Hemiarthroplasty For Fractures Research Articles

Mid- to long-term outcome of reverse total shoulder arthroplasty as revision procedure for failed hemiarthroplasty after proximal humerus fracture

BackgroundInsufficient tuberosity healing is the most common reason for poor outcome after treatment of proximal humerus fractures (PHFs) using hemiarthroplasty (HA). In these cases, revision to reverse total shoulder arthroplasty (RTSA) can improve function and reduce pain in the short term, however, long-term results remain scarce. Aim of this study was to evaluate the clinical and radiological mid- to long-term results in patients with a revision RTSA after failed HA for PHF.MethodsIn this retrospective study all patients that received a revision to RTSA after failed fracture HA between 2006 and 2018 were included. A total of 49 shoulders in 48 patients (38 female, 10 male; mean age 82 ± 9 years) were identified in our database. A total of 20 patients (17 female, 3 male; mean age was 79 ± 9 years) were available for follow-up examination after a mean time period of approximately eight years (3–14 years) after revision surgery. At final follow-up, patients were assessed using a subjective shoulder value (SSV), range of motion (ROM), visual analogue score (VAS), the Constant Score (CS) and the 12-Item Short Form Survey (SF-12).ResultsAt final follow-up, mean CS was 55 ± 19 (19–91), VAS averaged 3 ± 3 (0–8) and mean SSV was 61 ± 18% (18–90%). Mean SF-12 was 44 (28–57) with a mean physical component summary (PCS) of 38 (21–56) and a mean mental component summary (MCS) of 51 (29–67). On average active forward flexion (FF) was 104° (10–170°), active abduction (ABD) was 101° (50–170°), active external rotation (ER) was 19° (10–30°) and active internal rotation (IR) of the lumbosacral transition was reached. Three patients presented with a periprosthetic humeral fracture after RTSA implantation and underwent a reoperation (15%) during follow-up period.ConclusionsRevision RTSA results in promising clinical results in patients after initial failed HA after PHF. A complication and reoperation rate of 15% is tolerable in consideration of satisfactory functional and psychological outcome.Trial registrationRetrospectively registered.

Evaluation and compare the outcomes of patients undergoing either a unipolar or bipolar hemiarthroplasty for fractures of the femoral neck in aged patients

Evaluation and compare the outcomes of patients undergoing either a unipolar or bipolar hemiarthroplasty for fractures of the femoral neck in aged patients

International trends in shoulder replacement: a meta-analysis from 11 public joint registers.

International variation exists in the types of shoulder replacement used for treatment of specific diseases. Implant choice continues to evolve without high-quality evidence. Our aim was to evaluate trends in incidence rates of shoulder replacement and assess any recent changes in practice between countries by using registry data. Patient characteristics, indication and year of surgery, type of replacement, and collection methods of patient-reported outcomes (PROMs) was extracted from 11 public joint registries. Meta-analyses examined use of reverse total shoulder replacement (RTSR) for osteoarthritis, cuff tear arthropathy, and acute fracture; use of anatomical total shoulder replacement (TSR) for osteoarthritis; and use of humeral hemiarthroplasty for fracture. The annual growth rate of shoulder replacements performed is 6-15% (2011-2019). The use of RTSR has almost doubled (93%). RTSR is now universally performed for cuff tear arthropathy (97.3%, 95% confidence interval [CI] 96.0-98.1). Its use for avascular necrosis, trauma, and inflammatory arthropathy is increasing. The use of RTSR was similar (43.1%, CI 30.0-57.2) versus TSR (44.7%, CI 31.1-59.1) for osteoarthritis. The types of PROMs used, collection time points, and response rates lack standardization. COVID-19 had a varying inter-registry impact on incidence rates. The incidence of shoulder replacements has grown. Use of RTSR has increased for all disease indications despite limited high-quality evidence driving this change in indications outside of cuff arthropathy. Consequently, less variation is observed in international practice. Existing differences now relate to use of newer implant types and methodology of PROMs collection, which prevents international comparison and outcome analysis.

Converting to reverse shoulder arthroplasty from primary anatomic shoulder arthroplasty and fracture hemiarthroplasty: a radiographic and clinical outcome analysis at 8-years.

Revision shoulder arthroplasty can be challenging. One of the main considerations for surgeons is the type of implant that was placed in the initial surgery. Anatomic shoulder arthroplasty (ASA) is used for cases of osteoarthritis as well as for fractures of the humeral head. Hemiarthroplasty can be used for complex proximal humerus fractures. The purpose of this study is to determine whether there is a difference in clinical and radiographic outcomes between patients that failed primary fracture hemiarthroplasty (FHA), or ASA for osteoarthritis and then required reoperation with a conversion to reverse shoulder arthroplasty (RSA). Patients with failed anatomic shoulder replacement, who had undergone conversion to RSA, were enrolled after a mean follow-up of 107 (85-157) months. Two different groups, one with failed ASA implanted for osteoarthritis and one with failed FHA, were created. At follow-up patients were assessed with standard radiographs and clinical outcome scores. Twenty-nine patients (f = 17, m = 12; 51%) suffered from a failed ASA (Group A), while the remaining 28 patients (f = 21, m = 74; 49%) had been revised due to a failed FHA (Group B). Patients of Group B had a poorer Constant score (Group A: 60 vs. Group B: 46; p = 0.02). Abduction (Group A: 115° vs. Group B: 89°; p = 0.02) was worse after conversion of a failed FHA to RSA in comparison to conversions of failed ASA. The mean bone loss of the lateral metaphysis was higher in patients with failed FHA (Group A: 5mm vs. Group B: 20mm; p = 0.0). The initial indication for anatomic shoulder arthroplasty influences the clinical and radiological outcome after conversion to RSA. Conversion of failed FHA to RSA is related to an increased metaphyseal bone loss, decreased range of motion and poorer clinical outcomes when compared to conversions of failed ASA implanted for osteoarthritis. III Retrospective Cohort Comparison Study.

Promoting cemented fixation of the femoral stem in elderly female hip arthroplasty patients and elderly hip fracture patients: a retrospective cohort study from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register.

Uncemented stems increase the risk of revision in elderly patients. In 2018, we initiated a national quality improvement project aiming to increase the proportion of cemented stems in elderly female total hip arthroplasty (THA) and hip fracture hemiarthroplasty (HA) patients. We aimed to evaluate the association of this project on the frequency of cemented stems and the risk of secondary procedures in the targeted population. 10,815 THAs in female patients ≥ 75 years in the Norwegian Arthroplasty Register and 19,017 HAs in hip fracture patients ≥ 70 years in the Norwegian Hip Fracture Register performed in 2015-2017 and 2019-2021 at all Norwegian hospitals were included in this retrospective cohort study. The quality improvement project was implemented at 19 hospitals (8,443 patients). 1-year revision risk (THAs) and reoperation risk (HAs) were calculated for uncemented and cemented stems by Kaplan-Meier and Cox adjusted hazard rate ratios (aHRRs) with all-cause revision/reoperation as main endpoint. The use of cemented stem fixation in the targeted population increased from 26% to 80% for THAs and from 27% to 91% for HAs. For THAs, the 1-year revision rate decreased from 3.7% in 2015-2017 to 2.1% in 2019-2021 (aHRR 0.7, 95% confidence interval [CI] 0.5-0.9) at the intervention hospitals. For HAs, the reoperation rate decreased from 5.9% in 2015-2017 to 3.3% in 2019-2021 (aHRR 0.6, CI 0.4-0.8) at the intervention hospitals. The quality improvement project resulted in a significant increase in the proportion of cemented stems and reduced risk of secondary procedures for both THAs and HAs.

Medium-term results of the Ascension Pyrotitan surface replacement and Pyrocarbon hemiarthroplasty in the shoulder

HypothesisThe purpose of this study was to review two surgeons’ medium-term results with the Ascension Pyrotitan surface replacement and the Pyrocarbon hemiarthroplasty. We hypothesized they would provide good medium-term outcomes with no significant difference between the two implants. MethodsThe first 21 implants were surface replacements and the subsequent 58 hemiarthroplasties making a total of 79. Overall, the minimum follow-up was two years and maximum nine years and nine months (average = five years and six months). The average follow-up for the Ascension Pyrotitan was eight years and two months and Pyrocarbon hemiarthroplasty was five years and two months. Survivorship, Oxford, and Subjective Shoulder Value (SSV) scores, and incidence of squeaking were recorded. The average age at implantation was 57.7 years (range 20-80). Thirty-five were female and 44 male. The indication for surgery was osteoarthritis in 56 patients, post instability in 10 patients, post fracture in 7 patients, avascular necrosis in 4 patients, synovial osteochondromatosis in one, and rheumatoid arthritis in one. ResultsOf the 79 patients in the cohort, five were deceased, two were revised to reverse for cuff failure, one was revised for Cutibacterium acnes infection, and one was revised to Pyrocarbon hemiarthroplasty for fracture of a Pyrotitan surface replacement. This left 70 patients, all of whom were included in this review. Survivorship at final follow-up for the Pyrotitan surface replacement was 88.9% and Pyrocarbon hemiarthroplasty was 96.4%. The average SSV for all patients reviewed was 86%, the Ascension Pyrotitan patients scoring 87% and the Pyrocarbon hemiarthroplasty scoring 86%. The average Oxford score for the whole cohort was 42 out of a maximum of 48, with Ascension Pyrotitan scoring 42.3 and Pyrocarbon hemiarthroplasty 41.9. Recent Oxford score for the postinstability group was 44, osteoarthritis 42.6, postfracture 39.5, and 35 for avascular necrosis (not statistically significant). Fourteen of 70 patients reported squeaking (20%), 4 daily, 5 weekly, and 5 monthly. Average Oxford score in those who experienced squeaking was 39 compared with nonsqueakers at 43 (P = .02). Correlation between Oxford score and SSV was high with a correlation coefficient of 0.79. The Oxford score for the Pyrotitan at 42.3 was significantly better than the New Zealand Joint Registry score for the Global Cap at 34.5 (P = .001) and the Pyrocarbon hemiarthroplasty at 41.9 significantly better than the Aequalis CoCr hemiarthroplasty at 36.8 (P = .005) ConclusionPyrocarbon looks to be a durable bearing surface and a good option for the younger osteoarthritic patient where risk of glenoid component failure is high.

Artículo traducido] Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera

IntroductionHip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methodsWe conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. ResultsThe women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DiscussionOur study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

IntroductionHip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methodsWe conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. ResultsThe women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DiscussionOur study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Are We Training Surgeons to Cement a Femoral Component in Hip Arthroplasty? The Trainees' Perspective.

The importance of surgical technique is widely recognized when cementing a femoral component in hip arthroplasty. Concern exists that surgeon trainees in the United States are not being adequately trained in cement technique. The purpose of this study is to describe recent trainees' perceived experience with their training in this skill. Orthopedic graduate candidates attending a national board review course were polled with an anonymous 15-question survey regarding their experiences during training with cemented femoral components. Means and standard deviations were calculated for Likert scale questions, and univariate statistics were used to compare answers for select questions. A total of 152 surveys were completed. Ninety percent of respondents anticipated that they would be performing hemiarthroplasty for fracture in their future practice, 99% of whom anticipated using cement for stem fixation in at least some of these cases. Only a minority of respondents planned further training in an adult reconstruction fellowship (21%). Only 37% of residents perceived their training in cement technique to be comprehensive or very comprehensive, with 17% reporting that their training was inadequate or nonexistent. Forty percent reported being less than satisfied with their training. Although 96% of residents felt prepared to implant a cementless femoral component, only 82% felt adequately trained to properly cement a femoral implant. Feeling prepared to perform a well done cemented femoral stem correlated with higher percentage of cemented stems in training and higher satisfaction with training (both P= .001). Although most trainees feel prepared to cement a femoral component, many young surgeons do not perceive that they are receiving adequate training in femoral cement technique.

Comparison of the effects of physiotherapy and ergotherapy applications on independent movement in hip fracture patients with hemiarthroplasty and PFN-A

Objective:In this study, our aim is to compare the effects of post-hip fracture hemiarthroplasty or PFN-A applications on the post-operative hip joint to provide enough range of motion to assist in daily activities, helping to regain lost muscle strength and to compare the effects on independent movement. Patients and Methods: 15 patients who underwent hemiarthroplasty (Group 1) and 15 patients who underwent PFN-A (Group 2) were included in this study. These patients were aged between 50-80 who had operated at least 3 months ago, had no other lower extremity operation or trauma in the last 6 months, did not have any other physical and mental problems that prevented physiotherapy and occupational therapy due to the hip fracture. Physical therapy and occupational therapy methods were applied to both groups after surgery. These two group were evaluated with the early postoperative period, after physical therapy and after occupational therapy, the Lower Extremity Functional Scale, Functional Independence Scale, Barthel Daily Living Activities Index, Harris Hip Assessment Scale and Timed Get Up and Go tests. Results: After physical therapy applied according to the early postoperative period; a significant difference was obtained for all patients in the evaluations made with lower extremity function scale, Functional independence scale, Timed up and go test, and Harris hip assessment scale. In addition to this treatment, a significant difference was achieved for all patients after the ergotherapy methods. No statistically significant differences were found for Barthel's daily life activities test. Conclusion: The negative thoughts created by the limitations in the functions of the elderly people is reduced with the ergotherapy application plan and providing support both physically and psychologically. The emotional changes that vary on according to the level of dependency of the patients, the use of auxiliary devices is taught in elderly individuals, especially considering their desire to be independent, their functions were restored with the multiple working method and the quality of life is increased.

Cemented Bipolar Hemiarthroplasty for Fracture

Ashley Cooper recognized fractures in the proximal femur distal to the insertion of capsule. He noted that they invariably united without difficulty often with external rotation and shortening leading to coxa vara. Till the 1940s the standard treatment was reduction of the fracture and immobilization in plaster spica or in traction. The long period of immobility required for this treatment carried considerable morbidity, particularly in elderly patients. In addition to problems of prolonged bed rest, reports about various management strategies were not satisfactory. The justification for early rehabilitation in this group was accurately summed up by this quotation by Evans. '' The very old patients who sustain this injury tolerate pain and immobility badly; their mental state is often precarious and is quick to develop bed sores or pulmonary complications. We believe that they should be treated as surgical emergency and the older and more feebler the patient the more urgent is the need for the operation" The aim of this prospective and retrospective study is to analyse the short term follow up results of cemented bipolar hemi arthroplasty in neck of femur fracture and unstable intetrochanteric fractures of the elderly done in our institution.

Study the complications of displaced fracture neck of femur in elderly patients treated with cemented bipolar hemiarthroplasty

Aims and Objectives: To evaluate the complications of displaced fracture neck of femur in elderly treated with cemented bipolar hemiarthroplasty. Material and Methods: The present research was a prospective study of 44 cases of displaced femur bone fractures admitted to S.N.M.C. and H.S.K. Hospital in Bagalkot between October 2017 and October 2019. Cases were selected on the basis of inclusion and exclusion criteria. Medically unsuitable and non-operative patients have been removed from the study. Cases have been treated with cemented bipolar hemiarthroplasty. Results: In our 44 cases, there were 30 females and 14 males, with a median age of 92 years, a minimum age of 65 years and an average age of 72.72 years. There was a small predominance of left-sided fractures (54.55 per cent) relative to the right-sided fractures. The average score for the final 1 year follow-up was 86.75 per cent (maximum score of 95 and a minimum score of 66). Patients progressed well with few complications such as a difference in limb length, with 36.36% of patients ranging from 1 to 1.5 cm in length. Conclusion: Cemented bipolar hemiarthroplasty for fractures of the femoral neck offers a greater range of movement, relief from pain and a quicker return to unassisted operation with a reasonable complication rate. End-to-end functional outcomes depend on the age of the patient, underlying co-morbidity, and optimum post-operative recovery. Long-term results using bipolar hemiarthroplasty need more study in a larger community for a longer period of time. Bipolar prosthesis is a safe option in the treatment of fractures of the femur in elderly patients with serious rehabilitation, despite having multiple comorbidities.

Reimbursement for Hip Fractures: The Impact of Varied Current Procedural Terminology Coding Using Relative Value Units

BackgroundMany orthopedic practices routinely code hip fracture hemiarthroplasty as Current Procedural Terminology (CPT) 27125 even though 27236 is the correct CPT code. Our objective is to determine the financial impact this simple mistake has on surgeon reimbursement. MethodsOur data comprised cases assigned International Classification of Diseases, Tenth Revision code S72.001A through S72.035A and CPT code 27125 or 27236 within the American College of Surgeons National Surgical Quality Improvement Program 2016-2017 database. Relative value units (RVUs) per CPT code and the Centers for Medicare and Medicaid Services reported that RVU conversion factor of $36.0896 per 1 RVU was used to calculate reimbursement per case. The dollar difference and percent difference per case was then calculated between cases assigned CPT code 27125 and those assigned 27236. ResultsOur total sample consisted of 12,287 National Surgical Quality Improvement Program cases. Of those, 4185 (34%) were cases of a hip fracture treated with hemiarthroplasty that were incorrectly coded as CPT code 27125. That error in coding results in a decrease in reimbursement of $35.01 per case, a 5.51% difference. ConclusionSince the current healthcare reimbursement model relies solely on CPT codes to determine RVUs, it is imperative that orthopedic surgeons understand the financial impact of incorrect coding. Although correct coding of hemiarthroplasty procedures for hip fractures is an easy task to fix in the future, we hope that through this study a greater emphasis is placed on coding in orthopedic surgery.

Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont.

Shoulder replacement is indicated for the surgical treatment of proximal humeral fractures in elderly patients, when severe comminution and osteoporosis jeopardize the chances of success of any fixation technique. Two different implants are available for this purpose: anatomical hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA). HA for fractures was popularized by Charles Neer in the ‘50s and for several decades remained the only reliable implant for these injuries. However, many authors reported inconsistent results with HA as a consequence of the high rate of tuberosity and rotator cuff failure. In 1987, Paul Grammont designed the first successful RTSA, which was the end result of a long thought process on functional surgery of the shoulder. This implant was initially used to treat cuff tear arthropathy and shoulder pseudoparalysis, but indications have gradually expanded with time. Since RTSA does not rely on a functional cuff for shoulder elevation, it was felt that results in fractures could be improved by this prosthesis. In this study, the salient features of these implants are described to understand the rationale behind both approaches and highlight their pros and cons. Several clinical studies comparing HA vs RTSA for proximal humeral fractures have been published during the last two decades. A literature review is carried out to analyze and compare outcomes of both implants, analyzing clinical results, radiographic findings and complications. The final goal is to provide an overview of the different factors to consider for making a choice between these two prostheses.

A one-year prospective study of morbidity and mortality in first year following a hip fracture among the elderly patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hip fractures are one of the most commonest and devastating injuries among the geriatric population. Increasing age, cognitive impairment and higher ASA scores are significantly associated with mortality among the geriatric age group. The objective of this study to evaluate the incidence and causes of morbidity and mortality associated with fracture of the hip in first year after the injury among the elderly population.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A eighteen months prospective study at Narayana Medical College was conducted among patients aged &amp;gt;60 years treated for fracture of hip by arthroplasty and internal fixation. The cases were followed up for one year and mortality and morbidity were evaluated. Associated medical co morbidities were noted for all the cases in the study. Statistical analysis was carried out with IBM SPSS 24.0 and Stata 14 software.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In the study, 76 cases with M:F ratio of 7:12 and mean age of 63.21±1.4 years were included. Cardio vascular disease and anaemia were common co morbidities. Total mortality percentage in the present study after one year of follow up was 31.58%. Mean age of the cases with death in arthroplasty group was 71 years and 69 years in internal fixation group. Associated medical conditions had a direct relationship with mortality on the patients following surgery for fracture of the hip.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hemiarthroplasty for fracture of the neck and Internal fixation using dynamic hip screw for trochanteric fracture are still good options in the elderly. Proper post-operative management and follow up management for medical co morbidities provide better functional outcome and good results.&lt;/p&gt;

Reverse shoulder–allograft prosthesis composite, with or without tendon transfer, for the treatment of severe proximal humeral bone loss

The treatment of severe proximal humeral bone loss (PHBL) secondary to tumor resection or failed arthroplasty is challenging. We evaluated the outcomes and complications of reconstruction with reverse shoulder-allograft prosthesis composite (RS-APC), performed with or without tendon transfer. An RS-APC procedure was performed in 25 consecutive patients with severe PHBL (>4 cm): 12 after failed reverse shoulder arthroplasty, 5 after failed hemiarthroplasty for fracture, 6 after failed mega-tumor prosthesis placement, and 2 after tumor resection. The median length of humeral bone loss or resection was 8 cm (range, 5-23 cm). Humeral bone graft fixation was obtained with a long monobloc reversestem and a "mirror step-cut osteotomy," without plate fixation. Nine infected shoulders underwent a 2-stage operation with a temporary cement spacer. In addition, 9 patients (36%) underwent an associated L'Episcopo procedure. The median follow-up duration was 4 years (range, 2-11 years). Overall, 76% of patients (19 of 25) were satisfied. In 8 patients (32%), a reoperation was needed. At last follow-up, we observed incorporation at the allograft-host junction in 96% of the cases (24/25); partial graft resorption occurred in 3 cases and severe in 1. The median adjusted Constant score was 53% (range 18-105); Subjective Shoulder Value, 50% (range 10%-95%). Additional tendon transfers significantly improved active external rotation (20° vs. 0°, P < .001) and forward elevation (140° vs. 90°, P = .045). (1) Shoulder reconstruction with RS-APC provides acceptable shoulder function and high rates of graft survival and healing. (2) Additional L'Episcopo tendon transfer (when technically possible) improves active shoulder motion. (3) The use of a long monobloc (cemented or uncemented) humeral reversestem with mirror step-cut osteotomyprovides a high rate of graft-host healing, as well as a limited rate of graft resorption, and precludes the need for additional plate fixation. (4) Although rewarding, this reconstructive surgery is complex with a high risk of complications and reoperations. The main advantages of using an allograft with a reverse shoulder arthroplasty (compared with other reconstruction options) are that this type of reconstruction (1) allows restoration of the bone stock, thus improving prosthesis fixation and stability, and (2) gives the possibility to perform a tendon transfer by fixing the tendons on the bone graft to improve shoulder motion.

Comparative study of PFN A2 vs bipolar hemiarthroplasty in unstable senile intertrochanteric fractures

Introduction: Successful outcome in the treatment of intertrochanteric fracture in elderly lies in early mobilization of the patient so as to avoid the morbidity, complications and poor recovery. With the associated medical comorbidities and osteoporosis, presents a great challenge in selecting the surgical procedures in these patients. Even though the primary choice of surgery revolves around Osteosynthesis in these type of fractures, there is a conspiracy in the choice of implants for the fractures. Many surgeons have resorted to primary hemiarthroplasty in these fractures to avoid uncertainties and implant failures and able to allow full weight bearing walking after surgery. Off late PFNA2 nail have been preferably used to stabilize these fractures with relatively lesser complications and early mobilization of these patients. The purpose of this study is to compare the outcome of PFNA2 and hemiarthroplasty and to study advantages, disadvantages, complications of both the groups. Materials and Methods: 20 patients each were included in PFNA2 group and hemiarthroplasty group from May 2017 to August 2018 who satisfied the inclusion and exclusion criteria. Patient followed up upto 1 year. Patients were evaluated with multiple variables, complications and Harris hip score. Results: PFNA groups had significantly less blood loss, less surgery time, less hospital stay as compared to hemiarthroplasty group. Both groups had similar medical and Orthopaedic complications. PFNA patients can be mobilised early as with hemiarthroplasty group. Hemiarthroplasty groups have better Harris hip score in initial 3 months but similar score at the end of 1 year. Conclusion: PFNA2 provide less morbidity to patients with early mobilisation and good functional outcome. It can definitely be a better option than replacement in elderly intertrochanteric fracture.

Does the etiology of a failed hemiarthroplasty affect outcomes when revised to a reverse shoulder arthroplasty?

The purposes of this study were to evaluate patient outcomes after revision of hemiarthroplasty to reverse shoulder arthroplasty (RSA) based on initial pathology, to determine the re-revision rate, and to identify characteristics that may predict subsequent re-revision. A total of 207 shoulder hemiarthroplasty, bipolar prosthesis, and humeral resurfacing cases revised to RSA between January 2004 and January 2017 were reviewed. Outcome measures included shoulder motion and American Shoulder and Elbow Surgeons and Simple Shoulder Test (SST) scores. Sixteen RSAs underwent re-revision. A case-control study with each revised RSA matched to 4 controls based on age, sex, and minimum 2-year follow-up was performed to evaluatefor factors predicting re-revision. The mean time from initial hemiarthroplasty to RSA was 3.6 years (range, 0.1-20 years). There were 114 patients with a minimum of 2 years' follow-up (mean, 57 months; range, 24-144 months). The most common initial diagnoses for hemiarthroplasty were fracture (n = 72), cuff tear arthropathy (CTA) (n = 22), and osteoarthritis (OA) (n = 20). Overall mean scores and range-of-motion values were as follows: American Shoulder and Elbow Surgeons score, 59 (95% confidence interval [CI], 54-64); SST score, 4 (95% CI, 4-5); forward flexion, 106° (95% CI, 96°-116°); and abduction, 95° (95% CI, 85°-105°). Compared with fracture cases, CTA cases had better forward flexion (P = .01) and abduction (P = .006)and OA cases had better SST scores (P = .02) and abduction (P = .04). The re-revision rate was 7.7% at a mean of 31 months (range, 0-116 months), with the most common diagnosis being fracture (10 of 16 cases). Humeral loosening (8 of 16 cases) was the most common failure mechanism, and larger glenosphere sizes were more likely to be revised. Functional outcomescores of hemiarthroplasty cases revised to RSA were better for patients with OA than for patients with CTA or fracture. Cases of hemiarthroplasty for fracture had decreased motion after revision to RSA compared with CTA and OA. Humeral loosening was the most common failure mechanism.

ЕNDOPROSTHESIS AFTER FRACTURE OF PROXIMAL HUMERUS IN ELDERLY PATIENTS – 3-YEAR EXPERIENCE

The proximal humerus is the third most common fracture location in elderly patients after the proximal femoral bone and the distal radial bone. In order to restore the anatomy and bring it as close to normal as possible, blood reposition with internal fixation is a method of choice for unstable fractures. However, surgical treatment is difficult and problematic because of disturbed approach to the fracture and the large fragmentation of pieces. A proximal shoulder bone fracture, which disturbs blood supply of the humeral head, may require placement of prosthesis. Hemiarthroplasty is a logical attitude in such cases, but analysis of functional results and complications has identified a certain number of risk factors limiting indications. Strict analysis of patient characteristics and of fracture type is an essential prerequisite to deciding against treatment by immobilization or osteosynthesis. Results in hemiarthroplasty are primarily dependent on respecting the rules of the art, which aim at stable anatomic osteosynthesis of the surrounding structures so as to restore normal shoulder function. The critical steps are the adjustment of implant height and retroversion, reduction and fixation of tuberosities and good management of the postoperative course. The recent development of fracture-dedicated shoulder implants should improve results. In elderly patients, when local conditions are unsuitable to hemiarthroplasty, a reverse prosthesis may be used, with an adapted surgical technique. Whatever the type of prosthesis, implantation for proximal humerus fracture is a demanding operation with definitive impact on the functional evolution of the shoulder. Following reports of results for shoulder prosthesis in proximal humerus fracture from 1970, several attempts were made to reproduce the encouraging initial findings. Most found good results in terms of pain, but much less satisfactory functional outcome. Analyzing the causes of failure identified risk factors and enabled solutions to be suggested. Among these, one of the first was to select indications, eliminating baseline situations of poor prognosis. Following good results reported in arthropathy involving rotator cuff tear and in revision of hemiarthroplasty for fracture, reverse prostheses were recommended as an alternative attitude in case of proximal humerus fracture in elderly subjects. This particular indication is currently under assessment.This article presents results of a 3-year experience in shoulder endoprothesis after fracture of proximal humerus in elderly patients at Orthopaedics and Traumatology Department, St. Anna General Active Treatment Hospital – Varna, between 2016 and 2018. In this time period, 79 shoulder endoprothesis have been implanted, 68 of which have been actively and carefully observed in the first 12 months of the post-surgery recovery. For the treatment of functional results was utilized Constant Shoulder Score (CSS) that aided following patients’ condition, pain levels, as well as functioning and shoulder movements. Results suggest that in the time span of one year, 51% of the patients show excellent overall recovery state and 38% are in good overall recovery state. These fine results of post-surgery shoulder functioning are in large part due to precise surgery techniques and detailed pre-surgical diagnosis and planning.

Cemented vs uncemented bipolar hemiarthroplasty in neck of femur fractures: A case series of 90 patients

Introduction: The purpose of our study was to compare results of cemented vs cementless bipolar hemiarthroplasty in fractures of neck of femur with regards to functional outcome, operative time, pain, blood loss and complications.Materials and Methods: Ninety patients with displaced femoral neck fracture operated with bipolar hemiarthroplasty were enrolled in this study and their medical records were reviewed. 35 patients had undergone uncemented bipolar hemiarthroplasty and 55 had undergone cemented bipolar hemiarthroplasty. Post-operative status of the patients was assessed using Harris Hip Score (HHP) and Visual Analogue Score (VAS). Patients were reviewed after one year of surgery at 6 wks interval. Results: Mean operation and bleeding times were longer in the cemented group compared to the uncemented group. The mean pain score was significantly less in the cemented group compared to the uncemented group. Hip functional outcome based on HHS was more in the cemented group. The intraoperative and postoperative complication rate was higher in the uncemented group.Conclusion: Although higher rates of intraoperative bleeding and longer surgery time were seen with cemented bipolar hemiarthroplasty in patients with femoral neck fracture compared to uncemented bipolar hemiarthroplasty, cemented bipolar hemiarthroplasty is better because of better functional outcome and less residual pain.