Hemiarthroplasty For Treatment Research Articles

Comparison of outcomes of dual-mobility cemented total hip arthroplasty versus bipolar cemented hemiarthroplasty in patients with femoral neck fractures

Background: Elderly people with femoral neck fractures are more likely to experience complications after hip replacement. Compared with total tripolar hip arthroplasty (THA), bipolar hemiarthroplasty (HA), more effective alternative treatments that improve overall safety. We aimed to review the benefits of dual mobility tripolar arthroplasty and compare it to bipolar hemiarthroplasty in treatment of the femoral neck in the elderly. Methods: This study was conducted as a comparative randomized controlled prospective study. Patients were divided randomly to two equal groups 19 patients each one group underwent cemented bipolar hip hemi arthroplasty and the other group underwent cemented tripolar total hip arthroplasty, surgical approach for the two study groups was modified lateral Hardinge approach. The patients were followed up after one month, three months 6 months and one year. The follow up period was one year, and modified Harris hip score was reported, and radiograph scan of fracture site was done before and after surgery. Complications were reported whether intraoperative or in the follow up period. Results: The result of the study showed that the operative time was much longer in tripolar group as compared to bipolar group, there was more blood loss in tripolar group more than bipolar group. The functional outcome assessed using Harris hip score showed better outcome in tripolar group as compared to bipolar group. As regard complication, there was one case of periprosthetic fracture intraoperative in bipolar group and one case of cement extrusion in tripolar group. There was no dislocation in both groups. Conclusions: Tripolar total hip arthroplasty had better functional outcome than bipolar hip hemiarthroplasty and we recommend more studies for a longer period of follow up to assess rate of complications and functional outcome on the long run.

Comparative Interrupted Time Series Analysis of Medical Expenses in Patients with Intertrochanteric Fracture Who Underwent Internal Fixation and Hemiarthroplasty.

The objective of this study was to assess postoperative direct medical expenses and medical utilization of elderly patients who underwent either hemiarthroplasty (HA) or internal fixation (IF) for treatment of a femoral intertrochanteric fracture and to analyze differences according to surgical methods and age groups. Data from the 2011 to 2018 Korean National Health Insurance Review & Assessment Service database were used. Risk-set matching was performed for selection of controls representing patients with the same sex, age, and year of surgery. A comparative interrupted time series analysis was performed for evaluation of differences in medical expenses and utilization between the two groups. A total of 10,405 patients who underwent IF surgery and 10,405 control patients who underwent HA surgery were included. Medical expenses were 18% lower in the IF group compared to the HA group during the first year after the fracture (difference-in-difference [DID] estimate ratio 0.82, 95% confidence interval [CI] 0.77-0.87, P<0.001), and 9% lower in the second year (DID estimate ratio 0.91, 95% CI 0.85-0.99, P=0.018). Length of hospital stay was significantly shorter in the IF group compared to the HA group during the first two years after time zero in the age ≥80 group. A noticeable increase in medical expenses was observed for patients who underwent HA for treatment of intertrochanteric fractures compared to those who underwent IF over a two-year period after surgery. Therefore, consideration of such findings is critical when designing healthcare policy support for management of intertrochanteric fractures.

Displaced Geriatric Femoral Neck Fractures: A Retrospective Comparison of Total Hip Arthroplasties Versus Hemiarthroplasty.

Controversary exists around the best surgical management for traumatic geriatric displaced femoral neck fractures. The study objective was to compare outcomes among those managed with a total hip arthroplasty (THA) to those managed with a hemiarthroplasty (HA). This retrospective matched cohort study included geriatric hip fractures (≥65y/o) admitted 7/1/16-3/31/20. Patients were matched on having an advanced directive, pre-existing dementia, and age. Outcomes included: time to surgery, length of stay (LOS), blood loss volume, and discharge destination. THAs were compared to HAs; an alpha of <.05 indicated statistical significance. There were 191 patients: 86% were treated with HA and 14% with THA. Most (40%) were 80-89years old, 66% were female, and 92% were white. After matching, the groups were well balanced on demographics and baseline characteristics with 27 patients/arm. The median time to surgery was 23hours for both arms, P = .38. The LOS was significantly longer for those managed with a HA when compared to those managed with a THA, 5.6 vs 4.0days, P = .001. The median blood loss volume was significantly lower for HAs than for THAs, but the difference was small, 100 vs 120mL, P = .02. Patients managed with a HA were less likely to be discharged home than those managed with a THA, 22% vs 70%, P = .005. While patients managed with a THA had significantly more blood loss than those managed with a HA, the difference in blood loss was small and not clinically relevant. Those managed with a THA experienced a significantly shorter LOS and were more likely to be discharged home than patients managed with a HA. Among a healthier, younger geriatric population, THA may lead to shortened LOS and improved discharge destinations when compared to HA for treatment of femoral neck fractures.

PROSPECTIVE FUNCTIONAL OUTCOME STUDY OF PRIMARY CEMENTED HEMIARTHROPLASTY USED IN MANAGEMENT OF UNSTABLE INTERTROCHANTERIC FRACTURES IN THE ELDERLY PATIENTS

Introduction: Hip fractures are the most commonly occurring fracture which leads to substantial morbidity and mortality in elderly population. Conventional treatment with internal xation devices in osteoporotic bones leads to screw cutout,implant breakage, varus collapse of femoral head and shortening on early weight bearing. Aim of this study is to asses functional outcome of cemented bipolar hemiarthroplasty in treatment of unstable intertrochanteric fracture. This study includes 20 cases of comminuted, Material&amp;Method: unstable (AO/OTA type 31-A2.2 and type 31-A2.3) intertrochanteric fractures which had undergone cemented bipolar hemiarthroplasty and functional outcome was measured on sequential follow up on 3, 6 and 12 months post operatively with help of modied harris hip score. Bipol Results: ar hemiarthroplasty can be used as an alternative to conventional internal xation techniques as it provides stable xation and early weight bearing mobilisation, but is a technically demanding procedure so it requires more operative time, familiarity of surgeon to the technique along with incresed intraoperative blood loss. Conclusion: Bipolar hemiarthroplasty provides an effective alternative to internal xation techniques for treatment of unstable intertrochanteric fractures

Readmission, reoperation, and nonhome discharge rates in patients receiving surgical treatment for proximal humerus fractures.

BackgroundProximal humerus fractures (PHFs) are generally surgically treated with open reduction internal fixation (ORIF), hemiarthroplasty (HA), or total shoulder arthroplasty (TSA). Diverse fracture patterns and a high prevalence in the elderly population make it difficult to establish objective guidelines for the decision to undergo surgical treatment. The purpose of this study was to investigate risk factors associated with readmission, reoperation, and nonhome discharge following ORIF, HA, and TSA for PHFs.MethodsData on all patients who underwent ORIF, TSA, or HA for treatment of closed PHF between 2015 and 2017 were obtained by querying the American College of Surgeons National Surgical Quality Improvement database. Rates of postoperative readmission, nonhome discharge, and reoperation within 30 days were collected. Multivariate logistic regression was employed to identify predictors of readmission, nonhome discharge, and reoperation.ResultsA total of 2825 patients were included in this study: 1829 underwent ORIF, 707 underwent TSA, and 289 underwent HA. The significant predictors for readmission were having an American Society of Anesthesiologists class ≥ 3 (odds ratio [OR] 1.95, P = .003) and being of dependent functional status (OR 3.15, P < .001). The significant predictors for reoperation were male sex (OR 2.41, P < .001) and dependent functional status (OR 2.92, P = .006). The significant predictors for nonhome discharge were age 66-80 years (OR 7.00, P < .001), age ≥ 81 years (OR 16.31, P < .001), American Society of Anesthesiologists ≥3 (OR 2.34, P < .001), dependent functional status (OR 2.48, P < .001), and inpatient status (OR 3.32, P < .001). TSA showed slightly higher rates of nonhome discharge than HA and ORIF.ConclusionSignificant risk factors for readmission, reoperation, and nonhome discharge within 30 days following surgical treatment for PHF were identified. Additionally, TSA was significantly associated with nonhome discharge compared with HA and ORIF.

Primary cementless bipolar long stem hemiarthroplasty for unstable osteoporotic intertrochanteric fracture in the elderly patients

Background: Intertrochanteric fracture (ITF) is a major part of fracture in femur. 95% of ITF are found in elderly patients. Osteosynthese is the preferred method of choice. However, elderly patients had osteoporotic, combined with many of chronic disease conditions that increase the rate of osteosynthese failure. Hemiarthroplasty bipolar long-stem is a surgical method that helps patients relieve pain, facilitate early rehabilitation, limit long-term complications, and improve quality of life for patients. Aim: The aim of our study is to evaluate the clinical of the result of primary cementless bipolar long stem hemiarthroplasty in treatment for unstable ITF in the elderly patients. Methods: We retrospectively analyzed 35 cases of primary hemiarthroplasty performed for osteoporotic unstable intertrochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3 and Evans type III or IV fractures). There were 26 females and 9 males with a mean age of 77.1 years (range, 62-89 years). Results: Mean age of studied subjects was 84.29 ± 6.17, the lowest was 71, the highest was 96; ratio of male/female was 1:288. Follow-up of 33 patients for at least 6 months showed 88.6% caused by a low-energy injury; Average rehabilitation time was 4.63 ± 1.7 days. The average Harris point at the end was 90.4 ± 4.72. Conclusion: Primary cementless bipolar long stem hemiarthroplasty is one of good choices in treatment of unstable ITF in elderly patients with severe osteoporosis, helped patients improve the quality of life.

Comparative Study Of Results Of Unstable Trochanteric Fracture Femur Bipolar Hemiarthroplasty Versus Intra Medullary Nail Fixation

Abstract Objectives : The main objective of our study is to assess the effectiveness of internal Fixation by Intra Medullary Nail versus Bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fracture femur method: The study was done for (18) patients with unstable intertrochanteric fracture femur. The patients were classified into 9 patients fixed with Intra Medullary Nail and 9 patients by bipolar hemiarthroplasty. the follow up period was one and half year. Results 18 patients (12 females, 6 males) with closed Unstable intertrochanteric Fracture Femur were included for analysis . the patients classified into 9 patients fixed with Bipolar hemiarthroplasty and 9 patients fixed by Intra Medullary Nail Fixation from december 2016 to May 2018 with near follow up period of one and half year .There were similar results between the two groups according to age, complications(orthopedic), Harris Hip Score, revision surgery, and at one and half year follow-up. Significant difference were found between the two groups in blood loss , blood transfusion (interaoperatively) , medical complications, time of surgery .Conclusion: These results indicate that Intra Medullary Nail has advantages than hemiarthroplasty in treatment of unstable intertroch fractures. Hemiarthroplasty has greater surgical trauma and high incidence of medical complications .

Long Term Results of Bipolar Hemiarthroplasty in Treatment of Fracture Neck Femur

Femoral neck fractures are intracapsular fractures that occur in the proximal femur in the area beginning distal to articular surface of the femoral head and ending just proximal to the intertrochantric region. to evaluate the functional outcome of bipolar hemiarthroplasty in patients with intra capsular femoral neck fractures . and to determine the factors affecting the outcome and to see whether bipolar hemiarthroplasty meets desired end result or not; patient will be evaluated using Harris hip score and radiographic assessment. The present work was a retrospective study including twenty patients. These patients were be followed up for minimum five years post-operatively and traced to detect their actual hip function and performance. The early complicated patients would be excluded. The mean age of the patients was 73.4 years. The Harris hip score showed satisfactory results at the end of follow up three patients (15%) had hip scores from 100 to 91 (excellent). eight patients (45%) cases had hip scores90 to 81 (good). Two patients (10%) were rated 80 to 70. (fair), and seven patients (35%) were rated below 70(poor) . The mean Harris hip score at the end of follow up was71.0 (range from 25.0– to97.0) with SD 22.4. It was found that the greater motion at the inner bearing correlated with better clinical results. Therefore the amount of motion at the two interfaces appears dependent on a number of variables and still a topic of debate.

Perioperative Mortality After Cemented or Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures—A Systematic Review and Meta-analysis

BackgroundDebate surrounds the use of cemented or uncemented prostheses for the treatment of displaced femoral neck fractures (FNF). Many guidelines recommend the use of the cemented hemiarthroplasty (CHA). Proponents of CHA point out the increased re-operation rate while proponents of uncemented hemiarthroplasty (HA) highlight the increased mortality rate in the perioperative period. The aim of this study was to systematically review the literature to evaluate perioperative mortality after HA for displaced FNFs. MethodsA systematic review and meta-analysis was performed of MEDLINE, Cochrane Library, and Embase databases evaluating perioperative mortality after HA for displaced FNFs. Randomized control trials and observational studies were included comparing current-generation stem designs. A meta-analysis was performed on studies that directly compared the different modes of fixation. ResultsTwenty-two studies were included (seven randomized control trials and 15 observational studies), with a total of 183,167 HAs for treatment of a displaced FNF. Fourteen studies were included in the meta-analysis. There was a higher cumulative odds of death within the first 48 hours in those with CHA compared with uncemented HA (OR: 1.64; 95% CI: 1.35, 2.00; P ≤ .01). No difference was found in mortality at 7 days, 30 days, and one year. ConclusionCHA is associated with an increased mortality rate within the first two days of surgery with no difference at 7 days, 30 days, and one year. Surgeons should consider tailoring their stem choice based on the physiological status of the patient when planning HA for FNFs. Techniques to reduce the risk of bone cement implantation syndrome should be used.

Cemented versus cementless Bipolar Hemiarthroplasty in treatment of Fracture neck of Femur.

Cemented versus cementless Bipolar Hemiarthroplasty in treatment of Fracture neck of Femur.

Primary Cementless Bipolar Long Stem Hemiarthroplasty for Unstable Osteoporotic Intertrochanteric Fracture in the Elderly Patients.

BACKGROUND:Intertrochanteric fracture (ITF) is a major part of fracture in femoral head fracture. 95% of ITF are found in elderly patients. Osteosynthese is the preferred method of choice. However, elderly patients had osteoporotic, combined with many of chronic disease conditions that increase the rate of osteosynthese failure. Hemiarthroplasty bipolar long-stem is a surgical method that helps patients relieve pain, facilitate early rehabilitation, limit long-term complications, and improve quality of life for patients.AIM:The aim of our study is to evaluate the clinical of result of primary cementless bipolar long stem hemiarthroplasty in treatment for unstable ITF in the elderly patients who have severe osteoporosis.METHODS:Between 01/2016 and 12/2017, 35 patients with ITF type A2.2 and A2.3 (AO) were included in our prospective study. These patients were over 70 years old and treatment by hemiarthroplasty cementless long stem at E hospital and Saint Paul hospital by one group surgeons.RESULTS:Mean age of studied subjects was 84.29 ± 6.17, the lowest was 71, the highest was 96; ratio male/female was 1/4. Follow-up of 35 patients for at least 6 months showed 88.6% caused by a low-energy injury; Average rehabilitation time was 4.63 ± 1.7 days. The average Harris point at the end was 90.4 ± 4.72.CONCLUSION:Primary cementless bipolar long stem hemiarthroplasty is one of good choices in treatment unstable ITF in elderly patients with severe osteoporosis helped patients improve the quality of life.

Dual Mobility Acetabular Cup Versus Hemiarthroplasty in Treatment of Displaced Femoral Neck Fractures in Elderly Patients: Comparative Study and Results at Minimum 3-Year Follow-up.

Background:Hip fractures are serious injuries associated with relatively high mortality rates and disabilities, commonly seen in elderly persons. There is an ongoing debate regarding the advantages of various hip arthroplasty devices. This study aimed to analyze the long-term advantages of 2 different surgical procedures and assess if the dislocation rate, Harris Hip Score (HHS), and functional independence measure (FIM) are more favorable in dual mobility (DM) than those in hemiarthroplasty (HA).Hypothesis:Dual mobility procedures provide better postoperative outcomes than HA in terms of HHS, FIM, and dislocation rate.Materials and Methods:The survey was a prospective, comparative interventional single-blinded study performed at the University Clinical Center of Kosovo, a tertiary health-care institution. A total of 94 patients underwent DM or conventional bipolar HA for repair of displaced femoral neck fractures within 2 weeks of injury. Primary outcomes were postoperative dislocation rate, FIM, and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, mortality rate, and postoperative infection rate.Results:There were no significant differences for most parameters between the groups. We found a significant difference in the dislocation rate between the 2 groups, wherein there were no dislocations in the DM group and 3 dislocations in the HHS group (0% vs 6.4%). In terms of postoperative HHS at 12 months and 3 years, DM provided better outcomes (<0.034 and <0.014, respectively).Discussion:Dual mobility compares favorably to HA in terms of dislocation rate and HHS, while no difference was found for FIM. In order to have a more complete overview, we recommend more intense long-term studies including several heterogeneous parameters to compare the clinical outcomes between DM and HA.Level of evidence (with study design):Level II.

Early results of primary bipolar hemi arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients: A prospective study

Background and Objectives: Unstable intertrochanteric fracture in elderly is a challenging surgical condition with a high risk of morbidity and mortality. The aim of this study is to evaluate the results of bipolar arthroplasty as an alternative to the standard treatment of internal fixation. Methods: This prospective study was conducted at Department of Orthopedics, Government Medical College, Jammu from October 2014 to May 2017. Records of total 34 patients with unstable intertrochanteric fractures treated under our hospital's Orthopedic Department were analyzed. Results: Out of 34 patients enrolled in the study, 2 patients died during the study, hence the results of remaining 32 patients were analyzed with an average follow-up of 12 months. The average age of the patient was 79.35 years (range 70-94 years). The average surgery time was 82.53 min (range 62-110 min). The average intraoperative blood loss was 409.37 cc and average stay in the hospital was 14.53 days (range 5-21 days). At 1-year follow-up with help of Harris Hip Score, 8 patients (25%) were graded as excellent, 10 patients (31.25%) as good, 10 (31.25%) as fair, 2 (6.25%) as poor, and 2 (6.25%) as failed. Interpretation and Conclusion: Treatment of unstable intertrochanteric fractures in elderly patients with cemented bipolar hemi arthroplasty results in reduced complications of prolonged immobilization and easy rehabilitation along with rapid return to functional level.

Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review

ABSTRACT The optimal treatment of proximal humerus fractures is debated; however, reverse total shoulder arthroplasty (RTSA) has become increasingly popular as the primary treatment. We systematically reviewed the PubMed, EMBASE, and Scopus databases to identify English-language clinical studies (evidence levels I through IV) comparing the results of RTSA with those of hemiarthroplasty (HA) for the treatment of acute proximal humerus fractures. We evaluated the following outcomes: Range of motion, patient-reported outcome measures (including pain relief), and complications. We identified eight published studies comparing RTSA with HA for treatment of acute proximal humerus fractures. The RTSA group (180 patients) showed significantly better postoperative pain relief, active anterior elevation, Constant-Murley scores, and American Shoulder and Elbow Surgeons (ASES) scores compared with the HA group (439 patients; all p &lt; 0.05). There were no significant differences between the two groups for overall complications (RTSA, 11.8% vs HA, 20.8%), infections (2% for both groups), dislocations (RTSA, 0% vs HA, 2.5%), or nerve injury (RTSA, 1% vs HA, 2.8%). Scapular notching occurred in 15.8% of RTSA cases (grade I, 53%; grade II, 32%; grade III, 16%; and grade IV, 0%). In the treatment of acute proximal humerus fractures, RTSA provided better pain relief, postoperative anterior elevation, and outcome scores after surgery compared with HA and had similar complication rates. Keywords Complications, Outcomes, Pain, Reverse total shoulder, Shoulder hemiarthroplasty, Surgery, Systematic review. How to cite this article Borade AU, Familiari F, Choi K, Joseph J, McFarland EG. Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review. J Postgrad Med Edu Res 2017;51(4):182-187.

Evaluation of functional outcome of cemented bipolar hemiarthroplasty for treatment of osteoporotic proximal femoral fractures in elderly people

Background: In India the estimated geriatric population is going to rise from 8% of total population in 2010 to 19% by 2050. Incidence of osteoporosis and associated fractures will rise in coming years with increasing elderly population. Management of fracture neck of femur and unstable intertrochanteric fractures in osteoporotic bone is challenging in elderly as they are more prone for fracture associated complications like pressure sore, deep vein thrombosis and pneumonia. Aim: The purpose of this study is to evaluate the role of cemented bipolar hemiarthroplasty in management of osteoporotic proximal femoral fractures in elderly people. Patients and Methods: In this prospective study twenty patients with osteoporosis having proximal femoral fractures (fracture neck of femur/unstable intertrochanteric fracture) were treated by cemented bipolar hemiarthroplasty. Patients were followed up at 3 weeks, 3, 6, and 12 months to evaluate the function outcome. Mean age of the patients in this study was 73.84 years. Results: Average duration follow up in this study was 14.63 month. Mean Harris Hip Score in the post-operative period was 42.73±8.78 which improved to 81.57±9.11 at 6 months. Average post-operative mobilization duration was 3.84 day and average hospital stay was 11.31 day. At 1 year follow up 85% patients had excellent to fair outcome and 10% had poor outcome. Conclusion: Treatment of osteoporotic proximal femoral fractures with cemented bipolar hemiarthroplasty gives better functional outcome. Keywords: Proximal Femoral Fractures, Elderly, Osteoporosis, Cemented Bipolar Hemiarthroplasty

Meta analysis of unipolar versus bipolar hemiarthroplasty for elderly patients with femoral neck fracture

Objective To evaluate the effect of unipolar versus bipolar hemiarthroplasty for treatment of femoral neck fracture in the elderly Methods Related randomized controlled trials (RCTs) and quasi-randomized controlled trials (qRCTs) were searched from computerized databases MEDLINE,EMBASE,Cochrane Library,and CBM disc.Additional studies were identified through hand searches of 10 domestic journals.Time period of the search was from 1966 to June 2012.RevMan 4.2.8 software was used for data analysis.Results A total of 7 RCTs and 3 qRCTs were included.In this meta analysis,bipolar hemiarthroplasty was associated with better hip function compared with unipolar hemiarthroplasty at postoperative 6 months (RR =0.74,95％ CI0.62-0.88,P ＜ 0.01).However,the two procedures revealed no significant differences in terms of postoperative one-year dislocation rate (RR =1.01,95％ CI0.54-1.89,P ＞ 0.05),reoperation rate (RR =1.13,95％ CI 0.74-1.72,P ＞ 0.05),major complication incidence (except for dislocation) (RR =1.27,95％ CI 0.74-2.18,P ＞ 0.05),and postoperative 2-year mortality (RR1.16,95％ CI 0.73-1.87,P ＞ 0.05).Conclusion Bipolar hemiarthroplasty is preferable to unipolar hemiarthroplasty for hip function improvement,but postoperative one-year dislocation rate,reoperation rate,major complication incidence (except for dislocation),and postoperative twoyear mortality are similar for the two procedures. Key words: Femoral neck fractures ; Aged ; Arthroplasty, replacement, hip; Meta-analysis

Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients with rotator cuff tear arthropathy and preserved subscapularis muscle function: preliminary report and short-term results

Humeral resurfacing arthroplasty represents an alternative option to hemiarthroplasty for treatment of cuff tear arthropathy (CTA), with the advantages as follows: suitability for relatively young and high-demand patients because of preservation of bone stock and no loss of length, less invasive surgery, shorter operation time, no risk of periprosthetic stem fractures, and revision surgery can be undertaken easily. In the current study, resurfacing arthroplasty in combination with latissimus dorsi tendon transfer for CTA was performed. Three hypotheses: first, humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer would improve the overall functional outcome in patients with CTA. Second, this combination would improve humeral external rotation. Third, this combination would improve abduction and shoulder elevation. Study was conducted as an observational case series. Fourteen patients (nine ♀ and five ♂) having CTA were included. Follow-up was carried out at the end of the 28th month for all patients. Constant Score was used for follow-up evaluation. Dorso-axillary approach was used for latissimus dorsi tendon transfer and ventral deltopectoral approach for Copeland resurfacing. Tendons were fixed to the greater tuberosity with two anchors. The absolute Constant Score significantly improved from 34 preoperatively to 69 postoperatively, relative Constant Score from 42 to 91%, elevation from 95° to 138°, abduction from 88° to 147°, and external rotation from 16° to 22° (not significant). Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients having CTA with preserved subscapularis function has satisfactory short-term functional clinical outcome. IV.

Comparison of intramedullary fixation and hemiarthroplasty for treatment of femoral intertrochanteric fracture in the elderly patients following stroke

Objective To compare the operative outcomes of intramedullary fixation and hemiarthroplasty in the treatment of femoral intertrochanteric fracture in the elderly patients following stroke.Methods A retrospective study was conducted to analyze the clinical data of the elderly patients who had received surgery in our department from June 2005 to June 2011 for femoral intertrochanteric fracture following stroke.They were 24 males and 8 females,with a mean age of 80.3 years (from 65 to 91 years).By AO classification,8 cases were of type A1,14 of type A2 and 10 of type A3.Twelve patients received hemiarthoplasty and 20 patients intramedullary fixation.The 2 groups were compared in terms of incision length,intraoperative blood loss,operation time,ambulation time,complications and Harris score one year postoperation.Results In the hemiarthoplasty and intramedullary fixation groups,the incision length was respectively 10.0 ± 2.1 cm and 5.1 ± 2.3 cm,the intraoperative blood loss respectively 301.8 ± 98.2 mL and 156.3 ±45.1 mL,the ambulation time respectively 6.4 ±2.9 days and 30.5 ±8.7 days,the intraoperative complication rate respectively 33.3％ (4/12) and 65.0％ (13/20) and the Harris score one year postoperation respectively 61.3 ± 5.4 points and 57.4 ± 4.6 points.There were significant differences between the 2 groups in all the above items (P ＜ 0.05).There was no significant difference between the 2 groups regarding the postoperative complication rates [25.0％ (3/12) versus 26.3％ (5/19)] (P ＞ 0.05).Conclusion In treatment of femoral intertrochanteric fracture in the elderly patients following stroke,hemiarthoplasty may be better than intramedullary fixation because the former may reduce intraoperative complications,shorten time for ambulation and improve hip functional recovery. Key words: Cerebrovascular accident; Hip fractures; Arthroplasty, replacement, hip; Fracture fixation, intramedullary; Aged

Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture

Purpose: In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem. Materials and Methods: A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups. Results: Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition, there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2. Conclusion: Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.

A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures

Total hip arthroplasty or hemiarthroplasty are used to treat displaced femoral neck fractures. However, the optimal treatment of these fractures remained controversial. To assess the effects that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fractures in the elderly. We searched MEDLINE (January 1980 to 2010), EMBASE (January 1980 to 2010), and the Cochrane Library 2010; issue 1. Only prospective randomized controlled trials (RCTs) that compare total hip arthroplasty with hemiarthroplasty for the treatment of femoral neck fracture in the elderly were included. The analysis was performed with software RevMan5.0 from the Cochrane Collaboration. We identified seven relevant randomized controlled trials with a total of 828 participants. The meta-analysis showed relative risk of re-operation was 0.40 (95% CI=0.24-0.67, P=0.0004), the dislocation was 2.02 (95% CI=1.26-3.25, P=0.002), the mobility as functional outcome was 1.70 (95% CI=1.21-2.38, P=0.002). It was reported that the average operating room times and blood loss volumes in total hip arthroplasty were more than in hemiarthroplasty (P<0.001). Other results were not significantly different. Total hip arthroplasty is associated with better functional outcome and lower reoperation rate than hemiarthroplasty in treatment of displaced femoral neck fractures in the elderly patients.