Harris Hip Score Of Patients Research Articles

"Heterotopic ossification after total hip arthroplasty through direct anterior approach without a dedicated orthopaedic table or direct lateral approach: a quasi-randomized single-center study".

Heterotopic ossifications (HO) are common after total hip arthroplasty (THA). The invasiveness of surgical approaches plays a relevant role in HO development. The aims of this study were to assess the development of HO 6 months after THA through direct lateral approach (DLA) or direct anterior approach (DAA) without a dedicated orthopaedic table and to assess the clinical impact of HO. This is a single-center IRB-approved, quasi-randomized prospective cohort, observational imaging study. Fifty patients underwent primary THA through DLA and 50 through DAA. Age, sex, BMI and side of the affected hip were collected. At the 6 post-operative month the Harris Hip Score (HHS) and the presence of HO (scored through the Brooker classification system) were assessed. There was no significant difference in the demographic data between groups. Operative time was significantly higher in the DAA group (72 ± 10min vs. 58 ± 8min: p < 0.03). At 6 post-operative months the incidence of HO was 14% in the DAA group and 32% in the DLA group (p = 0.02). Severe HO (Brooker 3-4) were significantly more common in the DLA group (p = 0.04). There was no significant difference in the HHS of patients with HO between the DAA and DLA groups. There was no association between poorer clinical outcomes and the severity of HO. The DAA without a dedicated orthopaedic table is associated with a significant lower incidence of HO than the DLA 6 months after elective THA. Except for the surgical approach, no other factors correlated with the occurrence of HO. Even though a lower HHS was found with severe HO, the correlation between severity of HO and clinical outcomes did not reach statistical significance.

The Outcome of Total Hip Arthroplasty Without Subtrochanteric Shortening Osteotomy in Severe Developmental Dysplasia of the Hip

Background: Total hip arthroplasty (THA) is a surgical technique to correct developmental dysplasia of the hip (DDH). Various THA-based methods have been developed for managing end-stage osteoarthritis in patients with DDH Crowe type III or IV. Objectives: In this study, we evaluate the Harris hip score (HHS) before and after cementless THA without subtrochanteric shortening osteotomy (STO) in patients with DDH Crowe type III or IV who were candidates for THA, as well as complications and the need for revision surgery. Methods: This retrospective cohort study was conducted on patients with DDH Crowe type III and IV, who were candidates for cementless THA using the Watson Jones technique without shortening STO. The HHS was calculated and recorded in their medical files before surgery. Patients with missing or incomplete medical files, without written informed consent, with neurovascular diseases, immunosuppressive drug use, congenital bone and articular anomalies, low back pain radiating to the lower extremities, simultaneous fractures, a history of lower extremity fractures, or joint infections were excluded. The HHS was recalculated during outpatient follow-up. Neurovascular defects and the need for reoperation were also evaluated. All data were recorded and analyzed. Results: Thirty-two patients were enrolled with a mean ± SD age of 50.34 ± 15.45 years, most of whom were women (75%). The patients were followed for 2 to 7 years. Postoperative nerve defects were observed in only 1 (3.1%) patient. Hip reoperation was performed in 1 (3.1%) patient. The mean ± SD of HHS before surgery was 50.10 ± 12.48, which increased significantly to 77.99 ± 15.60 after surgery (P &lt; 0.001). Furthermore, the HHS was evaluated before and after the intervention for each gender, showing a significant increase in both. Conclusions: Cementless THA without shortening osteotomy can improve HHS in patients with DDH Crowe III and IV, providing satisfactory outcomes. Furthermore, complications, such as neurological defects and the need for reoperation, are minimal with this method.

Adjuvant Vitamin D Injection in Elderly Patients Before Intertrochanteric Fracture Surgery: A Randomised Controlled Trial.

There are multiple recommended protocols for Vitamin D (VitD) supplementation in elderly; however, only a few studies achieved to examine the role of VitD supplements before intertrochanteric fracture surgery on mortality and complications after surgery. This single-center block-randomized double-blinded trial was conducted on 80 patients with intertrochanteric fractures and a sufficient level of 25 (OH) VitD. The intervention group received an intramuscular 300,000IU VitD ampule before surgery. The primary outcome was a 6-month mortality rate, and the secondary outcomes were 1- and 2-year mortality rates and Harris Hip Score (HHS) in 6, 12, and 24months after surgery. Chi-square, t-test, repeated measure ANOVA, and Cox regression survival model was used for statistical analysis. 40 patients were allocated to each group. Demographic, clinical characteristics, and preoperative evaluations were not significantly different between the groups. Mortality rate 6-month after the surgery was 7.5% and 10% for the intervention and placebo groups respectively (P value = .71), 15% and 12.5% at 1-year (P value = .83), and 25% and 27.5% at 2-year (P value = .98). Based on the Cox regression model, only age was significantly associated with mortality (HR = 1.229, P value <.001). Significant HHS changes from baseline through 24 months after surgery were observed within both groups; however, mean differences were not significantly different between groups. A single preoperative 300,000IU VitD did not significantly impact 2-year survival and HHS in patients with intertrochanteric fractures and sufficient serum VitD level.

Hip-spine syndrome: Diagnostic difficulties

Introduction. Hip-spine syndrome (HSS) is a combination of coexisting hip osteoarthritis (OA) and degenerative lumbar spine stenosis (LSS). Main difficulties in treating patients with HSS are in early diagnostics and in choosing right surgery, because mistakes lead to pain maintenance. Existing diagnostic algorithms show right surgery choosing failure in 15–20%. We present results of examination patients with HSS in our survey.The aim – to present clinical and instrumental results of examination of patients with hip-spine syndrome.Materials and methods. We have examined 378 patients with typical pain pattern (buttocks, low back spine, groin and lateral hip) and difficulties in pain source definition. We performed hip X-rays and low back spine MRI.Due to results we divided patients into three groups – patients with HSS (n=100), with hip OA (n=172) and patients with LSS (n=106). We used Harris Hip Score, Oswestry Disability Index and Visual Analogue Score to determine hip and lumbar spine functional status and pain level.Results. Patients with HSS had higher (p&lt;0.05) pain levels (76.5±9.1 mm) than patients with hip (68.3±7.9 mm) or lumbar spine pathology (67.4±7.9 mm). Harris Hip Score in patients wirh HSS (52.7±8.1 points) was same as in patients with hip OA (55.5±9.1 points), Oswestry Disability Index in these patients (44.2±7.6%) was same as in patients with LSS (43.2±7.8%).Conclusion. High pain level and low Harris Hip Score and Oswestry index, along with clinical examination, on first visit can help suspect hip-spine syndrome and recommend both hip and lumbar spine imaging.

Lactate dehydrogenase (LDH) and C-reactive protein (CRP) as a potential prognostic factor in metastatic bone disease (MBD) of proximal femur based on Harris hip score (HHS) underwent cephalomedullary nailing and bipolar hemiarthroplasty

Introduction: Pathological fractures in the proximal femur are common, often caused by metastatic bone disease (MBD). Treatment options include resection, reconstruction, or fixation. This study explores the prognostic value of C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels in the Harris Hip Score (HHS) for patients with pathological fractures due to MBD. Methods: Forty patients with pathological fractures were divided into cephalomedullary nail (CM) and bipolar hemiarthroplasty (BHA) groups. CRP and LDH levels were measured. The correlation between CRP, LDH, and HHS was assessed using Pearson's and Spearman's correlation. Multiple linear regression was used to predict HHS from CRP and LDH. Results: The mean age of patients was 59 years, with 95% having poor HHS. CRP and LDH levels were significantly correlated with HHS (CRP: r = -0.47, p = 0.002; LDH: r = 0.59, p &lt;0.001). Multiple linear regression showed CRP and LDH as predictors of HHS (R² = 0.36, p &lt; 0.001), with the fitted model: "HHS = 95.76 - 0.317*(CRP) - 0.232*(LDH)". Elevated CRP and LDH levels indicate ongoing inflammation and cellular stress, potentially hindering recovery and impacting HHS. CRP's association with adverse prognoses in various cancers is highlighted. LDH's role in cellular stress and metabolism is emphasized. Combining CRP and LDH evaluations enhances the prognostic assessment of MBD and HHS outcomes. Conclusion: CRP and LDH levels significantly correlate with HHS in patients with MBD-related pathological fractures. Higher levels of CRP and LDH indicate worse functional outcomes. Evaluating these biomarkers aids in assessing disease severity and treatment effectiveness, assisting in informed clinical decisions. This study sheds light on the prognostic potential of CRP and LDH in the context of metastatic bone disease and its impact on hip function and recovery.

The Direct Anterior Approach versus the Posterolateral Approach on the Outcome of Total Hip Arthroplasty: A Retrospective Clinical Study.

ObjectiveTo compare the clinical results of the direct anterior approach (DAA) and posterolateral approach (PLA) in total hip arthroplasty (THA) patients.MethodsFrom January 2017 to September 2019, 80 patients who received primary THA in our hospital were retrospectively selected based on the propensity score matching (PSM) method. Baseline characteristics of patients who underwent the DAA and PLA were collected. Moreover, the incision length, intraoperative blood loss, operative time, length of stay, and Harris hip score were compared between patients in the two groups. The CK level was used to assess muscle damage between patients in the DAA and PLA groups. The complications of these two approaches were also evaluated at patients' 12‐month follow‐up evaluation.ResultsThere was no significant difference in baseline characteristics between patients in the two groups (p > 0.05). The patients in the DAA group had a shorter incision length (9.2 ± 0.2 vs 14.7 ± 0.5, respectively; p < 0.05) and shorter length of hospital stay (9.5 ± 0.7 vs 12.9 ± 0.8, respectively, p < 0.05) than patients in the PLA group. Moreover, the DAA was associated with a decrease in intraoperative blood loss compared with the PLA (109.1 ± 12.6 vs 305.1 ± 14.1 ml, respectively, p < 0.05). However, the operation time was longer in patients in the DAA group (130.7 ± 1.7) than in patients in the PLA group (112.6 ± 1.3 min, p < 0.05). The CK level of patients in the DAA group was lower than that of patients in the PLA group (p < 0.05). The CK level at 48 h post‐surgery was negatively correlated with the Harris hip scores at 6 months after THA (r = −0.538, p = 0.000). Compared with patients in the PLA group, the muscle strength of patients in the DAA group was significantly higher than that of patients in the DAA group at 4 days (p < 0.05) and 7 days (p < 0.05) after THA. The Harris hip scores of patients in the DAA group and PLA group were 81.0 ± 0.8 vs 70.8 ± 0.7 at 6 weeks, 93.4 ± 0.9 vs 86.4 ± 0.6 at 3 months, and 96.8 ± 1.1 vs 93.4 ± 0.8 at 6 months, respectively, both p < 0.05. There was no significant difference in the incidence of complications between patients in the DAA and PLA groups (p > 0.05).ConclusionDAA was superior to the PLA in improving hip function after THA. Compared with the PLA, the DAA could reduce muscle damage, which is negatively correlated with hip function. Further multi‐institution studies are required with longer follow‐up durations, and larger patient populations are needed to provide more definitive conclusions.

Comparative study of extramedullary versus intramedullary fixation for unstable Intertrochanteric femur fracture

Context: Most frequent fractures of proximal femur are intertrochanteric fractures which involve upper end of femur between both trochanters with or without extending into the upper femoral shaft occuring commonly in geriatric patients. Unstable contribute to about 50%-60% of all intertrochanteric fractures. Aims: Though intertrochanteric fractures unite without surgical intervention, malunion with coxa vara deformity occur with conservative management. The aim of fixation of intertrochanteric fractures is to prevent morbidity and mortality. With this aim of stable surgical reconstruct of intertrochanteric fracture this study was done to evaluate functional, clinical and radiological outcome of unstable intertrochanteric fracture operated with dynamic hip screw with trochanteric stabilization plate (extra meduary fixation) and proximal femoral nailing (intramedullary fixation) and study epidemiology and demographics of intertrochanteric femur fractures in Indian scenario. Settings and Design: Methods and Material: The study was conducted at New Civil Hospital Surat. 50 patients with unstable intertrochanteric femur fractures admitted between february 2018 to march 2019. Conclusions: In this study we found that both-extra-medullary or intramedullary fixation were able to provide good clinical result for unstable Intertrochanteric femur fracture. We conclude that there is statistically significant difference between patients operated with DHS with TSP (Extra medullary implant) and Proximal Femoral Nail (Intramedullary implant) in terms of Blood loss, Mean operative time and functional outcome. Harris hip score in patients treated with PFN had better Harris hip score at final follow up which was statistically significant. All patients in both groups had bony union at final follow up. Blood loss and duration of surgery was significantly less with intramedullary Implant.

EARLY FUNCTIONAL RESULTS OF BIPOLAR PROSTHESIS IN FEMORAL NECK FRACTURES

Background: The femoral neck fractures increased with the older age. Surgery considered the main treatment for femoral neck fractures displacement. There is no evidence for the treatment of displaced fractures of the neck of the femur which give the best clinical and functional results. Aim of the study: The aim of the work was to assess the functional outcome and quality of life in terms of pain, mobility, stability using Harris Hip Score in patients with femoral neck fracture, treated with bipolar hemiarthroplasty. Patients & Methods: The current prospective study was carried in the Department of Orthopedics at Faculty of Medicine, Zagazig University during the period from June 2018 to April 2019. The study included 18 patients over 50 years with intra-capsular fracture neck of femur and the fracture treated by hemiarthroplasty using Bipolar endoprosthesis. Results: the study group had excellent outcome according to Harris hip score, had good outcomes. Patients didn’t have pain, (27.8%) had slight pain and (5.5%) had moderate pain. This study showed that (50.0%) of the study group didn’t have limping, (38.9%) had slight limping and (11.1%) had moderate limping and (50.0%) of the study group didn’t need support. Conclusions: Cemented bipolar hemiarthroplasty for fracture neck of femur is a good option in elderly patients. Mobilization and early functional results are good to satisfactory. With this procedure the complication rate is very low and pre injury functional status is restored in majority of patients.

Preserving hip treatment of steroid-induced osteonecrosis of the femoral head

Objective To investigate the early diagnosis and treatment options for steroid-induced osteonecrosis of the femoral head (SONFH). Methods Retrospective analysis was conducted in 73 patients with unilateral SONFH from January 2010 to June 2017. There were 27 males and 46 females, aged 34.26±10.35 years (range, 20-45 years). The following type of cases were included, 21 cases of ARCO I, 24 cases of IIa, 8 cases of IIb, 18 cases of IIc and 2 cases of IIIa. Patients with ARCO I were limited in weight and were treated with low molecular weight heparin sodium and ginkgo dharma drugs after excluding bleeding risk. Core decompression was performed in patients with ARCO IIa and IIb vascularized greater trochanter bone transfer was conducted in patients with IIc and IIIa. During the follow-up duration, when the ARCO I progressed to ARCO IIa and IIb, the core decompression was performed. When the ARCO IIa and IIb progressed to the ARCO IIc or IIIa, the vascularized greater trochanter bone transfer was conducted. Vascularized greater trochanter bone combined with the tantalum rod was implanted in ARCO IIIb. The femoral head reconstruction with the larger trochanter bone flap or joint replacement was performed in ARCO IIIc and above. The Harris hip score was used to evaluate the clinical outcomes. The femoral head survival curve of SONFH was drawn with the end of joint replacement. Results All 73 patients were followed up for an average of 29 months (range, 18 to 48 months). After treatment of 21 patients with ARCO I, a total of 14 (67%) patients had no ARCO staging progress. After 6 months, three patients progressed to ARCO IIb and 4 patients progressed to ARCO IIc. All 32 patients with ARCO IIa and IIb were treated, of which 25 (78%) did not progress but 4 patients progressed to ARCO IIIa at 6 months. Only one patient progressed to ARCO IIIb at 6 months, and 2 patient progressed to ARCO IIIc at 12 months. There were 18 patients with ARCO IIc underwent treatment, of which 14 patients (78%) did not progress but 2 patients progressed to ARCO IIIa at 6 months and 2 patients progressed to ARCO IIIc at 24 months and to ARCO IV at 42 months, respectively. Two patients of ARCO IIIa, 1 patient did not progress and the other one progressed to ARCO IV at 36 months. The Harris hip score was 90.48±5.36 before treatment and 91.76±8.19 at the last follow-up. The difference was not statistically significant (t=1.231, P=0.402). The Harris hip score of patients with ARCO IIa and IIb in creased from 75.22±8.30 to 84.47±16.77 with statistically significant difference (t=5.624, P<0.001). The Harris hip score of patients with ARCO IIc and IIIa increased from 59.80±9.24 to 77.75±20.75 with statistically significant difference (t=12.033, P<0.001). Four patients eventually underwent arthroplasty. The femoral head survival rate was 98.6% at 2 years and 94.5% at 4 years. Conclusion The SONFH can be diagnosed early by screening, and is treated by different reserving hip methods according to severe stages. The short-term clinical effects are satisfied. Key words: Glucocorticoids; Femur head necrosis; Free tissue flaps; Decompression, surgical

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.

Correlation between miR-1207-5p expression with steroid-induced necrosis of femoral head and VEGF expression.

The aim of this study was to investigate the expression level of micro-ribonucleic acid-1207-5p (miR-1207-5p) in steroid-induced necrosis of femoral head (SNFH) and its correlation with SNFH. Meanwhile, we also aimed to analyze the relationship between miR-1207-5p expression and vascular endothelial growth factor (VEGF) in the femoral head. From May 2016 to December 2017, 60 patients aged (55.4±8.7) were selected in our hospital. All patients were diagnosed and confirmed as SNFH. Total RNA was extracted from the necrotic femoral head tissues and peripheral blood. Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was used to detect the expression level of miR-1207-5p in tissues. At the same time, immunohistochemistry and Western blotting were adopted to detect VEGF expression in the bone tissue of patients with high or low expression of miR-1207-5p. 7 patients with femoral neck fracture aged (45.6±4.51) were enrolled in the control group. In the animal experiment, the rat SNFH model was established by intraperitoneal injection of lipopolysaccharide and methylprednisolone. Subsequently, the expression levels of miR-1207-5p and VEGF in necrotic femoral tissues were detected. Meanwhile, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was applied to detect cell apoptosis in bone lacunae of miR-1207-5p high expression group and miR-1207-5p low expression group, respectively. The expression level of miR-1207-5p in the necrotic bone tissue of the SNFH group was significantly higher than that of the control group. The expression level of miR-1207-5p was inversely proportional to Harris Hip score (p<0.05). A higher expression of miR-1207-5p indicated a lower expression level of VEGF (p<0.05). The animal experimental results revealed that miR-1207-5p expression in the necrotic femoral head tissue of SNFH group was significantly higher than that of the control group. Furthermore, the number of apoptotic cells in bone lacunae was remarkably higher in miR-1207-5p high expression group (p<0.05). MiR-1207-5p is significantly up-regulated in necrotic femoral head tissue and serum of SNFH patients. Meanwhile, its expression level is inversely proportional to Harris Hip score of patients. The possible underlying mechanism may be related to the inhibitory effect of miR-1207-5p on VEGF.

Common hip conditions requiring primary total hip arthroplasty and comparison of their post-operative functional outcomes

BackgroundPrimary osteoarthritis of hip has been widely reported to be the leading cause for total hip replacement (THR) in the world. The other common causes are avascular necrosis of hip, inflammatory diseases and trauma sequelae. We report the prevalence of these disease as studied retrospectively at a tertiary healthcare centre and discuss the common age groups and sex ratios of these patients as compared to the West. Additionally, we compare the outcomes of these surgeries based on the aetiologies for which they were done. MethodologyPatients who underwent primary THR in our institute within six years were called and retrospectively analysed. Revision cases were excluded. All the surgeries were done by a single experienced arthroplasty surgeon. On follow ups, functional scores were assessed using standard Harris hip score (HHS) and quality of life scores were assessed using the Short musculoskeletal functional assessment (SMFA) score. Results118 hips in 99 patients (M:F- 3.2:1) with a mean age group of 43.22 years, were operated over a period of six years. Non traumatic avascular necrosis (AVN) of hip topped the list in our study with 42.4% of cases, followed by post-traumatic sequelae (30.5%). These were followed subsequently by primary osteoarthritis (OA) (14.4%) and the remaining were inflammatory pathologies (IA). The HHS of patients with non traumatic AVN hip, traumatic sequelae and primary osteoarthritis were significantly superior to inflammatory arthritis with a p value of 0.001, 0.001 and 0.016 respectively. Additionally the short musculoskeletal functional assessment score was also significantly higher in IA than AVN, OA and post trauma groups (p = 0.001, 0.037 and 0.002 respectively); where a higher score denotes inferior outcomes. ConclusionIn our part of the world, non traumatic AVN hip is the commonest indication for primary hip arthroplasty, followed by traumatic sequelae. The frequency of males undergoing hip arthroplasty is much more than females and at a younger age as compared to the West. Additionally, the functional outcomes in cases of inflammatory arthritis are inferior as compared to the other indications, probably because of associated contractures, deformity and spinal issues.

Assessing functional outcome using modified Harris hip score in patients undergoing total hip replacement

Introduction: Harris Hip Score (HHS) is used for assessing functional outcome in patients undergoing total hip replacement (THR). The present study aimed to assess patients who underwent THR for various indications with modified HHS at different stages pre- and post-operatively. Methodology: Patients who were admitted to our indoor ward for THR from December 2008 till December 2010 were included in the study. Detailed history and physical examination was done for all patients. On every follow up day patients were x-rayed and scored according to the Modified HHS. Pre-operative and intra-operative details were noted using a pretested semi-structured questionnaire. Results: We analysed 20 hip joints in the study. Most common indication of surgery was osteoarthritis secondary to avascular necrosis head of femur. Average modified HHS was 28 preoperatively, increased to 64 at 6 weeks, 86 at six months, 90 at one year and 92 at the last follow-up. After one year follow up, modified HHS was excellent in 17 patients and good in three patients. Modified HHS was excellent in 11 cases where duration of surgery was 136 to 160 minutes and in 2 cases where duration of surgery was 161-185 minutes. Furthermore, modified HHS was excellent in patients in whom partial and full weight bearing was started early. Conclusions: Patients who underwent early partial and full weight bearing also reported excellent modified HHS at final follow up. We recommend the use of modified HHS for assessing post-THR functional status of patients.

Comparison of proximal femur locking compression plate and proximal femur nail in treatment of complex proximal femoral fractures

Background: Proximal femur fractures are common injuries that mostly affect the elderly population. In young and healthy individuals, the injury results from high energy trauma, whereas these fractures are common in the elderly persons due to low energy trauma like simple fall. Methods: 20 patients treated by proximal femoral locking compression plate and 20 patients treated by proximal femoral nailing which operated for complex proximal femoral fractures(AO31 A2.3 and A3.3) selected for this prospective study. Results: Average operating time in PF-LCP is 66.05 mins (range 55.72-76.58mins) and in PFN was 49 mins (range 39.46-58.54 mins). Average blood loss in PF-LCP was 361.50ml (range 303.98-419.02ml) and in PFN was 260.00ml (range 204.37-315.63 ml). 8(40.0%) patients treated by PF-LCP had postoperative complications in which 1 had early deep infection, 2 had proximal screw back out, 3 had varus collapse and 2 had shorting >1 cm. 4(20.0%) patients treated by PFN had postoperative complications in which 1 had screw back out 1 had varus collapse and 2 had shortening >1 cm. Radiological union was seen in all 40(100%) cases and Average Harris hip score in patients treated with PFN is 90.0 (range 83.79-96.21)) and in PF-LCP is 81.15(71.56-90.74). Conclusions: The Functional outcome was better for PFN then PF-LCP.

Does restoration of hip center with subtrochanteric osteotomy provide preferable outcome for Crowe type III–IV irreducible development dysplasia of the hip??

BackgroundSubtrochanteric osteotomy and proximal placement of acetabular components are two common procedures used to manage irreducible, high riding developmental dysplasia of the hip (DDH). Some common and specific complications are observed in both procedures. We aimed to compare both the outcomes and complications between these two procedures. MethodsTwenty-one patients with unilateral, Crowe type III–IV DDH who were seen between 2002 and 2014 were included in this study. Subtrochanteric osteotomy with restoration of the hip center and proximal placement of the acetabular component were performed on 10 and 11 patients, respectively. Harris hip score (HHS) and radiographic images were used for outcome assessment. All patients completed a minimum of 2-year follow-up. ResultsThe HHS in patients who had undergone subtrochanteric osteotomy and proximal placement of the acetabular component were 89.4 and 91.9 points, respectively. However, this difference was not significant. There were six complications, including transient sciatic nerve palsy in two patients, nonunion at the junction in two, an intra-operative fracture in one and cup loosening in another. The complication rates in the subtrochanteric osteotomy and proximal placement of the acetabular component group were 30% and 27.5%, respectively. ConclusionWith regard to both clinical outcomes and complication rates, restoration of the hip center using subtrochanteric osteotomy may provide similar benefits to those patients with proximal placement of the acetabular component in treating Crowe type III–IV DDH.

Assessment of patients undergoing treatment for inter-trochanteric fractures of femur: A comparative study

Background: The incidence of intertrochanteric fractures is gender and race dependent and varies from country to country. Dynamic hip screw (DHS) is the most commonly used implant and is considered gold standard. Current preferred treatment shows an inclination towards use of proximal femoral nail (PFN) and gamma nail. Hence; we planned the present study to assess and compare the outcome of intertrochanteric fractures patients treated with DHS and PFN. Materials & methods: The present prospective study included assessment of 20 patients. All the patients were broadly divided into two study groups with 10 patients in each group. Group 1: Closed reduction and fixation with proximal femoral nail (PFN), and Group 2: Closed reduction and fixation with dynamic hip screw (DHS).A detailed history, preoperative and postoperative clinico-radiological examination was carried out in all 20 cases. Complete hematological and radiographic examination was done in all the patients. Treatment of patients of both the study groups was done depending upon the type of treatment protocol followed. Patients were re-called for follow up after every three weeks till union occurs and then were assessed according to Harris Hip score. All the results were analyzed by SPSS software. Results: There were 13 (65%) males and 7 (35%) females in the study population. We observed non- significant difference while comparing the harris hip score in patients of both the study groups. Conclusion: No significant difference occurred between the two modalities in terms of long term mobility and fracture union.

The Role of Highly Selective Implant Retention in the Infected Hip Arthroplasty.

There is debate around how to treat patients with periprosthetic joint infection of the hip. When there is an ingrown component on one side of the arthroplasty and a loose component on the other, treatment is typically revision of the entire construct. There is an argument to retain an ingrown implant in instances in which removal would result in severe bone damage. However, little has been reported on the likelihood of success with this approach. Among carefully selected patients presenting with an infected total hip arthroplasty (THA) who were treated with joint débridement and at least partial implant retention: (1) What proportion remained apparently free of infection at a minimum of 5 years of followup? (2) What were the Harris hip scores of patients thus treated? Between January 2000 and December 2010, a total of 293 patients were treated surgically at one hospital for a periprosthetic joint infection of the hip. Of these, 18 (2.9%) were treated with an approach that retained either the femoral component or the acetabular component (the removed component was exchanged at this same single-stage procedure). During that time, the general indications for this approach were patients who had complex THAs with ingrown femoral stems or complex acetabular components that were well fixed with no evidence of loosening on radiographs and CT. Patients had to be free from chronic debilitating diseases, had not developed a tracking sinus, and had a positive microbial growth from the hip aspirate. In 12 of these patients, the ingrown cementless femoral component was kept in situ and the femoral head and acetabular component were exchanged. In six patients, complex acetabular reconstructions including augments and/or cages were left in situ, and femoral revision with liner exchange was performed. The technique included removal of the loose component, thorough débridement, synovectomy, and extensive lavage. The ingrown component, be it femoral or acetabular, was thoroughly cleaned, lavaged, and scrubbed. Once there was a clear field, redraping was carried out and new instruments were used to reimplant the other side. In all patients, intravenous antibiotics were used postoperatively for a minimum of 5 days and oral antibiotics for a minimum of 6 weeks based on serology, wound healing, and nutritional markers. None of the patients were lost to followup. Minimum followup was 5 years; median followup was 7.1 years (range, 5-9.9 years). Reinfection occurred in three patients at 3, 9, and 10 months; all were treated by two-stage revision. No reinfection was noted in the other cases. At latest followup, the mean Harris hip score was 78 (range, 46-89). In some patients, staged revision of large and well-fixed components will result in bone damage and compromised function. These results suggest that partial implant retention and joint débridement may be an alternative for those patients who have complex well-fixed acetabular or femoral components, are not immunocompromised, have not developed sinus formation, and we were able to obtain a positive hip aspirate. We caution this technique should not be applied when patients have chronic illness such as diabetes or rheumatoid disease, have a negative hip aspirate for microorganisms, or show any signs of loosening on radiography, CT, or on intraoperative assessment. These results at a minimum of 5 years are reassuring in this small single-center series, but we suggest that the technique not be widely adopted until or unless larger groups of patients with longer term data have been studied. Level IV, therapeutic study.

Cemented Bipolar Hemiarthroplasty Provides Definitive Treatment for Femoral Neck Fractures at 20 Years and Beyond.

Displaced femoral neck fractures frequently are treated with bipolar hemiarthroplasties. Despite the frequency with which bipolar hemiarthroplasty is used to treat these fractures, there are few long-term data. We sought to evaluate (1) the cumulative incidence of revision for any reason of bipolar hemiarthroplasties at 20 years, and the proportion of patients who lived more than 20 years who still have the prosthesis in situ from the index arthroplasty, (2) the cumulative incidence of aseptic loosening at 20 years, and (3) the Harris hip score of the surviving patients at long term. We performed 376 cemented bipolar hemiarthroplasties for displaced femoral neck fractures in 359 patients between 1976 and 1985. At a minimum of followup of 20 years (mean, 24 years; range, 20-31 years), 339 of 359 patients (94%) were deceased, leaving 20 patients in the study group. Of those, one patient was confirmed to be lost to followup and two others had radiographic followup only. Three hundred fifty-nine patients (99.2%) (376 of the original 379 hips) were followed until death, revision of the hemiarthroplasty, or for at least 20 years (of clinical followup). Bipolar hemiarthroplasty was performed for displaced femoral neck fractures. Cemented fixation was the standard of care between 1976 and 1985 at our institution. The mean age of the patients at the time of surgery was 79 years (range, 60-99 years). The cumulative incidence of revision, estimated with death as a competing risk, and radiographs were evaluated for signs of aseptic loosening by a surgeon not involved in the clinical care of the patients. Clinical function was evaluated with the Harris hip score. The mean age of the patients at the time of surgery was 79 years. The 20-year cumulative incidence of revision for any reason was 3.5% (95% CI, 1.6%-5.3%). Of the 20 patients who survived more than 20 years, seven had the implant intact. The 20-year cumulative incidence of revision for aseptic loosening was 1.4% (95% CI, 0.2%-2.6%). The mean Harris hip score in patients who were still living and patient who did not have revision surgery was 63 ± 22, however 13 of the 20 patients had undergone revision surgery. The long-term survivorship of bipolar hemiarthroplasty prostheses used to treat displaced femoral neck fractures in the elderly was high, and the procedure can be considered definitive for the majority of elderly patients with a femoral neck fracture. In this series, 6% (20 patients, 339 of 359) of the patients survived more than 20 years after treatment of a femoral neck fracture with a bipolar hemiarthroplasty. Of those, 35% (seven of 20) survived with their index prosthesis in situ. Level IV, therapeutic study.

Modular tapered implants for severe femoral bone loss in THA: reliable osseointegration but frequent complications.

Modular tapered stems have been suggested as the optimal implants for patients with severe femoral bone loss (Paprosky Type IIIB and IV) undergoing revision total hip arthroplasty (THA); however, there are few data describing survivorship and hip scores associated with this treatment. At minimum 2 years, we sought to determine the (1) survivorship of these implants; (2) radiographic evidence of osseointegration; and (3) the Harris hip scores of patients revised with a modular tapered stem for severe femoral bone loss including the complications associated with their use. Between 1999 and 2010, we performed 1124 femoral revisions; of those, 135 (12%) were performed using a modular tapered stem. General indications for use of this device included bone loss, poor quality bone, leg length discrepancy, difficulty adjusting version, proximal femoral remodeling, and ectatic medullary canals in the setting of revision THA. This report reviewed 70 of those that were performed in Type IIIB and IV femurs. Of those 70 patients, 11 had died and one was lost before 2-year followup; the remaining 58 (83%, 33 with a Type IIIB femur and 25 with a Type IV femur) were followed for a minimum of 24 months (average, 67 months; range, 24-151 months). Survivorship free from revision, radiographic analysis for signs of subsidence or stem loosening, and Harris hip scores were tallied. One patient underwent stem revision for early subsidence followed by failure of ingrowth for a survivorship free from repeat revision of 98% (57 of 58 patients). Five other stems (for a total of six [10%]) subsided early but nonetheless achieved radiographic signs of ingrowth and were not revised again. All other stems demonstrated osseointegration without subsidence and remained radiographically well fixed. In patients with surviving implants, the mean Harris hip score improved from 34 (range, 11-49) preoperatively to 74 (range, 14-100; p<0.001) postoperatively. Overall, 15 of 58 patients (26%) experienced a complication, of whom 10 (17%) underwent reoperation. We found that modular tapered stems resulted in 98% survivorship at a mean of 67 months in patients with Type IIIB and IV femurs undergoing femoral revision, although the overall complication rate in this complex subset of patients is high. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The effect of post-discharge telephone intervention on rehabilitation following total hip replacement surgery

PurposeTo determine the effect of post-discharge telephone intervention with both patients and family caregivers on patient compliance with doctors' advice and rehabilitation progress in total hip replacement patients. MethodsIn total, 249 participants were assigned to either the control or telephone intervention group according to the discharge date. The patients in the intervention group were contacted by phone three to seven days after discharge, at one month, and at three months post-discharge. Their family caregivers received were contacted by phone twice a month. Content of the telephone intervention included discussion of exercise, cautions in daily life, and regular examination. The patients in the control group received routine health education and follow-up. All participants were evaluated by the questionnaire of compliance with doctors' advice when they were discharged at one, three, and six months after discharge. The Harris Hip Score of patients was assessed on discharge day and six months after discharge. ResultsThere was no significant difference between the patients' compliance scores in the two groups on discharge day or one month after discharge. Three and six months after discharge, the scores in the intervention group were significantly higher than the control group (p < 0.05). There was no significant difference between the groups in the Harris Hip Score on discharge day. Six months after discharge, the Harris Hip Score in the intervention group was significantly higher than the control group (p < 0.05). ConclusionTelephone intervention with patients and family caregivers improved patient compliance with doctors' advice and promoted functional hip joint rehabilitation.