Hip Hemiarthroplasty In Patients Research Articles

Comparative analysis of the quality of the cement mantle in hip hemiarthroplasty after femoral neck fracture between three different surgical approaches: a single-center retrospective observational study.

Achieving the initial stability of implants is necessary for hip hemiarthroplasty (HHA), especially in elderly patients, and this can be achieved with a cement mantle of quality. The direct anterior approach (DAA) for HHA lately has shown positive results. However, evidence is lacking of HHA in elderly patients with osteoporosis after femoral neck fracture (FNF). This study compares differences in cement mantle quality after HHA, its complications, radiological outcomes and functional status in elderly patients with FNF intervened through different approaches. A non-interventional, retrospective case-control study was conducted. 150 cases were selected based on the surgical approach (DAA, DLA and PLA) in a 1:1:1 proportion between 2018 and 2019. Under 75years old suspicion or confirmation of a pathological fracture were excluded. Antibiotic-loaded cement was utilized. Cement preparation involved vacuum centrifugation and standard instructions for preparation canal and filling, and prosthesis placement were followed. No statistically significant differences in cement mantle quality, radiological outcomes, and the majority of the postoperative complications and functional status considering the surgical approach (p > 0.05). However, the DAA was associated significantly with shorter hospital stays (8.3days vs 11.3 and 13days for DLA and PLA) a decrease in postoperative blood transfusion (22% vs 34% and 53%), and lower rate of loss of walking (8% vs 20% and 28.6%). The DAA for HHA in patients with FNF provides a high-quality cement mantle, similar to other approaches. Also, the DAA shows advantages like shorter hospital stays and lower transfusion rates in elderly patients.

Acetabular erosion after bipolar hip hemiarthroplasty for femoral neck fracture in elderly patients: a retrospective study.

The choice between total hip arthroplasty (THA) and hemiarthroplasty (HA) to treat displaced femoral neck fractures, particularly among the elderly, is still controversial. Acetabular erosion consists of a late multifactorial process that may happen after hip HA resulting in significant postoperative burden. This study aims to investigate the impact of acetabular erosion progress after hip HA in patients over 70 years old. This is a 5-year (2013-2018) retrospective study including consecutive series of patients >70 years who were treated with bipolar hip HA for femoral neck fractures. Patients were categorised into 3 groups for analysis (A = 70-75 years, B = 75-80 years, C = >80 years). The study enrolled a total number of 813 patients who met the inclusion criteria. We assessed acetabular erosion through radiological examinations and measured functional deterioration using the modified Harris Hip Score (mHHS) at 6 and 12 months follow-up. Our comprehensive investigation extended over a maximum period of 5 years. The correlation of patients' characteristics and HA features on erosion progress was assessed. There were no significant differences in sex distribution, injury side, BMI, ASA score, bipolar head diameter, mHHS and leg-length discrepancy among the groups (p > 0.05). During the follow-up period, acetabular erosion with consequential conversion to THA was observed in 6.13%, 4.22% and 1.96% for Groups A, B and C respectively (p = 0.009). A statistically significant difference of acetabular erosion was observed in Group A compared to patients of Group C. Age constitutes a significant factor of acetabular wear after HA in the elderly. The higher rate of acetabular wear in patients <75 years suggests that THA is a more viable option, as HA is for patients >80 years old.

Hip hemiprosthesis due to femoral neck fracture in the elderly population - are we doing it right?

Femoral neck fracture is one of the most common orthopaedic traumas affecting the elderly population. The standard treatment method is hip hemiarthroplasty and total hip arthroplasty. In hip hemiprostheses surgeons mainly have to reconstruct the femoral offset and limbs' length to obtain the correct gait biomechanics and a satisfactory surgical outcome.The aim of this study is to examine the radiological results of patients after hip hemiarthroplasty for femoral neck fracture and to evaluate the reconstruction of the femoral offset using standard neck angle stems. A consecutive series of 97 patients diagnosed with femoral neck fracture treated with a hip hemiprosthesis between 2017 and 2021 was identified and met the inclusion criteria. On preoperative images, the neck-shaft angle and the femoral offset on the healthy limb were measured. The femoral offset of the operated limb was measured on the postoperative X-rays. There was a significant positive moderate correlation between neck-shaft angle and femoral offset change (r = 0.568, p < 0.0001). There was a statistically significant difference between femoral offset change and neck-shaft angle (24:52 vs. 14:7, p = 0.005). This means that in patients with coxa vara the change in femoral offset was more often < -5 mm. Less than half of operated patients had the femoral offset restored within a safe range (between -5 and 5 mm). Our study proved that it is sometimes hard to achieve femoral offset within a safe range while performing hip hemiarthroplasty in patients with coxa vara. The topic of using high offset stems in partial hip arthroplasty has not been thoroughly researched worldwide. However, taking into account the results of our study, during a hip hemiarthroplasty the usage of high offset stems for varus hips should be considered in order to improve the clinical outcome and improve patients' quality of life and functioning.

Is there a higher risk of dislocation of hip hemiarthroplasty in patients with neuromuscular conditions? A clinical study of 3827 patients

Aim of the studyThe aim of this study is to identify if there is any association between neuromuscular disorders and prosthetic dislocation in patients treated with hip hemiarthroplasty for neck of femur fractures. Patients and methodsOur study is a retrospective analysis of data collected over 34 years for patients with intracapsular neck of femur fracture who underwent hip hemiarthroplasty. Pathological fractures and patients treated with other treatment modalities were excluded. The study population is composed of four groups; patients with no neuromuscular disorders, patients with Parkinson's disease, patients with previous stroke, and patients with mental impairment. ResultsA total of 3827 patients were treated with hip hemiarthroplasty. For the 3371 patients with no neuromuscular condition (Group I) the dislocation rate was 1.1%. 219 patients had Parkinsonism (Group II) with a dislocation rate of 3.2%, 104 patients had a previous stroke with weakness on the fracture side with a dislocation rate of 1.0% (Group III), and 984 patients had severe mental impairment with a dislocation rate of 1.8% (Group IV). The increased dislocation rate for those with Parkinson's disease was statistically significant (p = 0.02) while none of the other neuromuscular conditions were statistically significant. ConclusionOur study demonstrates an increased risk of dislocation after hemiarthroplasty for patients with Parkinson's disease in comparison to other groups. No increase was apparent for those with mental impairment or weakness from a previous stroke.

The effects of capsular repair on quality of life after hip arthroplasty with the anterolateral approach

Background/Aim: Hip fractures, commonly observed worldwide, cause severe functional problems and pose an economic burden. This study investigated the effects of different surgical approaches of joint capsule repair on morbidity and mortality and aimed to increase the quality of life after surgery with the most proper treatment option. Methods: This prospective case-control study was conducted on 186 patients over 65 years of age admitted to our clinic from 2006 to 2012 for displaced femoral neck fracture. All patients were treated via a hemiarthroplasty. The patients (66 males, 110 females with an overall mean age of 80.43 years (70-90)) were followed up regularly. All patients were divided into two groups: Group 1 was treated with capsular repair, and Group 2 without. The groups were compared in terms of pre-and peri-operative data, demographics, concomitant diseases, post-operative complications, mortality rates, pain level, and hip scores. Hospitalization time, average surgical duration, and time from fracture to the operation were also noted. Results: We found no significant differences between the groups in terms of surgery preferences (P>0.05). The survival of patients was significantly higher, blood loss was significantly less, and perioperative mortality rates were insignificantly lower in the noncapsular repair group (p=0.005, p=0.015, and p=0.515, respectively). Conclusion: The use of capsule repair during hip hemiarthroplasty in patients over 65 years of age had no negative impact on mortality or morbidity. Surgical preference changes during hip arthroplasty procedures are essential.

Cemented Vs Uncemented modular Bipolar hemiarthroplasty treatment for femoral neck fracture in elderly patients

ObjectivesFemoral neck fractures in the elderly are associated with high morbidity and mortality. The optimal treatment remains controversial regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients. MethodsThis study included 84 patients over 64 years of age with fracture neck femur treated with cemented and uncemented Modular Bipolar hemiarthroplasty. The patients (49 female, 35 male; mean age: 79.5 years; range: 64–95 years) included and were followed-up regularly till 02 years. Patients were divided equally into two groups: group A(n=42) was treated with cement; and group B(n=42) without cement. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. ResultsWe found no statically significant between-groups differences in terms of length of hospital stay, Harris Hip Score and complications. However in Uncemented group 03 patients developed loosening of implant at the end of 2year without any clinical of biochemical sign of infection. Walking ability and pain scores were better in the cemented group in the early follow-up period. ConclusionBased on our study we reached the conclusion that the use of cement during hip hemiarthroplasty in patients over 64 years of age who invariably has osteoporotic bone and wide femoral canal had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.

Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients?

ObjectivesControversy exists regarding the use of cement in hemiarthroplasty when treating a displaced femoral neck fracture in elderly patients. The primary hypothesis of this study was that the use of cement would afford better visual analog pain and activity scores in elderly patients.MethodsThis study included 133 patients over 65 years of age admitted to our clinics from 2006 to 2012 for the surgical treatment of a displaced femoral neck fracture. All patients were treated via hemiarthroplasty. The patients (66 males, 67 females; mean age: 78.16 years; range: 60–110 years) were followed-up regularly. All patients were divided into one of two groups: group A was treated with cement; and group B without. Both groups were compared in terms of preoperative features (demographics and associated diseases), pre- and postoperative complications, mortality rates, pain and activity levels, and hip scores. Hospitalization time, average surgical duration, and time from fracture to operation were also recorded. Mean follow-up duration was 30.9 (range: 5–51) months.ResultsWe found no significant between-groups differences in terms of length of hospital stay, Harris Hip Score, complications, or follow-up mortality rates. Walking ability and pain scores were better in the cemented group in the early follow-up period. Duration of surgery and perioperative mortality rates were somewhat lower in the cementless group, but the difference was not statistically significant.ConclusionThe use of cement during hip hemiarthroplasty in patients over 65 years of age had no negative impact on mortality or morbidity. Hemodynamic changes during cement application are important, but it is noteworthy that patients fitted with cemented endoprostheses had increased levels of activity and lower pain levels.

Bipolar cemented hip hemiarthroplasty in patients with femoral neck fracture who are on hemodialysis is associated with risk of stem migration

Background and purpose Femoral neck fractures are considerably more common in patients on hemodialysis than in the general population. We determined the outcome of bipolar hemiarthroplasty for hip fracture in patients with long-term hemodialysis and compared it with that of a matched-paired group of patients with intact renal function.Methods We analyzed 26 bipolar hemiarthroplasties in 23 hemodialysed patients with a mean age of 56 (41–78) years who were followed for mean 3.6 (1–8) years. These cases were matched for age, sex, and BMI with 26 patients with femoral neck fractures and normal renal function. The mean follow-up time in the control group was 7 (5–10) years. As primary surgery for their femoral neck fracture, all patients had a bipolar hemiarthroplasty with a 28-mm metal-polyethylene internal articulation and a cemented stem.Results The mortality rate was 21% in the hemodialysed group and 4% in the control group (p = 0.005). The bipolar head migrated in 1 patient in the hemodialysed group but in none of the patients in the case-matched group. In the hemodialysed group, 8 stems migrated and 3 of these were revised, whereas in the control group 3 stems migrated and 2 were revised. The stem migration in the hemodialysed group was not preceded by the development of osteolysis or radiolucent lines at the bone-cement interface. The cumulative survival for prosthesis migration as endpoint was 44% at 5 years in the hemodialysed group and 96% in the control group (p = 0.03).Interpretation The main mode of failure of cemented bipolar hemiarthroplasties in hemodialysed patients is stem migration, due to failure of the bone-cement interface.

Acetabular Outcome after Hip Hemiarthroplasty in Patients with Tumors

Acetabular Outcome after Hip Hemiarthroplasty in Patients with Tumors

Acetabular Outcome after Hip Hemiarthroplasty in Patients with Tumors

Hip hemiarthroplasty is performed routinely on patients with tumors of the proximal femur, although the long-term effect on the native acetabulum is unknown. We measured the amount of femoral head migration that would occur with intermediate and long-term followup. We also measured the amount of groin pain experienced by patients with longer followup and the overall rate of conversion to total hip arthroplasty. From a surgical database, we identified 442 patients with tumors who had 447 hip hemiarthroplasties without or with an allograft composite. We reviewed the medical records and radiographs of 32 patients with at least 5 years followup (median followup, 10 years) to determine their clinical and radiographic outcomes. The median proximal and medial migration measurements were 3 mm (range, 0-24 mm) and 2 mm (range 0-20 mm), respectively. Thirty-one patients had minimal or no groin pain. Seven of the 447 arthroplasties (1.6%) were converted to total hip arthroplasties. Even patients with long-term followup usually had minimal pain and radiographic changes. The overall rate of conversion to total hip arthroplasty was low. Concern regarding excessive acetabular wear resulting in conversion to total hip arthroplasty in patients with tumors is not supported by our data.

Dislocation Rate After Hip Hemiarthroplasty in Patients with Tumor-Related Conditions

Hemiarthroplasty is frequently used to treat femoral neck insufficiency resulting from neoplastic disease in the proximal part of the femur. The authors of a recent study analyzed the dislocation rates following hemiarthroplasty but excluded patients with tumor involvement of the site of the surgery as they hypothesized that the dislocation rates would be markedly higher in such patients. The current study was performed to compare the dislocation rate following hemiarthroplasties performed in patients without tumor involvement with the rate following hemiarthroplasties in patients with tumor involvement of the surgical site. Patients who had undergone hemiarthroplasty following resection of a tumor involving the proximal part of the femur were identified in a total joint registry, and the patients' charts were reviewed retrospectively to determine dislocation rates, preoperative conditions, and postoperative outcomes and treatments. Between 1974 and 2001, 1812 patients were treated with hemiarthroplasty for reasons other than tumor involvement and 320 hemiarthroplasties were performed because of tumor-related conditions. The patients who were treated for a tumor-related condition were younger, and a higher proportion of them were men. The ten-year dislocation rate after the hemiarthroplasties performed for tumor-related conditions (10.9%) was higher than that following the hemiarthroplasties performed for non-tumor-related conditions (2.1%) (p = 0.002). The median time to dislocation in the patients with a tumor-related condition (twenty-four days) was shorter than that for the patients without tumor involvement (thirty-seven days). Preservation of the greater trochanter in patients with tumor involvement did not have a significant influence on the dislocation rate, but it showed a favorable trend toward decreasing that rate (hazard ratio = 3.5, p = 0.06). The short-term and long-term dislocation rates associated with hemiarthroplasties performed for a tumor-related condition at the site of the surgery were significantly higher than those associated with hemiarthroplasties performed for reasons other than tumor involvement. Preservation of the greater trochanter showed a trend toward decreasing the likelihood of dislocation following the hemiarthroplasty, and it was more influential than the level of resection and the extent of soft-tissue compromise. We think that preservation of the greater trochanter should be attempted when it is justifiable according to the principles of oncologic surgery.