Hemiarthroplasty For Hip Fracture Research Articles

A national analysis of complications following hemiarthroplasty for hip fracture in older patients

There is emerging evidence that patients with fractured neck of femur (FNOF) aged >85 years have different demands on a health-care system when compared to younger patients. We sought to better quantify this in terms of comorbidity and complication rates. Retrospective review of national database. Data on all patients who underwent hip hemiarthroplasty for FNOF between January 2005 and December 2008 were extracted from the English hospital episode statistics database. There were 41 770 patients aged 65-84 years and 35 321 patients aged ≥85 years. The older cohort was less likely to have diabetes, chronic obstructive pulmonary disease and rheumatoid arthritis. However, they exhibited a significantly higher risk of lower respiratory tract infection [odds ratio (OR) = 1.58, 95% confidence interval (CI) 1.50-1.67)], myocardial infarction (OR = 1.67, 1.52-1.83) and acute renal failure (OR = 1.54, 1.40-1.70) within 30 days of surgery with an inpatient mortality risk at 90 days, double that of the younger age group. Length of stay (LoS) was significantly longer in patients >85 years compared to younger patients (median 18 days vs. 15, P < 0.001). Patients aged ≥85 years admitted for FNOF were found to have a lower incidence of major chronic disease but exhibited a greater incidence of acute events following hemiarthroplasty and their LoS was increased. Targeted medical interventions that focus upon this susceptible patient group may help reduce morbidity and improve survival.

Hip precautions after hemiarthroplasty: what is happening in the UK and at what cost?

INTRODUCTION The aim of this study was to observe current practice of the use of hip precautions following hemiarthroplasty for hip fractures in England and to audit the cost of hip precautions in this patient group. METHODS A telephone review was undertaken of all units identified by the National Hip Fracture Database as receiving centres for hip fractures across England to ascertain current practice in the use of hip precautions. A prospective audit of occupational therapy (OT) practice including the cost of equipment provision and OT time was carried out locally. RESULTS All 174 units in England were successfully contacted. Practice varied between centres but hip precautions were in use at 78% of centres. Prior to stopping hip precautions at the local hospital, we audited the costs associated with their use. Mean equipment costs per patient decreased by £12 (from £49 to £37, range: £0–£83) and mean OT time per patient decreased by 1.5 hours (from 8 hours to 6.5 hours, range: 1–22 hours) following removal of hip precaution guidelines. A mean of 0.25 days' discharge delay (range: 0–4 days) due to equipment provision was identified prior to removing hip precautions with no discharge delay following. CONCLUSIONS This study has highlighted the variation in practice across the country and inconsistency with the advice published by the British Orthopaedic Association and British Geriatrics Society in the ‘Blue Book’ (The Care of Patients with Fragility Fracture). Hip precautions are unnecessary after hemiarthroplasty, cost money both in therapist time and equipment provision and increase the length of hospital stay. Nevertheless, they continue to be used by three-quarters of trauma hospitals in England.

Bipolar Hemiarthroplasty for Hip Fractures in Patients Aged over 90 Years - The Factors Influencing the Postoperative Mortality -

평균 수명의 증가와 더불어 노인 인구가 급증함에 따라 노인성 고관절부 골절의 빈도도 점차 증가하고 있다. 이 러한 노인성 고관절부 골절은 사망과 직접적인 연관성을 가지고 있으며, 고관절부 골절 후 1년 내 사망률은 14~36% 정도로 보고되고 있다. 더구나, 고령화 사회가 진행함에 따라 90세 이상의 초고령 인구도 점차 증가하고 있으며, 이들 군에서의 고관절부 골절 또한 증가하고 있다 . 특히, 고관절부 골절이 있는 90세 이상의 초고령 환자 들은 대부분 내과적 동반 질환을 갖고 있는 경우가 흔하 Submitted: August 13, 2010 1st revision: September 27, 2010 2nd revision: October 27, 2010 3rd revision: November 9, 2010 Final acceptance: November 10, 2010

Technical Notes and Tips: Use of a K-Wire as an Aid to Ensuring an Accurate Neck Cut During Hip Hemi-Arthroplasty

During uncemented hemi-arthroplasty for hip fracture, the femoral neck must be cut parallel to the collar of the prosthesis. This cut is often made by ‘eyeballing’ the required angle from the top of the rasp (Fig. 1). The soft tissues often displace the rasp making it difficult to achieve an accurate neck cut. A standard K-wire can be bent to the required angle and the end slid up the femur below the vastus muscle. The cut can then be marked on the femur using the K-wire as a guide. This allows a perfectly angled cut to be made. Figure 1 K-wire bent to the required neck cut angle as determined by the rasp.

Cementless Bipolar Hemiarthroplasty for Hip Fracture in Patients More than Seventy Years Old with Osteoporosis

Cementless Bipolar Hemiarthroplasty for Hip Fracture in Patients More than Seventy Years Old with Osteoporosis

Diathermy versus scalpel incisions for hemiarthroplasty for hip fracture: a randomised prospective trial.

As the age profile of our population expands, we can expect subsequent increase in patients presenting with intracapsular fracture. The onus remains on the surgeon to make all reasonable efforts to find new and innovative means of reducing associated morbidity and mortality of the treatment of these injuries. This challenge is particularly relevant in the elderly and in patients with multiple co-morbidities. In this study, 100 patients were randomly allocated into two groups. One group had dissection to the level of the hip joint under direct diathermy control; the other group had dissection using a scalpel with supplementary electrocautery. Intraoperative total blood loss prior to dissection of the abductors was measured by collecting blood using wound swabs using a local protocol and results were statistically analysed using PROC GLM SAS. We demonstrate a clear advantage in the use of diathermy to create a hip incision showing a significant reduction in wound-related blood loss and a reduction, whilst not statistically significant, in total operative blood loss using diathermy incision. Larger randomised prospective trials are necessary to study the effects of this intervention in a larger patient population so that these end-points can be adequately assessed.

Diathermy versus scalpel incisions for hemiarthroplasty for hip fracture: a randomised prospective trial

Diathermy versus scalpel incisions for hemiarthroplasty for hip fracture: a randomised prospective trial

Serum zinc as a prognostic tool for wound healing in hip hemiarthroplasty.

Malnutrition in patients who had surgery leads to the risk of postoperative complications, especially impaired wound healing. Preoperative serum zinc levels and other nutritional parameters were analyzed to establish criteria that would enable delayed healing to be predicted. A prospective study of 97 patients who had hemiarthroplasty for hip fracture is reported. Univariate analysis established the relationship between serum zinc, nutritional parameters, and other demographic variables with delayed healing. Significant variables were included in a multivariate analysis. Univariate and multivariate analyses identified a significant correlation between impaired wound healing and serum zinc levels. The logistic regression equation for probability of delay was: P = 1/[1 + e]. Serum zinc levels less than 95 microg/dL increased risk of delayed healing 11.76 times. Serum zinc levels were shown to have predictive value for delayed wound healing in patients who had hemiarthroplasty for hip fracture.

Age-related Morphologic and Pathologic Features of Acetabular Labrum in the Adult Hip

Purpose : We evaluated the morphohistologic features of acetabular labral tear to confirm the cause of age-related hip pain in the adult hip. Materials and Methods : Sixty-two acetabular labrums were examined during hemiarthroplasty for hip fracture. We recorded the incidence, location, degree and morphology of the labral lesion. Twenty-five torn labrum specimens were stained with Hematoxylin and Eosin (H&E) and protein S-100 and Factor VIII antigen were examined immunohistochemically. Results : Among 53 cases with labral lesions, 88% of the hips (47 cases) were in patients older than 60 years, and 86.8% of the lesions were located in the anterior quadrant of the acetabulum. Torn labrums showed mainly degenerative change with collagen separation and myxoid change by H&E staining. Nerve fibers and nerve endings were rarely observed in the labral substance but were frequently observed in the adjacent synovium by immunohistochemistry for S-100. Microvessels were increased around labral lesions but did not invade into the deep labral substance at torn labrums in Factor VIII antigen staining. Conclusion : Acetabular labral lesion was common in the aging hip. Hip pain due to a labral lesion may be associated with inflammation of the adjacent synovium due to mechanical irritation.

First-year mortality and long-term results of hemiarthroplasty for hip fractures in the elderly

Hip fractures are injuries that affect not only the joint in an elderly person, but also the patient's survival. The aim of this study was to asses hemiathroplasty as a treatment for these lesions and their complications; mortality within the first year after fracture was assessed and functional results were compared with the previous conditions.

Unipolar Versub Bipolar Hip Hemiarthroplasty for Fractures of Femoral Neck in the Dlderly

Unipolar Versub Bipolar Hip Hemiarthroplasty for Fractures of Femoral Neck in the Dlderly

Separation of the Christiansen prosthetic components following dislocation of hemiarthroplasty for hip fracture.

During the period from April 1980 to July 1982 a total of 148 patients with acute femoral neck fractures had primary hemiarthroplasties with the Christiansen trunnion-bearing endoprosthesis. Dislocations occurred in six patients (4 per cent). Five of these required reoperation due to separation of the femoral head in relation to the stem or of the plastic head and the metallic cap of the prosthetic head.