Harris Score Research Articles

Six-Part Classification of Femoral Intertrochanteric Fractures: A Classification Method to Improve the Diagnosis Rate of Unstable Fractures.

Three-dimensional (3D)-CT data is currently insufficient for classifying femoral trochanter fractures. Fracture classification based on fracture stability analysis is helpful to evaluate the prognosis of patients after internal fixation. Currently, there is a lack of fracture classification methods based on 3D-CT images and fracture stability analysis. The aim of this study was to propose a new six-part classification method for intertrochanteric fractures of femur based on 3D-CT images and fracture stability analysis to improve the diagnosis rate of unstable fractures. From January 2009 to December 2019, 320 patients receiving intramedullary nail surgery for femoral intertrochanteric fractures at Chengdu University's Affiliated Hospital were studied retrospectively. AO and six-part classifications were undertaken according to the 3D-CT image data of the patients, and the stability rates of two classifications were compared. According to the six-part classification stability criteria, the patients were divided into a stable and an unstable fracture group. The perioperative and follow-up indicators of the two groups were statistically analyzed, and the six-part classification's inter-observer and internal reliability was examined. There were 107 men and 213 females women the 320 patients, with an average age of 79.32 ± 11.26 years and an osteoporosis rate of 55.63% (178/320). The fracture stability rate of 39.69% (127/320) was studied using a six-part classification method. The AO classification fracture stability rate was 42.50% (136/320), with no significant difference (χ2 = 0.523, p = 0.470 > 0.05). There is no statistically significant difference between the two classification techniques in the examination of fracture stability (McNemer difference test p = 0.306 > 0.05; Kappa consistency test p < 0.001). According to the six-part classification, fracture stability and instability group were divided into two groups. The following indicators were compared between the two groups: The surgery time (p = 0.280), fracture reduction quality (p = 0.062); function independent measurement (p = 0.075); timed up and go test (TUG) (p = 0.191), and Parker-Palmer score (p = 0.146). Were as compared according to the six-part classification of stable and unstable fracture groups. Perioperative blood loss (p < 0.001), the Harris score excellent and good rate (p = 0.043), fracture healing time (p < 0.001), and the entire weight-bearing duration (p = 0.002) were statistically significant. The difference in femoral head height (FHH) (p = 0.046), the change in femoral neck shaft angle (p = 0.003), the change in medial cephalic nail length (p = 0.033), and the change in tip-apex distance (TAD) (p = 0.002) were statistically significant compared to the relevant markers of imaging stability. Fracture stability had a substantial influence on Harris ratings at 3, 6, and 12 months following surgery, according to repeated measures analysis of variance (F(1,126) = 32.604, p < 0.001). The effect of time on the Harris score was similarly significant (F(1.893,238.508) = 202.771, p < 0.001). The observer intra-observer inter-group correlation coefficient (ICC) value was 0.941 > 0.75, the inter-observer ICC value was 0.921 > 0.75, and the intra-observer and inter-observer reliability were both good. The six-part classification of femoral intertrochanteric fractures based on 3D-CT images has broader guiding relevance for femoral intertrochanteric fracture stability analysis. Clinicians will find this classification simpler and more consistent than the AO classification.

Comparison of InterTAN and PFNA internal fixation for elderly patients with intertrochanteric fracture: A retrospective cohort study.

To compare the clinical outcomes of InterTAN nail and proximal femoral nail antirotation (PFNA) internal fixation for the treatment of intertrochanteric fractures in the elderly. We retrospectively reviewed the clinical records of 151 elderly patients with intertrochanteric fractures treated in The Second People's Hospital of Hefei from October 2019 to December 2021. Among them, 73 patients had undergone InterTAN (InterTAN group) and 78 patients had undergone PFNA (PFNA group) internal fixation. Operation-related variables (operation time, incision length, intraoperative bleeding volume, hospital stays length, and fracture healing time), complications, and Harris scores were compared between the two groups. The operation time and incision length were shorter and the intraoperative bleeding was less in the PFNA group than in the InterTAN group (all P-values <0.05), but the fracture healing time was longer in the PFNA group (P<0.05). We found similar hospital stays and surgical complications in the two groups (P>0.05). In addition, the Harris hip joint scores were significantly higher in the InterTAN group than in the PFNA group at one, six, and twelve months after the operation (P<0.05). InterTAN and PFNA internal fixation have their own advantages in treating patients with intertrochanteric fractures. InterTAN has better postoperative recovery results, while PFNA has less perioperative trauma. Clinically, InterTAN or PFNA should be selected based on the specific conditions of each patient to maximize the therapeutic benefit of each treatment method.

Comparison of clinical data between the proximal femoral bionic nail (PFBN) and hip replacement for the treatment of femoral intertrochanteric fracture.

The aim of this study was to compare the difference between proximal femoral bionic nail (PFBN) and hip replacement (HR) for femoral intertrochanteric fracture. A retrospective analysis of the differences in operative time, length of stay, postoperative Harris score, and postoperative mortality between patients with femoral intertrochanteric fracture treated by PFBN and HR admitted to Jinzhai County People's Hospital from October 2020 to September 2022 was performed. A total of 56 patients with femoral intertrochanteric fracture, 26 with PFBN and 30 with HR, were included in the study. There were no differences in the length of surgery, pre- and post-operative hemoglobin, or post-operative Harris score at 3 months between the two groups. Compared to the HR group, the PFBN group had a lower total cost, shorter hospital stays, and lower mortality but a longer ambulation time, with a difference of 3.36 weeks. PFBN may be a promising new treatment for femoral intertrochanteric fracture.

Retrospective clinical study of hip replacement in the treatment of traumatic arthritis secondary to acetabular fracture

To investigate the clinical effect of total hip replacement (THA) in the treatment of traumatic arthritis secondary to acetabular fracture. From October 2019 to June 2022, 15 patients with secondary traumatic arthritis of acetabulum fracture were treated with THA. There were 8 males and 7 females, aged from 40 to 76 years old with an average of (59.20±9.46) years old. Prosthesis loosening, dislocation of hip joint, range of motion of hip joint, nerve injury and other conditions were recorded before and after surgery. Harris score, visual analogue scale (VAS) and imaging were used to evaluate hip joint function and surgical effect. Follow-up time ranged 6 to 39 months with an average of (18.33±9.27) months. All the 15 patients successfully completed the operation, no nerve and blood vessel injury during the operation, postoperative wound healing was stageⅠ, no infection, one case of acetabular side prosthesis loosening at half a year after operation, and recovered well after revision surgery, one case of hip dislocation was cured after open reduction treatment, no adverse consequences. Harris score at the last postoperative follow-up was (88.60±4.01) points, compared with the preoperative (47.20±11.77) points, the difference was statistically significant (P<0.05), and VAS at the lateat postoperative follow-up was 1 (1) points, compared with the preoperative 8 (2) points, the difference was statistically significant (P<0.05). At the last follow-up, the pain symptoms were relieved or disappeared, and the joint function was satisfactory. The imaging data of the latest follow-up showed joint was well pseudoradiated, no abnormal ossification occurred, and the prosthesis was not loose. THA is effective in the treatment of traumatic arthritis secondary to acetabular fracture and can effectively improve the quality of life of patients. Preoperative comprehensive evaluation and bone defect evaluation of patients, and intraoperative management of acetabulum, femur, internal fixation and bone defect are key factors for the success of surgery.

Hip Arthroscopy Debridement Combined with Multiple Small-Diameter Fan-Shaped Low-Speed Drilling Decompression in the Treatment of Early and Middle Stage Osteonecrosis of the Femoral Head: 14 Years Follow-Up.

Osteonecrosis of the femoral head (ONFH) is a disease that occurs frequently in young and middle-aged people. Because of its high disability rate, it affects the ability to work, so the early treatment of this disease is particularly important. This retrospective study aimed to evaluate the clinical efficacy of hip arthroscopy combined with multiple small-diameter fan-shaped low-speed drilling decompression (MSFLD) in treating early-mid stage ONFH (ARCO II-IIIA) compared to MSFLD, with at least 10-year follow-up. A total of 234 patients who underwent hip arthroscopy and MSFLD for ONFH from 1998 to 2012 were analyzed retrospectively. This study enrolled patients between 18 and 60 years old with ARCO stage II-III A, diagnosed clinically and through imaging, in accordance with the 2021 guidelines for the treatment of ONFH. Clinical data, including demographics, operation mode, BMI, pre- and postoperative Harris score, and femoral head survival rate, were collected. Patients were divided into hip arthroscopy + MSFLD and MSFLD groups based on the operation mode. The t-test was used to compare the postoperative efficacy, Harris scores, and survival rates of the femoral head between the two groups. Among the 234 patients, 160 cases were followed up, including 92 cases in the hip arthroscopy + MSFLD group and 68 cases in MSFLD group, the follow-up rate was 68.38%, and the follow-up time was (10-22)14.11 ± 3.06 years. The Harris score (80.65 ± 6.29) in the hip arthroscopy + MSFLD group was significantly higher than that in the MSFLD group (p = 0.00), and the survival rate of femoral head (5-year survival rate was 84.78%, 10-year survival rate was 23.91%) was also higher than that in the MSFLD group (5-year survival rate was 63.24%, 10-year survival rate was 8.82%). The 5-year and 10-year survival rates of patients with ARCO II were 82.11% and 28.42%, which were better than 54% and 33% for ARCO III A. The femur head survival rate of alcoholic ONFH (5-year survival rate 61.54%, 10-year survival rate 9.23%) was significantly higher than that of other types of ONFH. Clinical follow-up of at least 10 years suggests that hip arthroscopy combined with MSFLD is an effective treatment for early-mid stage ONFH, with good clinical effect and high survival rate of femoral head.

Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint

To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint. A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively. The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05). For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

Single Kocher-Langenbeck approach combined with anterograde channel screw technique in treatment of acetabular transverse and posterior wall fractures

To assess the effectiveness of the single Kocher-Langenbeck approach combined with anterograde channel screw technique for the treatment of acetabular transverse and posterior wall fractures. Between March 2020 and October 2022, 17 cases of acetabular transverse and posterior wall fractures were treated with the single Kocher-Langenbeck approach combined with anterograde channel screw technique. There were 11 males and 6 females, with an average age of 53.6 years (range, 42-64 years). Causes of injury included traffic accident in 12 cases, and falling from height in 5 cases. The time from injury to operation ranged from 4 to 16 days with an average of 8.8 days. The operation time, intraoperative blood loss, and fluoroscopy frequency were recorded; X-ray films were reviewed regularly after operation to observe the fracture healing, and postoperative complications were recorded. At last follow-up, Matta score was used to evaluate the reduction of fracture, Harris score and modified Merle D'Aubigné-Postel scores system were used to evaluate the hip joint function. The operation time was 150-230 minutes (mean, 185.9 minutes), the intraoperative blood loss was 385-520 mL (mean, 446.2 mL), and the fluoroscopy frequency was 18-34 times (mean, 27.5 times). Postoperative fat liquefaction occurred in 1 case and the other incisions healed by first intention; 3 cases had limb numbness after operation, and the symptoms disappeared after active symptomatic treatment; no urogenital system and intestinal injury occurred. All patients were followed up 12-28 months (mean, 19.9 months). Bone union was achieved in all cases with an average healing time of 10.8 weeks (range, 8-14 weeks). There was no complication such as loosening and breakage of internal fixators. At last follow-up, according to Matta score, 12 cases achieved anatomic reduction, 3 satisfactory reduction, and 2 fair reduction, the satisfactory rate was 88.2%; according to Harris hip function score, 12 cases were excellent, 3 good, and 2 fair, the excellent and good rate was 88.2%; according to the modified Merle D'Aubign Aubigné-Postel scoring system, the results were excellent in 11 cases, good in 3 cases, and fair in 3 cases, with an excellent and good rate of 82.4%. The single Kocher-Langenbeck approach combined with anterograde channel screw technique is a minimally invasive method for the treatment of acetabular transverse and posterior wall fractures with less complications, simple operation, and satisfactory effectiveness.

Application of robot navigation system for insertion of femoral neck system in the treatment of femoral neck fracture

PurposeTo evaluate the short-term clinical efficacy and advantages of surgery robot positioning system for insertion of Femoral Neck System (FNS) in the treatment of femoral neck fractures.MethodsThe clinical data of 52 patients with Femoral neck fracture (FNF) who had been treated with FNS between June 2020 and September 2021 were retrospectively analyzed. Among them, 26 patients were treated with traditional FNS (control group), while 26 additional patients were treated with FNS assisted by an orthopaedic robot positioning system (study group). The operation duration, frequency of key-guide needle placement, intraoperative blood loss, incision length, fracture healing rate, fracture healing time, and the Harris scores at the last follow-up were calculated and compared between the 2 groups.ResultsThe study group had shorter operation duration, fewer numbers of placing the key-guide needle, less intraoperative blood loss, and smaller surgical incisions than the control group (all, P < 0.05). There was no significant difference in the rate of fracture healing rate between the 2 groups (P = 0.47), while the fracture healing duration of the study group was shorter than that of the control group (P = 0.03). At the last follow-up, compared with the control group, the Harris score and the number of excellent and good ratings were significantly higher in the study group (all, P < 0.05).ConclusionsUsing orthopaedic surgery robot positioning system-assisted FNS in the treatment of FNFs can effectively improve the efficiency of surgery, shorten operation time, and reduce the number of placing the key-guide needle, intraoperative blood loss, and operative trauma. Simultaneously, it shortens the duration of fracture healing and improves the recovery of hip function.

Study on the effect factors of discharge readiness of total hip arthroplasty patients.

In order to explore the correlation between discharge readiness and Harris score or self-care ability of patients undergoing total hip arthroplasty (THA) based on the enhanced recovery after surgery (ERAS) concept. We carried out this single center retrospective study. We enrolled 331 patients who underwent THA. These patients were divided into the higher score group and the lower score group according to median discharge readiness score. After the baseline data of these patients were compared, the effect factors of discharge readiness of these patients was analyzed through univariate and multivariate logistic regression analyses and mixed effects models. The results demonstrated that there was a correlation between discharge readiness and changes in Harris score 30 days after discharge (compared with that before surgery) in these patients. Besides, the Harris score and self-care ability 30 days after discharge were higher than those at the time of discharge. In addition, patients in the higher score group exhibited a higher Harris score compared with those in the lower score group. From the evaluation at different time points after discharge, there was a significant difference in the Harris score between both groups. It can be inferred that the discharge readiness of patients undergoing THA was correlated with the Harris score but not with the self-care ability. These results are expected to provide guidance for the physical and mental recovery of patients undergoing total hip replacement under the ERAS concept. Furthermore, these findings may contribute to higher diagnosis, treatment, and nursing levels of orthopedic medical staff.

The Efficiency of Antiosteoporosis Medicine after Intertrochanteric Fracture Surgery: A Retrospective Study of Refracture Rate, Function Recovery, Complications, and Mortality in the Chinese Elderly Population

Abstract Objective This research aimed to discern the effects of antiosteoporosis medication on postoperative functional recovery, refracture incidence, complications, and mortality in geriatric patients with intertrochanteric fractures. Methods A retrospective study was conducted on 250 patients aged 65 years and above who underwent surgery for intertrochanteric fractures between January 2013 and December 2014. Intertrochanteric fracture is diagnosed with International Classification of Diseases 10th Revision code (S72.101) and classified by the Evans–Jensen system. Collected data encompassed demographic details, pre- and postoperative histories of antiosteoporotic medication, functional outcomes (measured using Harris hip score, Parker Mobility Score, and EuroQol-5 Dimension [EQ-5D] scores), refracture incidences, complications, and survival rates. The antiosteoporotic regimen was categorized into essential (calcium, vitamin D) and advanced medications (bisphosphonate, calcitonin, etc.). Outcomes between patients on antiosteoporosis treatment (AO group) and those without (control group) were compared. Results The cohort comprised 250 patients, with a gender distribution of 85 males (34%) and 165 females (66%), and a mean age of 79.8 ± 7.0 years. The median follow-up period was 15.82 months (maximum 31.13 months). Postoperatively, 126 (50.4%) patients were administered antiosteoporotic treatment. The refracture incidence in the AO group (2.4%, n = 3) was notably lower than the control group (8.9%, n = 11), manifesting a substantial risk reduction (odds ratio 0.251, 95% confidence interval 0.068–0.920, p = 0.024). While no marked differences in functional outcomes between the AO and control groups were observed (Harris score [96.17 ± 7.77 vs. 97.29 ± 6.74, p = 0.074), Parker score [8.54 ± 1.26 vs. 8.62 ± 1.18, p = 0.411], EQ-5D [0.83 ± 0.05 vs. 0.82 ± 0.06, p = 0.186]), patients administered a combination of essential and advanced drugs showcased significantly improved Harris and EQ-5D scores compared to those on essential drugs alone (Harris score [77.93 ± 2.04 vs. 84.94 ± 2.73, p = 0.015], EQ-5D [0.65 ± 0.03 vs. 0.75 ± 0.04, p = 0.015]). Conclusion Postoperative antiosteoporosis treatment acts as a deterrent against refracture following intertrochanteric fracture surgeries, evidenced by a decline in refracture rates. However, the treatment's impact on functional recovery, quality of life, complications, and mortality remains indistinct. Interestingly, the combined administration of essential and advanced antiosteoporotic drugs seems to foster enhanced functional outcomes, warranting further exploration in future studies.

Does the limb lengthening reduce the incidence of hip dislocation in patients with neurological disorders and insufficient muscle tension who undergoing hip arthroplasty?

The soft-tissue tension is closely associated with postoperative hip dislocation in patients undergoing total hip arthroplasty (THA), especially for those patients with neurological disorders and insufficient muscle tension. The aim of this study is to explore the effect of limb lengthening on the incidence of complications following THA in patients with neurological disorders and insufficient muscle tension. This retrospective analysis examines individuals with neurological disorders, such as ischemic stroke and poliomyelitis, who underwent primary total hip arthroplasty (THA) at our medical center between January 2015 and April 2021. Demographic and baseline characteristics (such as age, gender, muscle strength) were obtained from medical records. The limb length, offset and the positional parameters of both acetabular and femoral component were measured on pre- and postoperative plain radiograph. The primary outcome was the occurrence of hip dislocation. The secondary outcome included the incidence of other complications and the hip function (determined by Harris score). The correlation between the occurrence of hip dislocation and limb lengthening was analyzed. A total of 258 patients were finally analyzed. The hip dislocations were identified in 35 patients (overall incidence = 13.57%). The incidence of early dislocation was lower in patients whose limb-length discrepancy (LLD) was over 20 mm (incidence = 4.1% for LLD >20 mm, 12.2% for LLD 10 mm-20 mm and 17% for LLD <10 mm). The odds ratio (OR) was 0.206 and 95% confidence interval (CI) was 0.058-0.737 (compared between LLD <10 mm and LLD >20 mm). But the no difference was identified regarding on the incidence of late dislocation among patients with different LLD. Moreover, the overall incidence of other complications was elevated in patients with LLD >20 mm (incidence = 17.58% for LLD >20 mm, 11.11% for LLD 10 mm-20 mm and 3.19% for LLD <10 mm; OR = 6.464, 95% CI = 1.768-23.640). And the Harris scores, which reflected the hip function, was gradually decreased with the increasing in LLD. In terms of the relationship between the offset and dislocation rate, it was found that increased offset discrepancy was associated with decreased dislocation incidence (incidence = 4.71% for offset discrepancy >10 mm, 12.5% for offset discrepancy 5 mm-10 mm and 17.20% for offset discrepancy <5 mm; OR = 0.238, 95% CI = 0.076-0.742). Furthermore, increased offset discrepancy also bring a reduction in late dislocation. The incidences of late dislocation were 0%, 2.5% and 10.8% for offset discrepancy >10 mm, offset discrepancy 5 mm-10 mm and 17.20% for offset discrepancy respectively. Different from that of LDD, the incidences of other complications were similar among patients with different offset discrepancy. Besides, no influence of offset discrepancy on the hip function was identified in this study. Unfortunately, although increasing in limb length could partially reduce early dislocation postoperatively, it could not affect the incidence of late dislocation in those patients with neurological disorders and insufficient muscle tension. Moreover, over limb lengthening was associated with other postoperative complications and worse hip function. Instead, additional offset could reduce the probability of postoperative dislocation, without increasing the incidence of other complications. Therefore, femoral stem with lower cervico-diaphyseal angle (higher offset) should be recommended to patients with neurological disorders who were in high risk of postoperative dislocation. Isolated increasing in limb length should be avoided.

Robot Navigation System Assisted PFNA Fixation of Femoral Intertrochanteric Fractures in the Elderly: A Retrospective Clinical Study.

The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly. From February 2021 to October 2022, the elderly (>65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups. There was no statistical difference in baseline data between the two groups (P>0.05). The intraoperative bleeding in the robot group was 68.17±10.66 mL, the intraoperative bleeding in the traditional group was 174±8.11mL (P<0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P<0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P<0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021). PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.

Application of multi-disciplinary team nursing model enhances recovery after surgery for total hip arthroplasty and total knee arthroplasty.

To explore the effect of a multidisciplinary team (MDT) nursing model based on enhanced recovery after surgery (ERAS) in total hip arthroplasty (THA)/total knee arthroplasty (TKA) and evaluate its application in the perioperative period of patients. A retrospective analysis was conducted on 100 patients with THA/TKA treated at Shaoxing Second Hospital Medical Community General Hospital from January 2021 to December 2023. The patients were divided into an observation group (n = 50) and a control group (n = 50) based on the nursing method employed. The control group received traditional perioperative nursing, while the observation group received an MDT nursing model intervention based on the ERAS concept. Visual analogue scale (VAS) scores were recorded at 6, 24, and 72 hours post-surgery. Additionally, postoperative activities, hospitalization duration, and postoperative complications were documented. Differences in knee joint range of motion (ROM), hip Harris score, psychological stress response score, and quality of life score between the two groups before and one month after surgery were analyzed. At 6, 24, and 72 hours post-surgery, patients in the observation group had significantly lower VAS scores compared to those in the control group (all P < 0.05). The observation group had an earlier first-time mobilization (P < 0.05). The length of hospitalization and hospitalization cost were significantly lower in the observation group than in the control group (both P < 0.05). The incidence rates of postoperative adverse reactions were 22.00% in the control group and 6.00% in the observation group (P < 0.05). One month post-surgery, the observation group showed significantly greater ROM, lower psychological stress and reaction scores, and higher Harris score and quality of life score compared to the control group (all P < 0.05). The MDT nursing model based on ERAS concept for THA/TKA perioperative patients effectively alleviates postoperative pain, promotes early activity, shortens hospital stay, reduces hospital cost, decreases the incidence of complications, restores joint function, enhances quality of life, and reduces psychological stress.

Comparison of the therapeutic efficacy of hip arthroplasty and proximal femoral nail antirotation internal fixation for unstable intertrochanteric femur fractures.

To compare the therapeutic efficacy of total hip arthroplasty (THA) versus proximal femoral nail antirotation (PFNA) internal fixation for treating unstable intertrochanteric femur fractures (UIFF). In this retrospective study, the clinical data of 86 patients with intertrochanteric femur fractures (IFF) treated in Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from January 2022 to December 2023 were collected and analyzed. Patients were categorized into two groups based on their treatment modality: the THA group (n=45, treated with THA) and the PFNA group (n=41, treated with PFNA internal fixation). The two groups were compared in terms of surgery-related indicators (operative time, incision length, intraoperative blood loss, postoperative drainage volume, and intraoperative fluoroscopy frequency), postoperative recovery indicators (time to first ambulation, length of stay, time until full weight-bearing ambulation), and the incidence of postoperative complications. The pain indicators (Wong-Baker Faces Pain Rating Scale) and hip joint function indicators (Harris Hip Scores) of patients in the two groups were assessed preoperatively and at 1, 3, and 6 months postoperatively. The hip joint function recovery outcomes of the two groups of patients were recorded at the last follow-up. The PFNA group had significantly shorter operative time, shorter incision length, lower intraoperative blood loss, lower postoperative drainage volume, and higher intraoperative fluoroscopy frequency compared to the THA group (all P < 0.05). The PFNA group also had significantly longer time to first ambulation, length of stay, and time until full weight-bearing ambulation (all P < 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Postoperative Wong-Baker scores in both groups decreased compared to preoperative levels. At 1 and 3 months postoperatively, the PFNA group had significantly higher Wong-Baker scores than the THA group (P < 0.05), but at 6 months postoperatively, the difference was not statistically significant (P > 0.05). Postoperative Harris scores increased in both groups compared to preoperative scores. At 1 month postoperatively, the PFNA group had significantly lower Harris scores than the THA group (P < 0.05); however, at 3 and 6 months postoperatively, the differences were not statistically significant (all P > 0.05). There was no significant difference in the rates of excellent recovery of hip joint function between the two groups at the last follow-up (P > 0.05). Both THA and PFNA internal fixation yield favorable outcomes in treating IFF with no significant difference in complications. The difference lies in the shorter operative time and lesser trauma inflicted by PFNA internal fixation, despite it involving prolonged radiation exposure and bed rest. Conversely, THA requires longer operative time and causes greater trauma but results in shorter postoperative recovery periods, allowing earlier ambulation.

Effect of Comprehensive Rehabilitation Training Based on Balance Function on Postoperative Recovery and Function of Hip Fracture in the Elderly: A Systematic Review and Meta-Analysis.

In China, the proportion of the elderly population is gradually increasing, followed by the increasing medical demands of elderly patients. Hip fracture is a common fracture in the elderly. The elderly are prone to serious postoperative complications, resulting in failure to restore normal hip function, which seriously affects patients' quality of life and further increases their mortality rate. Thus, hip fracture represents a remarkable public health issue within the realm of geriatric medical care. This study systematically evaluated the impact of comprehensive rehabilitation training, with a focus on balance function, on elderly individuals with hip fractures' postoperative recovery and functional outcomes. Results showed a significant difference in BBS scores favoring comprehensive rehabilitation training based on balance function over conventional intervention. Similarly, AM-PAC scores favored the balance-focused training. TUTG meta-analysis indicated its adoption in comprehensive rehabilitation training. FIM scores showed improvement with balance-focused training. Harris score meta-analysis also favored this approach. A funnel plot analysis revealed potential publication bias, likely due to study heterogeneity and limited publications. In conclusion, comprehensive rehabilitation training centered around balance function displayed clinical efficacy in enhancing postoperative hip joint function in elderly hip fracture patients. This approach improved balance, coordination, and posture control, facilitating lower limb function recovery and overall prognosis. It holds promise as a valuable treatment approach.

Functional outcome of total hip arthroplasty in tubercular hip arthritis: A prospective study

BackgroundTotal hip arthroplasty (THA) is a well-established procedure to cure tubercular hip arthritis in patients with healed tuberculosis while its role in active tuberculosis is still debatable. The aim of the study is to investigate the functional outcomes of THA in active tuberculosis with advanced hip arthritis. The reactivation of tuberculosis and complications postoperatively has also been assessed. Materials and methodsThe current open-ended prospective cohort study was carried out at a tertiary center from 2018 to 2020. Twenty patients of active tubercular hip arthritis (8 females and 12 males) were taken with a follow-up period ranging from 1 year to 3 years, with a mean of 14 months.Biochemical investigations were done both preoperatively and postoperatively. Preoperative anti-tubercular therapy (ATT) regimen was administered, as per standard norms, to patients for a minimum period of 6 weeks, and postoperatively for 6 months–12 months. Postero-lateral and Hardinge approaches were employed in all cases. Clinical and radiological parameters were assessed and functional outcomes were evaluated using the Harris Hip score (HHS). ResultsThe mean age of patients was 37.6 ± 11.38 years. Biochemical parameters were also found to improve postoperatively (p < 0.0001). The mean flexion, extension, abduction, external and internal rotation were found to increase postoperatively (p < 0.001). The mean flexion deformity in the preoperative period was 12.35 ± 4.716, whereas none of the patients had flexion deformities post operatively. The mean shortening was 2.12 ± 0.60 and 1 ± 0 at preoperative and postoperative respectively. The Total hip arthroplasty implant was found stable in all patients. The mean Harris score increased subsequently throughout the follow-up interval and differences were statistically significant (p < 0.0001). None of the patients had reactivation of tuberculosis infection postoperatively. ConclusionTotal hip arthroplasty is a reliable option to treat active advanced tubercular hip arthritis and gives good functional outcome with proper preoperative and postoperative ATT regimen.

Enhanced recovery after surgery speeds up healing for hip fracture patients.

To investigate the effects of enhanced recovery after surgery (ERAS) on the perioperative healing and stress response in patients with hip fractures. A retrospective analysis was conducted on the medical records of 86 patients with hip fractures admitted to the Affiliated Hospital of Southwest Medical University between January 2022 and August 2023. Among them, 48 patients in the research group received ERAS, while 38 patients in the control group received conventional nursing. Hip joint function, pain levels, stress response, fracture healing time, incidence of complications, and nursing satisfaction were compared between the two groups. After nursing, the Harris scores notably increased in both groups, with the research group showing notably higher scores compared to the control group (P<0.05). The levels of cortisol and epinephrine, as well as the visual analog scale scores significantly decreased in both groups, with the research group showing significantly lower levels (P<0.05). In addition, the research group experienced significantly shorter fracture healing time (P<0.05), higher nursing satisfaction (P=0.014), and lower incidence of complications (P=0.028). Logistic regression analysis revealed that age, underlying diseases, nursing method, emotional disorders, and timing of surgery were independent factors influencing the post-nursing outcomes. The ERAS mode can effectively alleviate pain, improve hip joint function, reduce fracture healing time and complications, mitigate stress response, and accelerate postoperative recovery in patients with hip fractures. It is worthy of application and promotion in clinical practice.

Effects of Total Hip Replacement and Femoral Head Replacement in the Treatment of Femoral Neck Fractures in Elderly Patients and Their Impacts on Hip Joint Function

Objective: To explore the therapeutic value of total hip replacement and femoral head replacement in elderly patients with femoral neck fractures. Methods: 30 elderly patients with femoral neck fractures were sampled from January 2019 to August 2023 and randomly divided into two groups. Total hip replacement was adopted in the research group, and femoral head replacement was performed in the control group. The surgical indicators, quality of life, hip replacement, Harris hip score, and surgical complications were compared between the groups. Results: The operation time of the research group was longer than that of the control group, and the intraoperative blood loss and postoperative drainage volume were higher than those of the control group, P &lt; 0.05; the SF-36 (36-Item Short Form Health Survey) score of the research group was higher than that of the control group, P &lt; 0.05; the Harris scores of various hip joints of the research group were higher than those in the control group, P &lt; 0.05; the femoral neck fracture complication rate in the research group was lower than that in the control group, P &lt; 0.05. Conclusion: Both total hip replacement and femoral head replacement can improve hip joint function in treating femoral neck fractures in elderly people. However, total hip replacement has better long-term efficacy and can enhance patients’ quality of life and reduce postoperative complications.

Analysis of influence of MR signs on Harris score in ARCO stages 2-4 femoral head necrosis

To analysis and determine MR signs of Harris score ARCO stages 2-4 in osteonecrosis of femoral head (ONFH). Thirty-four patients with ONFH of ARCO stages 2 to 4 who underwent routine MR, T2 mapping, 3D-SPACE sequence examination and Harris score were retrospectively collected from January 2019 to June 2020, and 3 patients were excluded, and 31 patients were finally included, including 23 males and 8 females, aged from 18 to 62 years old with an average of(40.0±10.8) years old. Among them 21 patients with bilateral femoral head necrosis, totally 52 cases, including 17 with ARCO stage 2 patients, 24 ARCO stage 3, and 11 ARCO stage 4. MR imaging signs (femoral head collapse depth, ONFH index, bone marrow edema, hyperplasia, grade and T2 value of cartilage injury, and joint effusion) were scored and measured on the picture archiving and communication system (PACS) workstation, and the cartilage quantitative parameter T2 value was calculated and measured on Siemens postprocessing workstation. Pearson correlation analysis was used to evaluate the correlation between various MR signs and Harris score, and then multiple linear regression analysis was used to examine impact of MR signs on Harris hip score. Femoral head collapse depth(r=-0.563, P=0.000), grade of cartilage injury(r=-0.500, P=0.000), and joint effusion (r=-0.535, P=0.000) were negatively correlated with Harris score by Pearson correlation analysis. Multiple linear regression analysis showed that joint effusion(β=-6.198, P=0.001) and femoral head collapse depth(β=-4.085, P=0.014) had a significant negative impact on Harris hip score. Femoral head collapse depth and joint effusion both had significant negative relationship with Harris hip score. It is recommended to routinely evaluate femoral head collapse depth and joint effusion quantitatively and gradedly, so as to efficiently and accurately assist clinical diagnosis and treatment.

Efficacy and risk factors for anxiety and depression after mini-incision hip arthroplasty for femoral head osteonecrosis.

Osteonecrosis of the femoral head (ONFH) is a prevalent orthopedic issue, leading to the collapse and fragmentation of the femoral head in its advanced stages, which can severely impair patients' quality of life. Total hip arthroplasty (THA) is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality. The conventional surgical technique is invasive and comes with an extended recuperation period, posing significant challenges for patients. With the progression of medical technology, the use of the mini-incision technique in minimally invasive THA (MITHA) has become more prevalent. However, comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce. Furthermore, understanding patients' psychological well-being is crucial given its profound influence on postoperative recuperation. To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression. A retrospective study was conducted on 125 patients treated for ONFH at Xi'an Hong Hui Hospital between February 2020 and January 2022, with the term "consecutive" indicating that these patients were treated in an unbroken sequence without any selection. Among these, 60 patients (control group) underwent traditional THA, while 65 patients (observation group) were treated with mini-incision MITHA. Variations in the visual analog scale (VAS) score and the Harris hip score were monitored. Additionally, shifts in pre- and posttreatment Hamilton anxiety (HAMA) and Hamilton depression (HAMD) scale scores were recorded. Patients with both postoperative HAMA and HAMD scores of ≥ 8 were identified as those experiencing negative emotions. Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes. Comparative analyses of surgical and postoperative metrics between the two groups were also conducted. Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group, while the Harris score was considerably lower (P < 0.0001). The observation group benefited from a notably shorter operation duration, reduced blood loss, diminished incision size, and a decreased postoperative drainage time (P < 0.0001), accompanied by a reduced hospital stay and lower treatment costs (P < 0.0001). The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group (P < 0.0001). Multivariate logistic regression revealed that being female [odds ratio (OR): 4.394, 95%CI: 1.689-11.433, P = 0.002], having a higher postoperative VAS score (OR: 5.533, 95%CI: 2.210-13.848, P < 0.0001), and having higher treatment costs (OR: 7.306, 95%CI: 2.801-19.057, P < 0.0001) were significant independent determinants influencing postoperative mood disturbances. Compared to conventional THA, mini-incision MITHA offers advantages such as reduced operation time, minimal bleeding, and a shorter incision in ONFH patients. Moreover, factors such as sex, postoperative pain (reflected in the VAS score), and treatment costs significantly impact postoperative anxiety and depression.