Hip Arthroplasty In Elderly Patients Research Articles

Can a cementless partial hip prosthesis be preferred in patients with hip fractures when the Spotorno criterion is greater than 5?

Aims: Partial hip arthroplasty is preferred in elderly patients with low activity levels, numerous comorbidities, and limited mobility for hip fractures. To decide whether to use cement in femoral stem implantation, scoring systems such as Spotorno, Dorr, and Canale Flare Indices are used. Generally, cemented application is frequently for patients with over 5 points according to Spotorno criteria. In this study, our aim is to present the outcomes of patients who had a score of 5 or more according to the Spotorno criteria and required cemented prostheses but instead received cementless partial hip prostheses. Methods: Patients who underwent partial hip arthroplasty due to post-traumatic femoral neck fractures in our hospital’s orthopedics and traumatology clinic between 2017 and 2021 were retrospectively evaluated. To calculate the total score according to the Spotorno criteria, which evaluate age, sex, singh index and morphological cortical index, the radiographs of the patients included in the study were assessed, and the Singh index and morphological cortical index (MCI) were calculated.Periprosthetic fractures, prosthesis dislocations, heterotopic ossification, femoral loosening and mortality had been recorded. A total of 192 patients over the age of 70 with ASA III and ASA IV who underwent cementless partial hip arthroplasty were included in the study. Among these patients, 126 were female (% 5.7) and 66 were male (%34.3). Mean follow up was 5.8 years (0-7 years). Results: According to the Spotorno criteria, the total score for all patients was greater than 6. Periprosthetic fractures were detected in % 3.1. Heterotopic ossification was observed in %9.3. In the postoperative 1st month, mortality was observed in %5. Conclusion: Cementless hip arthroplasty in elderly patients with a Spotorno score of 5 or higher can be as effective and applicable as cemented hip arthroplasty. Although the literature generally recommends cemented hip prostheses for such patients, cementless partial hip arthroplasty can be a viable option if standard latest-generation cementing systems are not available.

Predicting the Risk of Postoperative Delirium in Elderly Patients Undergoing Hip Arthroplasty: Development and Assessment of a Novel Nomogram

Objective To construct and internally validate a nomogram that predicts the likelihood of postoperative delirium in a cohort of elderly individuals undergoing hip arthroplasty. Methods Data for a total of 681 elderly patients underwent hip arthroplasty were retrospectively collected and divided into a model (n = 477) and a validation cohort (n = 204) according to the principle of 7:3 distribution temporally. The assessment of postoperative cognitive function was conducted through the utilization of The Confusion Assessment Method (CAM). The nomogram model for postoperative cognitive impairments was established by a combination of Lasso regression and logistic regression. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. Results The nomogram utilized various predictors, including age, body mass index (BMI), education, preoperative Barthel Index, preoperative hemoglobin level, history of diabetes, and history of cerebrovascular disease, to forecast the likelihood of postoperative delirium in patients. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.836 (95% CI: 0.797–0.875) for the training set and 0.817 (95% CI: 0.755–0.880) for the validation set. The calibration curves for both sets indicated a good agreement between the nomogram’s predictions and the actual probabilities. Conclusion The use of this novel nomogram can help clinicians predict the likelihood of delirium after hip arthroplasty in elderly patients and help prevent and manage it in advance.

Does total hip arthroplasty in elderly patients with femoral neck fractures reduce complications? A Japanese DPC study

BackgroundThe global increase in femoral neck fractures due to aging and osteoporosis is a major clinical challenge. The debate on the optimal surgical intervention for femoral neck fractures remains unresolved. This large-scale study explores femoral neck fractures among the elderly, focusing on the comparative outcomes of Total Hip Arthroplasty (THA) versus Bipolar Hemiarthroplasty (BHA) in Japanese patients. MethodsUsing the Japanese National Administrative Diagnosis Procedure Combination (DPC) database, we studied cases of femoral neck fracture from April 2016 to March 2023, and after propensity score matching by age, sex, and comorbidities, we examined the association between THA, complications, and clinical outcomes, and the usefulness of THA for elderly patients with femoral neck fracture. ResultsOne-to-one propensity score matching identified 7741 pairs of THA and BHA cases. There was no difference in length of stay between the THA and BHA groups. Significantly more blood transfusions were required in the THA group. There was no significant difference in mortality between the THA and BHA groups, but there was a reduced risk of pneumonia in the THA group, with a ratio of 0.547 (95% CI: 0.418–0.715). On the other hand, the THA group had a higher risk of pulmonary embolism, with a ratio of 1.607 (95% CI: 1.379–1.874). The THA group shows improved discharge rates directly home from the facility where the operation was performed, with a ratio of 1.798 (95% CI: 1.675–1.929). ConclusionThe findings of this research indicate that THA is more effective than BHA in enabling elderly Japanese patients with femoral neck fractures to be discharged directly home and in preventing pneumonia, despite concerns about pulmonary embolism. These findings suggest that THA may improve functional prognosis in elderly patients with femoral neck fractures, although there is a trade-off with an increased risk of pulmonary embolism.

Metformin Reduces the Risk of Total Hip Arthroplasty in Elderly Patients with Hip Osteoarthritis and Type 2 Diabetes Mellitus.

To assess if metformin could reduce the risk of total hip arthroplasty (THA) in elderly patients with hip osteoarthritis and type 2 diabetes (T2DM). It is a retrospective study among elderly patients (≥65 years) with hip osteoarthritis and T2DM. All included patients were divided into metformin group and non-metformin group, then propensity-score match (PSM) was performed to control potential confounding factors. The primary endpoint was the incidence of the first THA during the study period. Multivariate Cox regression analysis was employed to evaluate the association of metformin with the risk of THA. A matched cohort of 716 patients were finally included, with 308 metformin users and 308 metformin non-users. During a maximum follow-up of 10 years, the incidence of THA in metformin users was significantly lower than that in non-users (4.9% vs 25.0%, P<0.01). Multivariate Cox regression analysis indicated that metformin users were significantly associated with a lower risk of THA compared with non-users (HR = 0.17, 95% CI: 0.10-0.30; P<0.01). In addition, further analyses indicated that participants with long-term metformin use (HR = 0.10, 95% CI: 0.02-0.46; P<0.01) or high metformin dosage (HR = 0.15, 95% CI: 0.04-0.57; P<0.01) had a lower risk of THA. Metformin use could reduce the risk of THA in patients with hip osteoarthritis and T2DM, and the effect is accumulative and dose dependent.

How Much Protection Does a Collar Provide? Assessing Risk of Early Periprosthetic Femur Fractures Following Total Hip Arthroplasty in Elderly Patients

BackgroundPeriprosthetic fractures (PPFs) account for approximately 25% of early revisions following total hip arthroplasty (THA). Cemented femoral fixation is associated with a lower-risk of PPF, and collared-cementless stems may reduce the risk as well. The objective of this study was to compare early-PPF rates between cemented, collared-cementless, and non-collared cementless stems in elderly patients. MethodsA consecutieve-series of 11,522 primary THAs performed between 2016 and 2021 at our institution in patients >65 years of age was identified. Stem types used were categorized as cemented, collared-cementless, or non-collared cementless. Patients undergoing THA who had cemented-stems were older, more commonly women, and more likely to have a posterior-approach. To reduce confounding of patient characteristics, we matched patients in the 3 stem-categories according to age, sex, and body mass index. This generated 3-groups (cemented, collared-cementless, and non-collared cementless) consisting of 936 patients per group. The mean age of these 2,808 patients was 73 years, the mean body mass index was 27, and 67% were women. Logistic regressions were used to evaluate risk-factors for early-PPF. In the entire cohort of primary THA in elderly patients, there were 85 early PPFs (0.7%) over the study period. ResultsNon-collared cementless stems were associated with an increased risk of early PPF (OR: 3.11; P = .03) compared to collared-cementless stems. There were no early PPFs in the matched cemented cohort, 6 early PPFs in the matched collared-cementless cohort, and 16 early-PPFs in the matched non-collared cementless cohort (0% versus 0.64% versus 1.71%, P < .001). ConclusionsIn this large-series of patients >65 years of age undergoing primary THA, cemented stem fixation had the lowest incidence of early PPF, but collared-cementless stems had a nearly 3-fold decrease in risk for early PPF compared to non-collared cementless stems.

General anesthesia and femoral nerve block versus spinal anesthesia for cemented hip arthroplasty in elderly patients: A randomized controlled trial

ABSTRACT BACKGROUND Traumatic femoral fractures are a prevalent orthopaedic issue in elderly adults. General anaesthesia (GA) vs. spinal anaesthesia are still being discussed as the best anaesthetic method for cemented hip arthroplasty (SA). This study compared the impact of spinal anaesthesia versus general anaesthesia in combination with femoral nerve block on the mean arterial blood pressure (MAP) in patients having cemented hip arthroplasty operations. AIM OF THE STUDY To compare the impact of spinal anaesthesia on elderly patients undergoing cemented hip arthroplasty operations versus general anaesthesia in combination with femoral nerve block on mean arterial blood pressure. PATIENTS AND METHODS The study was registered at Pan African-Clinical Trial Registry.org with ID of (PACTR 202,111,575,647,784). At Ain Shams University Hospital, 60 patients receiving total hip arthroplasty were separated into two equal groups, each comprising 30 patients, for the purpose of this prospective randomised comparison study. Patients in Group (A) underwent spinal anaesthesia, while Group (B) received general anaesthesia together with an ultrasound-guided femoral nerve block. RESULTS This study showed that GA was associated with more stable readings of mean arterial blood pressure (MAP) after anesthesia induction and post cement implantation than SA (p-value = 0.04 and 0.038 respectively). CONCLUSION Patients who received general anesthesia (GA) had more stable hemodynamic parameters especially the mean arterial blood pressure (MAP) than those who received spinal anesthesia (SA).

Do nonagenarians have more complications and unplanned readmissions than octogenarians following primary THA? A retrospective cohort study.

The performance of total hip arthroplasty in elderly patients, especially nonagenarians, is challenging due to higher patient frailty and medical comorbidities. We compared 90-day postoperative complications and unplanned readmissions between nonagenarians and octogenarians undergoing elective THA. One hundred and eleven patients undergoing elective, unilateral THA were retrospectively analyzed. Forty-four patients were nonagenarians (Group A), and 67 patients were octogenarians (Group B). Demographic data included age, gender, body mass index (BMI), ASA score and Charlson Comorbidity Index(CCI). Frailty was defined according to the Rockwood Frailty Index. All patients underwent a thorough preoperative assessment through a specific institutional clinical pathway created for this matter. Postoperative adverse events were grouped into major or minor. A regression model was used to evaluate independent risk factors for the development of complications. There were no differences in the ASA score (65.9% vs. 53.7% ASA III-IV), prevalence of frailty (1% vs. 9%) and comorbidities between both groups (p > .05). The CCI was higher in nonagenarians (p = 0.007). Nonagenarians had more in-hospital complications, although most were minor (p = 0.002), none of which resulted in mortality. Ninety-day unplanned readmissions were similar between groups, with 4 (9.1%) and 6 (9%) in groups A and B, respectively (p = 1). Although age was a factor associated with the development of postoperative complications in the univariate regression model (OR 3.81, 95% CI 1.31 to 11.11, p = 0.014), it lost significance after performing the multivariate analysis (OR 2.48, 95% CI 0.78 to 7.90, p = 0.125). The age of 90years old was not a barrier to perform elective THA safely. Nonagenarians had higher in-hospital minor complications when compared to the younger cohort. However, age over 90years was not an independent risk factor for unplanned readmissions or mortality. Multimodal protocols of perioperative care are paramount for improving outcomes after THA in very old patients.

Comparison of general vs spinal anesthesia for direct anterior approach total hip arthroplasty in elderly patients: a retrospective study

Aim: It remains unclear whether spinal anesthesia is beneficial instead of general anesthesia in total hip arthroplasty (THA) performed via the direct anterior approach (DAA) in elderly patients. The aim of the present research was to investigate the safety and effectiveness of SA in elderly patients underwent DAA-THA. Materials and Methods: We made a retrospective analysis of 166 elderly patients underwent DAA-THA between January 2018 and December 2021. Patients were divided into two groups: general anesthesia (group GA, n=88) and spinal anesthesia (group SA, n=78). We compared the two groups regarding to 90-day readmission rate, amount of bleeding, blood product transfusion, length of hospital stays (LOS), major adverse cardiac events (MACE), postoperative pulmonary complications (PPC), and intensive care unit (ICU) requirement. We also recorded the demographics and procedure data of the two groups. Results: Ninety-day readmission rate, PPC, and ICU requirement in group SA were significantly lower than group GA (p&lt;0.05). There was no statistical difference between the two groups in terms of amount of bleeding, blood product transfusion, MACE, and LOS. Conclusion: Spinal anesthesia in elderly patients underwent DAA-THA may reduce 90-day readmission rate, PPC, and ICU requirement without increasing amount of bleeding, blood product transfusion, MACE, and LOS.

Does the Dual Mobility Cup Reduce Dislocation After Primary Total Hip Arthroplasty in Elderly Patients at High Risk of Dislocation?

The dual mobility cup (DMC) is designed to extend the longevity of the prosthesis by improving stability, enhancing the range of motion, and decreasing impingement without increasing wear. We hypothesized that DMC would reduce the risk of dislocation in elderly patients. This study aimed to investigate the clinical and radiographic outcomes of DMC-total hip arthroplasty (THA) in elderly patients at high risk of dislocation. From June 2016 to March 2020, 94 patients with a mean age of 77.7 years (97 hips) who underwent a posterolateral approach for DMC-THA in our department were followed up for at least one year. Preoperative and postoperative pelvic tilt angles (PTA) and DMC orientation were prospectively collected for all patients. Intraoperative and postoperative complications were recorded. A parametric test was used for normal distribution, and a non-parametric test was used for non-normal distribution. Abduction and anteversion angles of the cup were 42.4 and 18.0° in the supine position immediately postoperative. The average PTA for patients in the supine and standing positions were 26.5 and 34.5°, respectively. When moving from the supine to the standing position, patients experienced a mean posterior pelvic tilt of 9°. No intraoperative acetabular-related complications were recorded. Postoperative complications included early infection in one patient (1.0%) and dislocation in one patient (1.0%). Our study demonstrates that DMC-THA provides satisfactory short-term outcomes in elderly patients at a high risk of dislocation, regardless of the change in PTA resulting from postural transition.

The short-term outcomes of cementless stem for hip arthroplasty in the elderly patients: comparison with patients < 65 years

ObjectiveThe use of cement or cementless femoral stem prosthesis for hip arthroplasty in elderly patients has been controversial. This study investigated the efficacy and safety of cementless femoral stem in elderly patients (age ≥ 65 years).MethodsThe short-term efficacy of primary hip arthroplasty with cementless femoral stem in our hospital from January 2014 to June 2021 was retrospectively analyzed. Patients were divided into two groups according to age: young group (< 65 years) and the elder group (≥ 65 years). The evaluation index was the Harris Hip score (Harris), postoperative femoral stem prosthesis sinking distance and femoral plant-related complications (periprosthetic fracture, prosthesis loosening, infection, dislocation, etc.).ResultsThere were 72 cases of 86 hips in the young group and 83 cases of 92 hips in the elder group. The recovery trend of functional score in the elder group was similar to that in the young group, and the Harris score increased from (38.35 ± 18.21) before surgery to (86.91 ± 12.55) at last follow-up (p < 0.01). Compared with the two groups at the same time of 3 months, 6 months and 12 months after operation, the sinking distance of the elder group was significantly greater (P < 0.05). Even in the elder group, there was a significant difference in sinking distance between 6 and 3 months after surgery (2.44 ± 0.49 mm vs 2.10 ± 0.65 mm, P = 0.004). However, there was no significant difference between 12 and 6 months (2.53 ± 0.53 mm vs 2.44 ± 0.49 mm, P = 0.40). A total of 10 patients in the elder group and 6 patients in the young group had a complication event (P = 0.36).ConclusionsElderly patients with cementless femoral stems can achieve metal-bone integration slightly longer than young patients, but short-term clinical outcomes can be restored to a satisfactory level with adequate safety. However, the long-term efficacy still needs to be verified by multicenter, large sample size and prospective clinical follow-up results.

Comparison of Hemiarthroplasty and Total Hip Arthroplasty in Elderly Patients with Displaced Femoral Neck Fractures

Background and Aim: Hemiarthroplasty (HA) and total hip arthroplasty (THA) are the two alternate surgical interventions required for displaced femoral neck fractures in elderly patients. Though THA is superior in certain aspects such as hip pain, reoperation rate and function but had higher dislocation rate compared to HA. The present study aimed to compare the hemiarthroplasty and total hip arthroplasty in elderly patients with displaced femoral neck fractures. Patients and Methodology: This retrospective cohort study was conducted on 20 displaced femoral neck fractures patients in the Department of Orthopedic QAMC/ BVH Bahawalpur from January 2021 to August 2022. Prior to start of study, ethical approval was taken from the institute research and ethical committee. Written informed consent was obtained from each individual. Patients aged &gt;60 years and had femoral neck fractures were enrolled. Rheumatoid arthritis in fracture hip patients, non-ambulatory patients, and pathological fracture patients were excluded. Patients were categorized into two groups; group-I patients undergoing hemiarthroplasty and group-II patients undergoing total hip arthroplasty. Post-operative complications such as fracture, medical issues, dislocation, surgical site infection, and mortality (1 year) were assessed in both groups. Harris Hip Score (HHS) was used for the assessment of function outcome at one month, three months, six months, and twelve months. SPSS version 25 was used for data analysis. Results: Of the total 20 femoral neck fractures patients, 10 patients underwent hemiarthroplasty and 10 underwent total hip arthroplasty. The overall mean age was 69.44±7.91 years. Demographic details or baseline features were almost similar in both groups. During follow-ups, patients who underwent total hip arthroplasty (group-II) had higher Harris hip score than group-I patients. The mean HHS score in group-I patients were 61.53, 68.24, 70.81, and 76.16 at follow-up visit after one month, three months, six months, and twelve months respectively while In group-II, the mean HHS score were 66.23, 69.82, 73.25, and 78.92 respectively. Conclusion: Our study concluded that total hip arthroplasty in elder patients with femoral neck fractures provided better hip functional outcome and lower morbidity and mortality as compared to hemiarthroplasty group. THA could be considered as priority based treatment modality for femoral neck fractures patients than HA due to higher Harris hip scores and lesser complications. Keywords: Femoral neck fractures, Hemiarthroplasty, Total hip arthroplasty

Effects of Continuous Fascia Iliaca Compartment Block on Early Quality of Recovery After Total Hip Arthroplasty in Elderly Patients: A Randomized Controlled Trial.

PurposeIn recent years, patient-centered postoperative quality of recovery has gained attention. This study aimed to assess the influence of ultrasound-guided continuous fascia iliaca compartment block (CFICB) on early quality of recovery in elderly patients after total hip arthroplasty (THA) using the QoR-15 score.Patients and MethodsIn this single-center, randomized, prospective study, 60 patients scheduled for unilateral THA were randomized to the CFICB or patient-controlled intravenous analgesia (PCIA) group. The primary outcome was the QoR-15 score. The secondary outcomes were pain score, number of patients requiring rescue analgesics, time of first postoperative ambulation, incidence of postoperative complications, Bromage score, and length of hospital stay.ResultsThe QoR-15 score was significantly higher in the CFICB group than in the PCIA group at 24 h (P < 0.001) after surgery. However, the QoR-15 score was not significantly different at 48 h (P = 0.074) between the two groups. Pain scores at rest and during movement were lower in the CFICB group than in the PCIA group at 12, 24, and 48 h postoperatively (P < 0.05). There was no difference in the number of patients requiring rescue analgesics, time of first postoperative ambulation, incidence of postoperative complications apart from dizziness, or length of hospital stay between the two groups. In addition, Bromage score of 1 point was reported by four patients in the CFICB group at 24 h (P = 0.048) after THA.ConclusionIn elderly patients following THA, CFICB improved the quality of recovery at 24 h and reduced pain scores compared with PCIA. The time of first postoperative ambulation and length of hospital stay were not significantly affected.

Functional outcome of primary total HIP arthroplasty in elderly patients with fracture neck of femur: A prospective study

Background and Objective: Hip fractures caused by osteoporosis have become a leading source of morbidity and mortality in the adult and elderly populations worldwide. Normal locomotion necessitates a stable, pain-free, and mobile hip. Displaced subcapital and intracapsular femoral neck fractures are usually treated with surgery. The study aims to assess the functional outcome of primary total hip arthroplasty in elderly patients with fracture neck of the femur.Materials and Methods: Twenty-five patients with acute neck of femur fracture were treated with primary total hip arthroplasty between November 2019 to May 2021. All the patients were followed up for six months.Results: There were 11 male and 14 female patients in our study. The most common mode of injury was trivial trauma. The primary total hip arthroplasty in fracture neck of femur in elderly population provided a mean Harris Hip Score of 81.1 at the end of 1 month, 83.9 at the end of 3 months, and 85.7 at the end of 6 months. The functional outcomes obtained were excellent results in 32%, good results in 52%, fair results in 12%, and poor results in 4% of the study population, with a ‘p value’ of 0.045. The poor outcome was recorded in 1 patient due to lack of mobilization secondary to recovery from covid pneumonia.Conclusion: The key to success lies in selecting patients who are active, independent, mobile before the injury, motivated, and in a good mental state. We recommend the total hip arthroplasty as a primary procedure in elderly patients with fracture neck of femur for better function of the hip and to avoid further revisions in patients with long life expectancy.

Surgical Treatment of Marginal Impaction Injuries of The Acetabulum Associated with Posterior Wall Fractures

The procedure is performed with the patient under general anesthesia, placed under traction in either the prone or lateral position with use of a radiolucent flat-top fracture table and fluoroscopic guidance. The Kocher-Langenbeck approach is utilized. The big posterior wall fracture is identified and reflected in order to visualize the joint surface. Subsequently, traction is applied to facilitate visualization of the marginal impaction area(s). With use of an osteotome, the impacted fragments are disimpacted and elevated. The femoral head is utilized as a template for accurate reduction of the impacted fragments to the acetabular joint surface. The resultant subchondral void is assessed and may be grafted with use of a variety of bone graft materials. The 2-level reconstruction technique may also be considered when the surgeon desires to optimize stability of the impacted fragments and maintain anatomical reduction. The big posterior wall fragment is reduced and fixed with use of the standard posterior-wall reconstruction technique. Finally, irrigation and wound closure in layers is performed. Treatment alternatives include either delayed or acute primary total hip arthroplasty in elderly patients >70 years old. Preoperative identification of the marginal impaction is critical because articular incongruency leads to the development of early posttraumatic osteoarthritis. Achieving joint congruency is especially important in the young population in order to avoid an otherwise unnecessary early total hip arthroplasty. Expected radiographic outcomes are excellent or good in 82% of cases, as measured with use of the Matta radiographic score1-3. Expected function outcomes are good to excellent in 67.5% of patients, as measured with use of the Modified Merle d'Aubigné system1-3. Total hip arthroplasty has been reported as a secondary procedure within 2 years postoperatively in 7.6% of patients1-3. Joint irrigation is crucial in order to clarify the details of the fragmentation and facilitate removal of debris. Impacted articular cartilage fragments are often rotated and face away from the femoral head. Utilize osteotomes to elevate the impacted area, taking care to mobilize adequate subchondral bone and the accompanying cartilage in case the 2-level reconstruction technique is needed and can be successfully applied. Utilize the femoral head as a template after traction is released to facilitate anatomical reduction. A 1.6-mm Kirschner wire should be available in case it is needed to temporarily stabilize the impacted fragments. Avoid overstuffing the void with bone graft because this may subsequently hinder successful reduction of the posterior wall fragment. CT = computed tomographyAP = anteroposteriorK wire = Kirschner wirePDS = polydioxanone sutureAVN = avascular necrosis.

Intraoperative periarticular injection can alleviate the inflammatory response and enhance joint function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures.

Purpose:This study aimed to investigate the potential beneficial effects of periarticular injection (PAI) of multimodal drugs on the inflammatory response and joint function after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures.Methods:Fifty six elderly patients with unilateral osteoporotic femoral neck fractures were randomly allocated to 2 groups: the PAI group, which received the multimodal drug PAI intraoperatively before incision closure, and the control group, which received an injection of saline at the same time as placebo. The C-reactive protein (CRP), interleukin-1β (IL-1β), and IL-6 levels as well as the erythrocyte sedimentation rate (ESR) in peripheral venous blood samples were measured, along with the Visual Analogue Scale (VAS) score with activity and Harris hip score preoperation at 1, 2, 4, 7, and 14 days as well as 1 and 3 months post-operation.Results:The 2 groups were comparable in sex and age, and no significant differences were observed in the preoperative CRP, IL-1β, and IL-6 levels, ESR, VAS score, or Harris hip score between the 2 groups (all P > .05). However, during the postoperative period, the PAI group exhibited significantly lower levels of CRP, IL-1β, and IL-6 as well as a lower ERS and VAS score compared with the control group (P < .05), while the Harris hip score was significantly higher postoperatively in the PAI group (P < .05).Conclusion:Multimodal drug PAI can alleviate the inflammatory response and enhance hip function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures.

Primary total hip arthroplasty in elderly patients over 85 years old: Risks, complications and medium-long term results

IntroductionThe elderly population candidate for total hip arthroplasty (THA) is increasing exponentially in developed countries, due to the high prevalence of osteoarthritis (OA). The objective is to identify the overall survival in patients over 85 years with primary OA who underwent THA. Material and MethodsRetrospective observational study in patients over 85 years with primary hip OA performing a THA between 2012 and 2019. Demographic, clinical, comorbidity, complications, functionality and pain variables were collected. A descriptive analysis was performed and survival was estimated with the Kaplan-Meier method and the differences in pain and functionality before and after surgery with the McNemar-Bowker test. ResultsWe included 66 patients, 40 women and 26 men with a mean age of 87.22 years, of whom 15 had high comorbidity (Charlson> 2). Only 14 patients presented complications in the postoperative period, the most frequent was the confusional syndrome (5); and the most serious one, a death (1), with a median of admission of 8 days. Two cases of dislocation were detected during a mean follow-up of 3.61 years, without requiring revision surgery. Improvement of pain was evident after surgery (p < 0.0001). The median overall survival is 6.77 years, with no difference in survival adjusted by the Charlson index (p = 0.75) or by ASA anesthetic group (p = 0.23). ConclusionsWith good patient selection, TCA is a good option for those patients over 85 years of age with functional limitations or pain due to OA.

Study protocol: Effectiveness of dual-mobility cups compared with uni-polar cups for preventing dislocation after primary total hip arthroplasty in elderly patients — design of a randomized controlled trial nested in the Dutch Arthroplasty Registry

Background and purpose — Dislocation is the leading reason for early revision surgery after total hip arthroplasty (THA). The dual-mobility (DM) cup was developed to provide more stability and mechanically reduce the risk of dislocation. Despite the increased use of DM cups, high-quality evidence of their (cost-)effectiveness is lacking. The primary objective of this randomized controlled trial (RCT) is to investigate whether there is a difference in the number of hip dislocations following primary THA, using the posterolateral approach, with a DM cup compared with a unipolar (UP) cup in elderly patients 1 year after surgery. Secondary outcomes include the number of revision surgeries, patient-reported outcome measures (PROMs), and cost-effectiveness.Methods and analysis — This is a prospective multicenter nationwide, single-blinded RCT nested in the Dutch Arthroplasty Registry. Patients ≥ 70 years old, undergoing elective primary THA using the posterolateral approach, will be eligible. After written informed consent, 1,100 participants will be randomly allocated to the intervention or control group. The intervention group receives a THA with a DM cup and the control group a THA with a UP cup. PROMs are collected preoperatively, and 3 months, 1 and 2 years postoperatively. Primary outcome is the difference in number of dislocations between the UP and DM cup within 1 year, reported in the registry (revisions), or by the patients (closed or open reduction). Data will be analyzed using multilevel models as appropriate for each outcome (linear/logistic/survival). An economic evaluation will be performed from the healthcare and societal perspective, for dislocation and quality adjusted life years (QALYs).Trial registration — This RCT is registered at www.clinicaltrials.gov with identification number NCT04031820.

Correlation between C-reactive protein/albumin and contralateral hip refracture after total hip arthroplasty in elderly patients with hip fractures.

There is still a risk of refracture of the contralateral hip after total hip replacement, to analyze the expression of C-reactive protein (CRP) and albumin (Alb) in elderly patients with contralateral hip refracture after total hip arthroplasty (THA), and to determine its correlation with the risk of post-surgery refracture and guide the prediction of the risk of contralateral hip fracture in the future. The medical records of elderly patients who suffered hip fracture and underwent THA at our hospital between July 2016 and July 2019 were reviewed, and 224 eligible patients were finally enrolled. The patients were divided into the refracture group and the control group according to the incidence of contralateral hip refracture. The baseline data of the two groups were compared, and all relevant laboratory tests were performed before surgery. The serum levels of CRP and Alb were compared, along with the CRP/ Alb ratio, between the two groups to establish whether CRP/Alb is a predictor for post-surgery contralateral hip refracture in elderly patients. Twenty (8.93%) of the 224 patients suffered post-surgery contralateral hip refracture. There were no significant differences in the baseline data of the refracture and control groups (P>0.05). However, the patients who experienced refracture had significantly higher CRP levels and lower Alb levels compared with the controls, resulting in an elevated CRP/Alb ratio in the patients with refracture (P<0.05). Serum CRP level was negatively correlated to that of Alb (r=-0.443, P<0.001). The linear regression equation was Y=2.718-0.598X, indicating that the CRP/Alb ratio is a risk factor for contralateral hip refracture in elderly hip fracture patients following THA (P<0.05). The area under the receiver operating characteristic (ROC) curve of the CRP/Alb ratio as a predictor for post-THA contralateral hip refracture was 0.841 (95% CI: 0.702-0.914). The optimal cutoff value was 1.12, which corresponded to high specificity and sensitivity of 0.782 and 0.945, respectively, and the Youden index was 0.727. Serum CRP level is closely associated with Alb level in elderly hip fracture patients, and the CRP/Alb ratio is a risk factor for post-THA contralateral hip refracture. Therefore, preoperative measurement of serum CRP/Alb level can assist with predicting the risk of post-THA refracture in elderly hip fracture patients.

Effect of subarachnoid anesthesia combined with propofol target-controlled infusion on blood loss and transfusion for posterior total hip arthroplasty in elderly patients.

Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA. Totally, 240 patients (aged ≥65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, n = 80), GA (group G, n = 80), or subarachnoid anesthesia and propofol TCI (group T, n = 80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test. Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53 ± 64.33 mL) and group G (308.03 ± 64.90 mL) were significantly less than group C (455.40 ± 120.48 mL, F = 65.80, P < 0.001). Similarly, the autologous transfusion of group T (130.99 ± 30.36 mL) and group G (124.09 ± 24.34 mL) were also markedly less than group C (178.31 ± 48.68 mL, F = 52.99, P < 0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Z = 2.47, P = 0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (F = 496.84, P < 0.001), 10-min after the beginning of operation (F = 351.43, P < 0.001), 30-min after the beginning of operation (F = 559.89, P < 0.001), 50-min after the beginning of operation (F = 374.74, P < 0.001), and at the end of operation (F = 26.14, P < 0.001) among the three groups. Length of stay in PACU of group T (9.41 ± 1.19 min) was comparable with group C (8.83 ± 1.26 min), and both were significantly shorter than group G (16.55 ± 3.10 min, F = 352.50, P < 0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, χ = 7.96, P = 0.004) and G (69/80, χ = 5.01, P = 0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, χ = 4.10, P = 0.043) and group C (2/80, χ = 5.76, P = 0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected. Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications. chictr.org.cn: ChiCTR-IPR-17013461; http://www.chictr.org.cn/showproj.aspx?proj=23024.

The effect of post-operative ultrasound-guided transmuscular quadratus lumborum block on post-operative analgesia after hip arthroplasty in elderly patients: A randomised controlled double-blind study.

Background and Aim:The best analgesic technique after hip surgeries is a matter of debate. This clinical trial aimed to assess the effect of transmuscular ultrasound-guided quadratus lumborum (QL) block on post-operative analgesic consumption after hip arthroplasty in elderly patients.Methods:This prospective randomised double-blind study was carried out on 60 patients aged 60–80 years presented for total hip replacement under unilateral spinal anaesthesia. Patients were randomly allocated to one of two groups: A control group, receiving sham transmuscular QL block (QLB) (1 ml of normal saline), and a QL group, receiving real transmuscular QLB (30 ml of plain bupivacaine 0.25%). Post-operative morphine consumption (primary outcome), post-operative pain score (secondary outcome), time to the first request of rescue analgesia, patient's satisfaction and the occurrence of post-operative complications were measured.Results:Compared to the control group, the use of QLB in the second group significantly decreased intravenous morphine consumption postoperatively from 8.50 ± 3.06 mg to 5.60 ± 3.22 mg (P = 0.0007) with a significant prolongation of the time to the first call for analgesia (P < 0.0001). It also decreased the post-operative visual analogue score 4 h, 6 h and 8 h postoperatively (P < 0.05). However, there was no difference between both the groups regarding patient's satisfaction and the occurrence of complications (P > 0.05).Conclusion:The use of transmuscular QLB in patients undergoing total hip replacement decreased post-operative analgesic consumption and post-operative pain score and prolonged post-operative analgesia. It did not affect patients' satisfaction and occurrence of post-operative complications.