients̓ final Harris Hip scores were 98 for the first patient (at five years), and 91 for the second patient (at 1 ½ years). In conclusion, staged reconstruction of the hip joint with intra-articular acetabular plating does not weaken the acetabular bone that can accept insertion of THA with cementless biological acetabular fixation without complications and with an acceptable clinical outcome up to five years.

FIXATION OF UNSTABLE PERITROCHANTERIC FRACTURES OF FEMUR USING GAMMA NAIL

Introduction : The early operative treatment of the peritrochanteric fractures is widely accepted practice and different sliding nail-plate systems, including Gamma Nails (GN) are used in the treatment. The GN was designed to treat unstable trochanteric fractures.Aim: The aim of this study was to discuss the results of treatment of unstable peritrtrochanteric fracture of femur in 30 patients treated by fixation by Gamma nail regarding its outcome .Patients and methods :The study was based on a total of 30 patients surgically treated for the unstable peritrochanteric femoral fracture in the period between August / 2014 till July /2017. All patients underwent gamma nail osteosynthesis. The average age of the patients was 67.2 years (range 40-81 years) with 13 male patients and 17 female patients. The average operative time was 71.8 min (range 45 -100 min). Clinical and radiographic assessments were performed during follow-up visits at 2 weeks , 6 weeks , 12 weeks and 6 months up to one year.Results :According to the final Harris hip score , results were excellent in 7 patients , good in 13 patients , fair in 5 patients and poor in 4 patients while one patient ends with deep infection and non union.Conclusion :This study suggests that the gamma nail is an excellent alternative in treatment of unstable peritrochanteric fracture as it gives advantage of closed technique, allows early mobilization and early weight-bearing. It involves lesser perioperative complications.

Outcomes of Total Hip Arthroplasty Via the Direct Anterior vs Alternative Approaches for Acute Femoral Neck Fractures.

BackgroundTotal hip arthroplasty (THA) performed for displaced femoral neck fractures (FNF) is becoming a more frequent treatment in the active elderly population. The complication profiles associated with THA surgical approaches in the fracture setting are unclear. The purpose of this study was to compare a series of THA for FNF performed via the direct anterior (DA) approach vs alternative approaches (anterolateral and posterolateral).MethodsA retrospective review identified 52 patients who underwent primary THA for FNF between 2009 and 2018, including 20 via the DA approach and 32 by alternative approaches. All procedures were exclusively performed by high-volume arthroplasty surgeons. Perioperative results, complications, and clinical outcomes were compared with those of routine statistical methods. Mean follow-up duration was 3 years (range, 1-8).ResultsThe average age was 74 years (range, 57-92) with similar baseline characteristics between the 2 groups (P = .09). The DA cohort demonstrated significantly shorter length of stay (3 days vs 5 days, P < .01) and discharge to home vs skilled nursing facility (40.0% vs 9.4% P = .014). There was a trend toward decreased complications (0% vs 16%, P = .08). There were no dislocations or fractures in either cohort. Final Harris Hip Scores (94 vs 81, P = .07) and return to community ambulation (96%) were similar between DA and alternative approach groups.ConclusionThe DA approach to THA performed for FNF appears safe with improved outcomes compared with alternative approaches. Larger studies are needed to verify these results.

Mid-term results of total hip arthroplasty for relapsed osteoarthritis after joint-preserving operations for coxarthritis compared to primary total hip arthroplasty.

Several studies have reported no differences in outcomes between total hip arthroplasty (THA) of osteotomized hips and primary hip THA. However, our results were worse after THA for converted osteotomized hips. Therefore, this study's aim was to clarify the differences between THA after osteotomy and primary THA for osteoarthritis in developmental dysplasia of the hip (DDH). The data were collected retrospectively (December 1998-June 2013). The cohort contained patients with a previous osteotomy (40 femur osteotomies) for osteoarthritis with DDH who then underwent cementless THA (average 192months after osteotomy). The clinical and radiographic outcomes of 40 hips (osteotomy group) were compared with a matched group of 40 hips after primary THA (primary group). THA was performed and investigated only in patients with DDH. The mean follow-up period of the osteotomy group was 133months. One patient was lost to follow-up. They had significantly higher subluxation and a narrower canal than the primary group (p < 0.0001, 0.017, respectively). Preoperative and final Harris Hip Score values were worse in the osteotomy group than in the primary group (preoperative 35 vs. 44, p = 0.0009; final 88 vs. 96, p = 0.0001, respectively). Manual muscle strengths of the hip flexor at final follow-up were worse in the osteotomy group. Radiographic outcomes of the osteotomy group showed a larger postoperative leg length discrepancy and severe periprosthetic bone atrophy as judged by bone mineral density and stress shielding. Proximal femoral osteotomies showed worse outcomes after conversion THA at mid-term follow-up.

Bone marrow lesion on magneticresonance imaging indicates the last chance for hip osteonecrosis treated with vascularized fibular grafting before collapse.

Timing of surgery is the most critical prognostic factor for hip osteonecrosis treated with free vascularized fibular grafting (FVFG). Bone marrow lesion (BML) on MRI usually occurs immediately before femoral head collapse. We conducted a retrospective cohort study to evaluate whether the noncollapsed hips with BML can benefit from FVFG. Consecutive patients undergoing modified FVFG were identified from our clinical repository between January 2014 and December 2014. Based on whether BML was pre-operatively detected, the four year radiographic and clinical outcomes were compared. In the BML cohort, 22 of 53 hips (42%) showed radiographic signs of osteonecrosis progression, which was significantly higher than that in the control cohort (8 of 49, 16%; P = 0.005). The BML hips showed a significantly lower pre-operative Harris Hip Score (HHS) than those without BML (77.8 vs. 85.5, P = 0.046), whereas no such difference was observed in the final HHS or its post-operative improvement (HHS 90 vs. 94, P = 0.397; HHS improvement 12 vs. 8, P = 0.067). In the subgroup of patients with a pre-operative HHS lower than 80, BML hips were associated with a slightly lower final HHS than hips without BML. Four of 5 (80%) failed hips with BML had a poor pre-operative hip function. BML indicates the last chance for a reproducible improvement in the treatment of hip osteonecrosis with FVFG before collapse. However, the concomitant lower pre-operative HHS (< 80) is a poor prognostic factor for BML-positive hips.

Role of Biplane Double Supported Screw Fixation For Fracture Neck Femur In Elderly Population: A Prospective Study

Introduction:The treatment of fracture neck femur varies according to the age of patient, the displacement of fracture fragments and the duration of the fracture. Various treatment options available for elderly are screw fixation, hemiarthroplasty and total hip arthroplasty.Materials and Methods:This is a prospective study done at authors institutes between January 2014- December 2016. 30 patients aged more than 50 years who sustained fracture neck femur were included in the study. 3 patients were lost to follow up and 2 patients died due to medical comorbidities. Out of the 25 remaining patients, 17 were males and 8 were females and they were operated by the biplane double supported screw fixation method (BDSF TECHNIQUE) and were followed up for a period of two years. The final Harris Hip Score at the last follow up was calculated.Results:Out of the 25 patients, the union was achieved in all the patients. The mean duration of union was 10 weeks. 1 patient had progressive femoral head resorption due to chondrolysis resulting in antalgic gait and unbearable pain and underwent total hip arthroplasty. The mean harris hip score was 81.2Conclusion:In elderly patients with osteoporosis and in those patients who can not afford arthroplasty or in those patients where arthroplasty is contraindicated, BDSF method is an alternate method for fixing fracture neck femur.

Revision Total Hip and Knee Arthroplasties After Solid Organ Transplant

BackgroundAs solid organ transplant (SOT) patients' survival improves, the number undergoing total hip (THA) and total knee arthroplasty (TKA) is increasing. Accordingly, the number of revision procedures in this higher-risk group is also increasing. The goals of this study were to identify the most common failure mechanisms, associated complications, clinical outcomes, and patient survivorship of SOT patients after revision THA or TKA. MethodsA retrospective review identified 39 revision procedures (30 revision THAs and 9 revision TKAs) completed in 37 SOT patients between 2000 and 2013. The mean age at revision surgery was 62 years with a mean follow-up of 6 years. ResultsThe most common failure mode for revision THA was aseptic loosening (10/30, 33%), followed by periprosthetic joint infection (PJI; 7/30, 23%). The most common failure mode for revision TKA was PJI (5/9, 56%). There were 6 re-revision THAs for PJI (3/30; 10%) and instability (3/30; 10%). There were 2 reoperations after revision TKA, both for acute PJI (2/9; 22%). Final Harris Hip Scores significantly (P = .03) improved as did Knee Society Scores (P = .01). Estimated survivorship free from mortality at 5 and 10 years was 71% and 60% after revision THA and 65% and 21% after revision TKA, respectively. ConclusionRevision THA and TKA after solid organ transplantation carry considerable risk for re-revision, particularly for PJI. Although SOT recipients demonstrate improved clinical function after revision procedures, patient survivorship at mid- to long-term follow-up is low.

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

This study aims to assess the experience gained in a single institution in the treatment of mixed type femoroacetabular impingement (FAI) using safe surgical hip dislocation (SSHD) technique. In this study, 22 hips of 21 patients (7 males, 14 females; mean age 33.8±10.6 years; range 19-52 years) treated by SSHD technique in our clinic between October 2009 and October 2014 were retrospectively evaluated. Preoperative and final Harris hip scores (HHS) and alpha angles were compared. Age, gender, laterality, impingement tests, preoperative HHS, cam and pincer type FAI radiographic indicators and intraoperative articular findings were assessed in terms of their influence to the final functional outcomes. Mean duration of the symptoms was 29.5 months. Groin pain, activated by flexion and internal rotation of the hip, was the main symptom. A radiographic diagnosis of "mixed type FAI" was made in all hips. Mean follow-up duration of 22 hips was 48 months. The difference between the mean preoperative and latest HHS was statistically significant (60.0 vs. 87.6 points, p<0.001). The treatment was considered satisfactory in 17 of 22 hips (77%) having a mean HHS of 95.0 points. Hips having a preoperative HHS of less than 60 points were more prone to unsatisfactory outcome. Among the investigated patient-dependent, clinical, radiographic variables and intraoperative articular findings, coxa profunda sign in a plain radiograph was found correlated with a higher rate of unsatisfactory outcome (p=0.040). Safe surgical hip dislocation procedure has a success rate of 77% after a mean follow-up of four years. Coxa profunda sign is associated with the unsatisfactory clinical outcome. Preoperative HHS of less than 60 points seems to be a negative predictive variable on the clinical outcome.

Cementless Tapered Femoral Stems for Total Hip Arthroplasty in Octogenarians

BackgroundThe use of cementless femoral components has become the standard in younger patients due to increased implant survivorship and decreased loosening. However, it remains controversial whether these femoral stems can provide comparable results in elderly patients. Therefore, our purpose was to compare the (1) incidence of revisions; (2) clinical outcomes; (3) incidence of postoperative blood transfusions; and (4) differences in complications between the 2 cohorts. MethodsSeventy-four consecutive patients (78 hips) aged 80 years or older, who underwent primary total hip arthroplasty using a cementless, tapered, femoral stem were retrospectively compared with a matched cohort of 76 patients (78 hips) who were less than 80 years. Mean age was 83 years (range, 80-91 years) vs 59 years (range, 17-79 years) for the matched group. Minimum follow-up was 2 years. Revision rates, clinical outcomes using the Harris Hip Score, incidences of complications, and postoperative transfusion rates were evaluated. ResultsIn the octogenarian cohort, the aseptic survivorship was 99%, compared with 95% in the matched group. There were 2 aseptic loosenings (2.6%): 1 femoral implant loosening (1.3%) and 1 acetabular loosening, but only 1 revision was performed, as one of the patients declined revision surgery. In the matched cohort, there were 6 revisions (7.7%). There were no significant differences in revision rates between the 2 cohorts, and no significant differences in final Harris Hip Score scores. The incidence of blood transfusion in the study group was 42% vs 19% in control group (P < .01). ConclusionThe use of cementless, tapered, femoral stems yielded excellent results in the octogenarian group, although adequate patient preoperative optimization is necessary given the significantly higher transfusion incidence.

Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties.

We determined the effect of pre-operative bone structure upon the temporal effects of remodeling after total hip arthroplasty (THA) in a series of uncemented implants. We evaluated 345 patients (375 hips), who had either Dorr Type-A (238 hips) or Type-B (137 hips) bone, and who received a proximally-coated cementless THA and were followed for a mean of 6 years. Outcomes evaluated included aseptic survivorship, Harris hip scores, and radiographic evaluation for patterns of remodeling. The aseptic survivorship (97.5% vs. 98%) and the mean final Harris hip scores (92 vs. 94 points) were similar between Types-A and -B bone, respectively. Bone remodeling was seen significantly earlier and over a longer duration for patients who had Type-B bone. At 5-years, periprosthetic condensation (78% vs. 54%) and cortical hypertrophy (53% vs. 37%) were significantly higher and radiolucencies at any zone were lower (53% vs. 37%) in Type-B compared to Type-A bone. There was increased condensation in men and higher cortical hypertrophy in women. Various radiographic remodeling differences may not negatively impact clinical outcome at mid-term follow-up. Morphologic bone type appears to be predictive of physiologic response to loading.

Adult proximal humerus locking plate for fixation of paediatric subtrochanteric fractures

The current study was done to evaluate the outcome of paediatric subtrochanteric fractures managed by adult proximal humerus locking plate (PHLP). This prospective study included eight children (three females and five males) with femoral subtrochanteric fractures who met the inclusion criteria and underwent open reduction and internal fixation of the fracture with ipsilateral long adult PHLP. The mean age of the patients at the time of surgery was 13 years (range 10-16 years), and the mean follow-up was 32 months (range 18-48 months). Outcome at final follow-up was assessed using the Harris hip score. At the time of final follow-up, all fractures united at an average of 8.75 weeks (range 6-14 weeks). The average final Harris hip score was 80.25 (range 67-90). The only complain was prominent hardware in the proximal thigh, near the trochanteric ridge, which was present in two of our patients, and one of them opted for implant removal at 10 months. Internal fixation of paediatric subtrochanteric fractures using the proximal humeral locking plate of the ipsilateral side appears to be a good treatment option for the age group of 10-16 years, though comparative studies with a larger sample size are required to further support this observation.

Outcomes of Total Hip and Knee Arthroplasty After Cardiac Transplantation

The outcomes of 18 primary or revision total hip (THA) and knee arthroplasties (TKA) in 9 patients with cardiac transplants were reviewed. Primary total joint arthroplasties were performed for osteonecrosis (5 hips) or osteoarthritis (5 hips, 4 knees). There were no infections in any of these patients. Final Harris Hip Scores were 71.8 for patients with osteonecrosis and 88.6 for osteoarthritis. Eight of 10 hips were pain-free at final follow-up. Two of the 10 primary THAs required late revision at 7 and 10 years after the index arthroplasty. One patient (2 hips and 1 knee) had chronic bilateral lower extremity pain. Total knee arthroplasty range of motion averaged from 7.5° to 118°. Average final Knee Society function score was 79, and objective score was 88. One of 4 patients with primary TKA required a manipulation under anesthesia. No reoperations were required in this group. Overall, patients with heart transplantations on immunosuppression had generally good pain relief after THA and TKA. There were no infections in this small cohort; however, there were many complications.

Arthroscopic Treatment of Hip Chondral Defects: Autologous Chondrocyte Transplantation Versus Simple Debridement—A Pilot Study

To compare the effectiveness of simple arthroscopic debridement versus arthroscopic autologous chondrocyte transplantation (ACT) for the treatment of hip chondral lesions. We carried out a controlled retrospective study of 30 patients affected by a post-traumatic hip chondropathy of the third or fourth degree, according to the Outerbridge classification, measuring 2 cm² in area or more. Of these patients, 15 underwent arthroscopic ACT, whereas the other 15 underwent arthroscopic debridement. The 2 groups were similar in age, sex, degree, and location of the pathology. All the patients were assessed before and after the procedure with the Harris Hip Score (HHS). In both groups the mean follow-up was approximately 74 months (range, 72 to 76 months). The mean size of the defect was 2.6 cm². The patients who underwent ACT (group A) improved after the procedure compared with the group that underwent debridement alone (group B). The mean HHS preoperatively was 48.3 (95% confidence interval [CI], 45.4 to 51.2) in group A and 46 (95% CI, 42.7 to 49.3) in group B (P = .428 [no significant difference]). The final HHS was 87.4 (95% CI, 84.3 to 90.5) in group A and 56.3 (95% CI, 54.4 to 58.7) in group B (P < .001 [significant difference]). This study indicates that an ACT procedure can be used in the hip for acetabular chondral defects. Level III, retrospective comparative study.

Trabecular Metal Cup without Augments for Acetabular Revision in Case of Extensive Bone Loss and Low Bone-Prosthesis Contact

Current evidences in revision hip arthroplasty suggest to treat severe acetabular bone loss with dedicated implants, such as anti-protrusio cages, stemmed cups, modular systems supplied with iliac flanges and obturatory hook. However recent literature is reporting satisfactory outcomes with simple elliptical Trabecular Metal cups. Purpose of the study was to evaluate mid-term results of such a surgical procedure. All hip revisions performed from 2008 to 2009 with implantation of a TMT multi-hole acetabular cup without augmentations were retrospectively reviewed. The cases with low-degree acetabular bone loss (stage I and II according to GIR classification), with surgical report poorly describing the bone defect, with inadequate pre- and post-operative x-rays were ruled out. Twenty-five cases were identified, but four were lost to follow-up. The twenty-one patients were 71 year-old on average (from 60 to 82), with stage IV bone loss in 6 cases and stage III bone loss in 15 cases. Mean interval from surgery to evaluation was 20.9 months (from 13 to 30). The evaluation included bone-prosthesis contact estimation, component position, survivorship, complications, final Harris Hip Score, presence of periprosthetic radiolucencies. Host bone-prosthesis contact was estimated to be about 35%. Only three implant were subsequently reoperated (for infection, early migration, recurrent dislocation). The HHS among non-reoperated 18 patients was 81.96 on average (from 63.44 to 95.82). Six cases showed thin radiolucencies in one of the three Charnley zones, while three cases showed radiolucencies in two. None of these images was evolutive, thus they were not considered signs of loosening. The mid-term results of this series confirm the hypothesis that a porous tantalum acetabular cup is an effective option to deal with difficult acetabular revisions. Although no extra-acetabular fixation device is available, the very high surface friction guaranteed by the material and the supplemental stability provided by trans-acetabular screws seem to be sufficient to allow satisfactory reimplantation even in severely damaged pelves.

The Influence of Aetiology of Hip Instability on the Results of Pelvic Support Osteotomy

Pelvic support osteotomy and femoral lengthening are sometimes employed in cases of hip instability. We assessed the efficacy of surgery following sepsis and congenital dislocation in relation to functional results. Between March 2005 and May 2007 we performed pelvic support osteotomy and femoral lengthening for 21 hips in 20 patients. Preceding pathology included congenital dislocation in 13 hips (12 patients) and sequelae of sepsis in 8 hips. All surgical procedures were performed as described by Ilizarov. The mean follow-up period was 33.5 months. There was no significant difference between the final Harris Hip Scores of the 2 groups. The number of patients with persisting abductor weakness was similar between the 2 groups. Complications were more frequent following congenital dislocation, and additional physiotherapy to restore knee motion was required in almost half of these. Patient satisfaction was higher in cases with sequelae of sepsis.

Long-Term Results of Anti-Protrusio Cage and Massive Allografts for the Management of Periprosthetic Acetabular Bone Loss

From 1992 to 1995, 71 total hip arthroplasties with extensive acetabular bone loss underwent revision using bulk allografts and Burch-Schneider anti-protrusio cages. Twelve patients died of unrelated causes and 3 were lost to follow-up. Fifty-six hips were available for clinical and radiographic follow-up examination at an average of 11.7 years after surgery. The average final Harris hip score was 75. X-ray signs of incorporation of massive bone graft were observed in 49 hips. Two cases developed deep infection that required resection arthroplasty. Aseptic loosening of the acetabular cage occurred in 5 patients, and 2 of them underwent re-revision. With a total survival rate of 87.5%, anti-protrusio cages and structural allografts compare favorably with other techniques in the long-term reconstructive treatment of extensive loss of acetabular bone stock.

Management of osteoporotic pertrochanteric fractures with external fixation in elderly patients

We evaluated the results of osteosynthesis with external fixation for intertrochanteric hip fractures in elderly patients with a high anesthesia risk. Fourteen ASA 4 patients (5 men, 9 women; mean age 75 years; range 65 to 81 years) with intertrochanteric hip fractures were treated with a unilateral external fixator under epidural anesthesia combined with mild sedation. According to the AO/OTA classification, six fractures were A1.2, seven fractures were A2.2, and one fracture was A3.1. All were closed fractures. The mean preoperative Singh index of the contralateral hip was 3.1 (range 3 to 5). Eleven patients received an AO tubular external fixator, and three patients received a unilateral external fixator. Final evaluations were made using the Parker-Palmer mobility score and Harris hip score. The mean follow up was 12 months (range 9 to 17 months). The mean operation time was 37 min (range 25 to 44 min), the mean fluoroscopy time was 1.5 min (1 to 2 min), and the mean hospital stay was seven days (5 to 15 days). None of the patients required blood transfusion. Bone union was obtained in all the patients in a mean of 4.1 months (3 to 5 months). The mean femoral shaft-neck angles in the early postoperative period and at the latest follow-up were 133 degrees (127 degrees to 139 degrees ) and 132 degrees (126 degrees to 138 degrees ), respectively. Five patients (35.7%) developed grade I pin-tract infection. Medial displacement of the distal fragment, limb shortening, or fixator failure were not seen. Three patients (21.4%) died within the first postoperative year due to associated diseases. The mean final Harris hip score was 61 (range 45 to 80) and the mean Parker-Palmer mobility score was 6.6 (range 5 to 8). Osteosynthesis with an external fixator in elderly patients with a high anesthesia risk is a fast, minimally invasive procedure in the treatment of pertrochanteric fractures, resulting in fewer pre- and postoperative complications.

Revision of Failed Acetabular Components with Use of So-Called Jumbo Noncemented Components&lt;sbt aid="1082509"&gt;A Concise Follow-Up of a Previous Report&lt;cross-ref type="fn" refid="fn1"&gt;*&lt;/cross-ref&gt;&lt;/sbt&gt;

Acetabular revision in the presence of major bone-stock deficiency is a difficult clinical and surgical problem. Of an original pool of twenty-four consecutive patients treated with an acetabular revision with a so-called jumbo (>65-mm) cementless hemispherical acetabular component, fifteen were followed for an average of seven years in our previous study. The current report presents the results for the twelve patients in this group who were alive at a minimum of twelve years (mean, 13.9 years) postoperatively and agreed to return for follow-up. The average final Harris hip score was 79 points. No acetabular shell had been revised because of aseptic loosening, and none was loose as seen radiographically. The complication rate was high but was largely related to infection. In the patients without infection, the fixation of these large sockets remained excellent at the time of long-term follow-up.