Hip Hemiarthroplasty Research Articles

Symptomatic Acetabular Erosion After Hip Hemiarthroplasty: Is It a Major Concern? A Retrospective Analysis of 2477 Hemiarthroplasty Cases

Background/Objectives: Acetabular erosion is a postoperative condition that can occur after hip hemiarthroplasty (HA), potentially leading to pain and requiring conversion to total hip arthroplasty (THA). Given the discrepancy in its incidence and impact in the literature, this study aims to report the incidence of symptomatic acetabular erosion and the subsequent conversion to THA in all HA cases performed in a single health system. Methods: A total of 2477 HA cases had their clinical notes and serial radiographs examined for this retrospective study. Outcome measures included any records of hip or groin pain and conversion to THA that were attributed to acetabular erosion as documented in the clinical notes. Results: Two thousand four hundred and seventy-seven HA cases were reviewed in this study. The mean age for all patients in the study was 81.5 years and the mean follow up was 3.7 years. Out of the 2477 HA cases, only 12 HA cases (0.48%) in 12 patients had data records of chronic hip pain, attributable to acetabular wear in the clinical notes, of variable severity and presentations. The mean duration until the clinical documentation of acetabular wear-induced pain was 25.6 months (range, 1.4–146.4 months), with most symptomatic hip erosion cases presented within the first year (50% presented within the first 6 months) after the index HA surgery. Despite that, only five cases underwent conversion to THA (0.2%) while seven patients received conservative management. Conclusions: In patients older than 65 years of age who are candidates for HA, the incidence of symptomatic hip erosion and the subsequent conversion to THA is low and hence HA remains a viable treatment option. Based on the duration until clinical presentation of acetabular erosion, this study suggests that the state of acetabular cartilage during surgery may influence the development of early acetabular wear in most symptomatic patients. On the other hand, hip hemiarthroplasty is a rare treatment option for displaced femoral neck fractures in patients younger than 65 years of age, and its use in this patient subset depends on conditional and patient-related factors such as the activity level, cognitive function, and medical comorbidities.

Cost-effective Skin Marking in Joint Replacement Surgery: A Comparative Study between Methylene Blue Ink and Commercially Available Skin Markers.

This study aimed to assess and compare the effectiveness and safety of methylene blue ink and commercially available surgical marker pens in pre-operative skin marking for joint replacement procedures. The objective was to evaluate the visibility of the surgical instruments during the operation and their influence on the occurrence of infections after the surgery, providing valuable information on the practical use and cost-effectiveness. This retrospective randomized study involved 150 total cases, which included knee replacements, total hip replacements, and hip hemiarthroplasty performed between 2020 and 2023. The same surgeon conducted all procedures, and the patients were randomly assigned to two groups: One marked with methylene blue ink and the other with a commercially available sterile marker pen. Limb preparation followed an identical protocol for both groups. The primary outcomes assessed were the visibility of markings at the end of the procedure and the incidence of post-operative infections. The visibility of markings was satisfactory in both groups, with the methylene blue group displaying more pronounced visibility. Importantly, there were no cases of post-operative infections or permanent tattooing attributed to either marking method. This study demonstrates that both methylene blue ink and commercially available surgical marker pens provide effective skin markings for surgical procedures without increasing the risk of post-operative infections or causing permanent tattooing. Methylene blue ink showed more evident marking post-procedure and ink form remains a cheaper alternative.

Cemented Modular Bipolar Hip Hemiarthroplasty: Outcomes in Elderly with Femoral Neck Fracture

Cemented Modular Bipolar Hip Hemiarthroplasty: Outcomes in Elderly with Femoral Neck Fracture

Cemented Hemiarthroplasty Results in Substantial Cost Savings Over Uncemented Hemiarthroplasty for the Treatment of Femoral Neck Fractures in Patients Over 60 Years Old: A Markov Analysis

BackgroundWhile there is growing scientific evidence supporting superior outcomes following cemented versus uncemented hip hemiarthroplasty (HHA) in elderly femoral neck fractures (FNFs), the relative cost-effectiveness of this in the United States is unknown. Thus, the purpose of this study was to compare the cost-effectiveness of cemented versus uncemented HHA for the treatment of FNFs in patients > 60 years old in the United States, accounting for postoperative outcomes including periprosthetic fractures. MethodsA Markov model utilizing Monte Carlo microsimulation was developed to evaluate the outcomes and costs of patients at least 60 years of age (mean ± standard deviation, 84 ± 8 years) undergoing cemented versus uncemented HHA for the treatment of FNFs. Health utility values, transition probabilities, and upfront costs were derived from the published literature. Outcome measures included average total costs associated with each treatment (including those from patients who sustained a periprosthetic fracture), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). ResultsMean total costs resulting from cemented and uncemented HHA were $19,462 ± 3,581 and $21,997 ± 3,574, respectively (upfront costs from the published literature were $18,267 for cemented HHA and $16,803 for uncemented HHA). Average QALYs resulting from cemented and uncemented HHA were 4.0 ± 0.7 and 3.1 ± 0.6. The resulting ICER was -$2,688.9/QALY. Cemented HHA was found to be the most cost-effective treatment strategy in 89% of the patients in the Monte Carlo microsimulation model. ConclusionDespite documented higher upfront costs for cemented HHA, the averaged total costs over a 10-year time horizon were $2,534 less for cemented HHA than for uncemented HHA. In addition, cemented HHA resulted in an additional 0.9 QALYs relative to uncemented HHA. The findings of this United States-based study replicate the financial and quality-of-life benefits of cemented HHA for elderly FNFs seen in other health systems.

Efficacy of Intraarticular Vancomycin in Preventing Infection in Patients Undergoing Hip Hemiarthroplasty

Background: Hip fractures are among the top ten causes of disability in adults worldwide. Patients with hip fracture are at significant risk of mortality and morbidity and reduced quality of life. This study was conducted with the aim of investigating the effect of intra-articular vancomycin in preventing infection in patients undergoing hip hemiarthroplasty. Materials and Methods: This double-blind controlled clinical trial study was conducted on 48 patients with femoral neck fracture candidates for hip hemiarthroplasty hemiarthroplasty in Orthopedic clinic of Golestan and Imam Khomeini Hospital, Ahvaz, Iran between June and November 2023. Eligible patients were divided into two equal groups. The intervention group received 1gram vancomycin intra-articularly during the operation before closure of fascia, and the control group did not receive vancomycin. The patients were followed up for 6 months after the operation, and the rate of superficial infection, periprosthetic joint infection (PJI) and wound complications were compared in two groups. The obtained data were statistically analyzed with IBM SPSS Statistics 21.0 for Windows. Results: The vancomycin group and the control group had no significant difference in the incidence of overall infection. The PJI in vancomycin and control groups were 4.16% and 8.33%, respectively. This difference was not statistically considerable (P=0.55). The results showed the incidence of superficial estimated 8.33% in vancomycin group and 4.16% in control group with no considerable difference in infection (P=0.52). Moreover, there was no meaningful difference in side effects between the two groups (P=0.63). There was no significant difference in wound complications between the two groups (P=0.3). . Conclusion: Intra-articular injection of 1gram of vancomycin suspension did not reduce the overall, superficial and deep infection after surgery. It is suggested that more clinical trial studies with higher sample size be conducted.

Tripolar total hip arthroplasty versus Bipolar hip hemiarthroplasty in displaced femoral neck fracture in elderly: a randomized controlled trial

Tripolar total hip arthroplasty versus Bipolar hip hemiarthroplasty in displaced femoral neck fracture in elderly: a randomized controlled trial

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.

THE X-RAY CALIBRATION PROJECT

Increasing the accuracy of information provided through X-Rays maximises pre-operative planning. Aim of this project is to determine the necessity of calibration probes that would improve the accuracy of pre-operative templating. This is a retrospective study involving leg length and pelvis X-Rays performed across the NHS Lanarkshire from 01/03/2023 until 31/04/2024.A total of 87 leg length X-Rays were identified, 18 had a calibration probe present. Leg length was measured on each and the X-Rays were calibrated against the existing probe. In 66.7% of cases there was a major leg length discrepancy of over 2cm between the pre-calibrated and post-calibrated X-Rays. Pelvic X-Rays of 80 patients that underwent total hip replacement were reviewed. Preoperative templating was compared to the implants inserted. An average of 1.94 discrepancy in the size of the acetabular implant was identified whilst in 30 cases the size of the femoral stem was incorrect by at least 1 size. Magnification of 119.7% on X-Rays was found to provide the most accurate templating. Seventy seven cases of pelvic X-Rays before and after hip hemiarthroplasty were also reviewed. The implant head was templated incorrectly in 74% of cases and the stem in 51%. It was identified that pelvic X-Ray magnification of 121.7% would provide the most accurate results.X-Rays with no calibration probes provide inaccurate measurements leading to faulty preoperative planning. Standardised use of a calibration sphere is strongly suggested and whenever that is not available, we suggest magnification of 121%.

Outcomes and Management of Dislocated Hip Hemiarthroplasty.

Purpose and aims Hip hemiarthroplasty (HHA) is a common procedure undertaken to manage intracapsular neck of femur fractures. Dislocation of HHA is one of the most dreadful complications. There is a paucity of clinical evidence to guide decision-making for managing these patients. The aim of this study was to describe the operative management and outcomes of patients with dislocated hemiarthroplasties of the hip and outline a treatment strategy for their management. Methods We conducted a retrospective analysis of all the patients presenting to University Hospitals of Derby and Burton, UK with hip fractures between 2016-2022. We included all the patients who underwent a hemiarthroplasty for their fracture. We excluded patients who had malignancy and if clinical data was missing. Each operative intervention and subsequent dislocationswere recorded. We recorded the following outcome measures: dislocation, surgical interventions, mortality, revision surgery, cognition status, residential status, and mobility. We also compare these outcomes with the patients who had HHA and did not sustain any dislocation. Results Of the 1134 patients treated with HHA during this period, 33 patients sustained dislocation. Of the 33 patients, 29 were female and 4 were male with mean ages of87.4±7.4 and89.25±9.54,​ respectively. Following the first dislocation, 25 patients were treated with closed reduction, six patients had excision arthroplasty (EA), and two patients were treated non-operatively. About 21 patients went on to have second and third dislocations, none of these had EA and others had conversion to total hip replacement (THR). Nearly 80% of dislocations occurred within two months of the initial procedure. The mean mental test score was 7.91±2.01 (p=0.001) and was significantly higher in patients who underwent conversion to THR. The average ASA grade was significantly higher in patients who had closed reduction (2.93±0.25, p=0.001)and EA (3.28±0.46, p=0.002)compared to the patients who had no dislocation. Patients who underwent EA had significantly higher acute length of hospital stay23.5±13.5(p=0.02) and mortality (p=0.001)compared to other groups. We found no significant difference in dislocation rates where the initial procedure was carried out by registrars or consultants (p=0.567). Conclusion We concluded that the dislocation risk is higher in females and within the first two months of the index procedure. More than 80% of patients had a second dislocation following a successful closed reduction. In our cohort, 45% of patients had EA (Girdlestone procedure) and 36% had a conversion to THR. EA was associated with increased mortality rates, acute length of hospital stays, and significant change to premorbid mobility status. Amultidisciplinary team (MDT) approachis necessary following the second dislocation to prevent further morbidity associated with recurrent dislocations.

Trends and Factors Influencing Surgical Choices for Femoral Neck Fractures

Introduction: Femoral neck fractures pose significant health risks, particularly in the elderly population, leading to mortality, morbidity, and decreased quality of life. Surgery is the preferred treatment to restore function and alleviate pain, with options including total hip arthroplasty (THA) and hemiarthroplasty (HA). However, clinical guidelines for selecting surgical procedures remain heterogeneous, prompting the need for further investigation into treatment trends and influencing factors. Methods: Data from the NIS database spanning 2016–2019 were analyzed, focusing on patients diagnosed with intracapsular femoral neck fractures and undergoing THA or HA as primary in-hospital surgeries. Advanced statistical analyses using SPSS and MATLAB were conducted to identify trends and factors influencing surgical choices. Results: Comorbidity profiles varied significantly between HA and THA patients, with specific conditions such as Alzheimer’s disease showing higher prevalence in HA patients. Demographic differences included a higher proportion of females and Medicare-insured individuals in the HA group. Racial disparities were observed, with differences in surgical preferences among various ethnic groups. THA adoption gradually increased over the study period, indicating a shift in surgical priorities. Additionally, THA patients tended to be younger on average compared with HA patients. Conclusions: This study highlights evolving trends in surgical management for femoral neck fractures and identifies factors influencing treatment decisions in our cohort. Understanding these trends and disparities is crucial for optimizing patient care and informing future clinical guidelines. Further research should focus on assessing different surgical approaches’ long-term outcomes and cost-effectiveness.

Liposomal Bupivacaine Does Not Decrease Postoperative Pain in Patients with Intracapsular Femoral Neck Fracture Treated with Hemiarthroplasty: HEAT-A Randomized, Controlled Trial.

Liposomal bupivacaine (LB) is a long-lasting local anesthetic agent that was developed for use in the surgical setting to help manage postoperative pain. The objective of this study was to evaluate the effect of LB on postoperative pain, function, and overall hospital course in patients with intracapsular hip fractures who were treated with hip hemiarthroplasty. This was a single-center, randomized prospective double-blinded study of 50 patients with an isolated intracapsular femoral neck fracture who were treated with hip hemiarthroplasty from 2018 to 2022. The study group consisted of 25 patients who were treated with intraoperative LB and bupivacaine hydrochloride injections, while the control group consisted of 25 patients who were treated with intraoperative bupivacaine hydrochloride injections only. Primary outcomes were a visual analog scale (VAS) score for pain, total morphine milligram equivalents (MME), delirium, and time to ambulation with physical therapy. No significant differences between the study and control groups were found in any of the outcomes measured. Most notably, there were no differences in the average postoperative pain score (VAS, 2.26 versus 2.7; p = 0.34), total MME used postoperatively (11.73 versus 9.98 MME; p = 0.71), and postoperative day of discharge (4.00 versus 3.88 days; p = 0.82). The results of our study suggest that use of LB is not associated with substantially improved postoperative pain or function or with a shorter hospital course following hip hemiarthroplasty for a femoral neck fracture. Given the higher cost of LB compared with standard postoperative pain modalities, it is worth questioning its use in the setting of geriatric hip fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Mapping Staphylococcus aureus at Early and Late Stages of Infection in a Clinically Representative Hip Prosthetic Joint Infection Rat Model.

Prosthetic joint infection (PJI) continues to be a devastating complication following total joint replacement surgeries where Staphylococcus aureus is the main offending organism. To improve our understanding of the disease pathogenesis, a histological analysis of infected peri-implant tissue in a hip PJI rat model was utilized to assess S. aureus spread and tissue reaction at early and late stages of infection. Sprague-Dawley rats were used and received a left cemented hip hemiarthroplasty using a 3D-printed titanium femoral stem. The rats received an intra-articular injection of S. aureus Xen36. These infected rats were sacrificed either at 3 days post-infection (early-stage infection) or at 13-days post-infection (late-stage infection). The femoral and acetabular tissues of all animals were harvested at euthanasia. Histological analysis for the harvested tissue was performed using immunohistochemistry, hematoxylin and eosin, as well as Masson's trichrome stains. Histological examination revealed significant quantitative and qualitative differences in peri-implant tissue response to infection at early and late stages. This hip PJI rat model identified clear histologic differences between early and late stages of S. aureus infection and how quickly bacterial infiltration could occur. These findings can provide insight into why certain surgical strategies like debridement and antibiotics may be associated with high failure rates.

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.

First hip hemiarthroplasty in a Göttingen Minipig; surgical and post-mortem protocol

BackgroundProsthetic joint infections (PJI) are recalcitrant, hard-to-treat infections and severe complications of joint arthroplasty. Therefore, there is a need to develop new effective treatment strategies, and animal models of high clinical relevance are needed. This study aimed to develop a detailed surgical protocol for hip hemiarthroplasty in Göttingen minipigs and a thorough post-mortem sampling protocol to pave the way for creating a minipig PJI model.MethodsThree adult female Göttingen minipigs underwent surgery with insertion of a hip hemiarthroplasty, using the anterior approach to the hip joint. After surgery the minipigs were followed closely with daily clinical evaluation and gait scoring. Comprehensive post-mortem analyses were performed with evaluation of macroscopic lesions, microbiology, synovial fluid analysis and histology.ResultsThe study resulted in the first Göttingen minipig with hip hemiarthroplasty and identified several points of awareness when inserting a hip prosthesis in minipigs, especially the high risk of joint dislocation. A spontaneous PJI occurred in one of the minipigs, revealing an impaired ability of the immune cells to reach the bacteria at the bone-prosthesis interface.ConclusionThe present study provides a detailed description of surgical technique and post-mortem sampling and validates the suitability of the hip hemiarthroplasty minipig model for future experimental modeling of PJI.

Shall We Not Pressurise It? Effects of Bone Cement Pressurisation on Mortality and Revision Following Hip Hemiarthroplasty for Neck of Femur Fracture Patients: A Comparative Cohort Study.

This study aimed to compare 30-day post-operative mortality, and revision for aseptic femoral component loosening and all-causes following hip hemiarthroplasty performed with or without pressurisation of the bone cement in neck of femur fracture patients. Design: Retrospective cohort study. Level I trauma center. Patients ≥60 years with OTA/AO 31B who underwent a cemented hip hemiarthroplasty from 10th December 2007 (database inception) to 15th November 2023 (search date) were reviewed.Outcome Measures and Comparisons: Comparisons were made between patients who underwent hip hemiarthroplasty with versus without pressurisation of the bone cement for outcomes 30-day post-operative mortality, revision for aseptic femoral component loosening, and revision for all-causes. 406 procedures among 402 patients, and 722 procedures among 713 patients were performed with and without pressurisation of the bone cement respectively. Mean ages were 83.1 and 84.3 years (p=0.018), with 72.2% and 68.6% (p=0.205) females in the pressurised and non-pressurised cement patient groups respectively. There were no differences in 30-day post-operative mortality (7.2% versus 8.2%; HR 0.89, 95%CI 0.46-1.73, p=0.727). There were no differences in all-cause revision (HR 1.04, 95%CI 0.27-4.04, p=0.953). No revisions were performed for aseptic loosening. Survival at 10 years post-operatively was 15.3% (95%CI 11.46-19.64) and 12.6% (95%CI 7.67-18.82) among patients who underwent hemiarthroplasty with and without bone cement pressurisation respectively. There were no differences in 30-day post-operative mortality among patients who underwent hemiarthroplasty with, compared to, without bone cement pressurisation. Bone cement pressurisation did not confer any advantages for revision outcomes which may be attributed in part to patients' high mortality rate and low survival beyond 10 years post-operatively. Level III. See Instructions for Authors for a complete description of levels of evidence.

The Superior Approach in Hemiarthroplasty for Femoral Neck Fracture: A Comparative Analysis with the Posterior Approach.

The concept of a superior approach (SA) involves the use of a tissue-sparing posterior approach (PA), with exposure of the piriformis muscle and gluteus medius/minimus muscles. The objective of this study was to clarify the features of hip hemiarthroplasty (HA) using a SA in regard to early recovery and mid-term outcomes, with a comparison of the outcomes of SA-HAs and HAs using a PA (PA-HAs). A total of 120 HAs for treatment of primary femoral neck fracture with a healthy opposite hip joint were performed in our hospital from 2013 to 2018. Propensity score matching in regard to age, sex, body mass index, walking ability before injury, place of residence, time to surgery, and American Society of Anesthesiologists-Physical Status was performed for 79 patients with SA-HAs and 41 patients with PA-HAs. The final analysis included 34 patients who underwent SA-HAs and 34 patients who underwent PA-HAs. The duration of surgery was 57.1 minutes and 72.1 minutes (P=0.001) for SA-HAs and PA-HAs, respectively. The scores for walking ability at postoperative one week were 4.9±1.4 and 4.2±1.0 (P=0.021) for SA-HAs and PA-HAs, respectively. The Barthel index (BI) at the start of rehabilitation was 26.2±18.7 and 17.4±16.3 (P=0.042) for SA-HAs and PA-HAs, respectively. The 4-year complication-free survival rates were 74.2% and 56.3% for SA-HAs and PA-HAs, respectively (P=0.310). SA-HA can be performed without torsion of the muscles and ligaments around the hip joint. Early recovery of walking ability and BI was a significant feature of SA-HAs.

Sharma's risk assessment score as a decision making tool to decide between total hip arthroplasty or hemiarthroplasty as a treatment option for elderly patients with fracture neck of femur. A prospective observational study

PurposeThe decision to do a total hip arthroplasty (THA) or a hemiarthroplasty (HA) in an elderly with a fracture neck of femur (FNOF) is commonly based upon the surgeon's preference, pre-anesthetic fitness, hospital setup, and intensive care backup. The author devised a Sharma's risk assessment score (SRAS), based upon all the common factors that affect the surgical outcomes following FNOF in the elderly, to help orthopedic surgeons decide between THA or HA as a treatment for FNOF. Material & methodsIt was a prospective observational study conducted in a tertiary-level institute. SRAS is based upon 10 parameters with each parameter having a max score of 4 and a minimum score of 1. So the maximum score a patient can score is 40 and the minimum a patient can score is 10. It was hypothesized that a patient with FNOF with a preop SRAS score >20 if subjected to a (HA) and a patient with a preop SRAS score ≤ 20 if subjected to a (THA) would have better outcomes and low complication rates. Out of Eighty-eight patients with FNOF, 7 were lost to follow-up. The remaining 81 patients with FNOF were prospectively followed between May 2018 and May 2022 and segregated into two groups THA (n = 47) and HA(n = 34) based on the SRAS. ResultsThe average length of follow-up was 2.6 years (6 months–4 years). The average SRAS was an average 25.7(21–32) in the HA group and 16.2 (11–20) in the THA group. Complications were seen in 12.7 % of the THA group and 17.6 % of the HA group. We had a 2.1 % 90-day mortality in the THA group and a 2.9 % 90-day mortality in the HA group. One year mortality in THA was 2.1 % and it was increased to 5.8 % in the HA group. ConclusionSRAS is a useful decision-making tool that would guide surgeons to decide between THA or HA as a treatment option for elderly FNOF and would help minimize post-operative complications and reduce mortality. Level 3 studyProspective observational study.

Clinical outcomes of total joint arthroplasty in patients with bowel ostomies.

The influence of prior colostomy or ileostomy on patients undergoing joint arthroplasty remains poorly understood. Our study aimed to assess whether patients with an ostomy undergoing hip and knee arthroplasties have worse postoperative outcomes and increased rates of revisions. A single-center, retrospective review of patients with a history of bowel ostomy who underwent a primary total hip arthroplasty (THA), hemiarthroplasty (HA), and total knee arthroplasty (TKA) from 2012 to 2021. A total of 24 THAs, 11 HAs, and 25 TKAs in patients with open small or large bowel stoma were identified. A ten-to-one propensity score match was utilized to establish cohorts with comparable demographics but no prior ostomy procedure. Patients with stomas undergoing elective THA showed greater 90-day ED visits (20.0 vs. 5.0%, P = 0.009), 90-day all-cause readmissions (20.0 vs. 5.0%, P = 0.009), 90-day non-orthopedic readmissions (10.0 vs. 0.5%, P < 0.001), 90-day readmissions for infection (5.0 vs. 0.5%, P = 0.043), all-cause revisions (15.0 vs. 0.5%, P < 0.001), revisions for PJI (5.0 vs. 0%, P = 0.043), and revisions for peri-prosthetic fracture (10.0 vs. 0%, P < 0.001). Patients with stomas undergoing non-elective hip arthroplasties exhibited a longer mean LOS (12.1 vs. 7.0 days, P < 0.001) and increased 90-day all-cause readmissions (40.0 vs. 17.3%, P = 0.034), 90-day orthopedic readmissions (26.7 vs. 6.0%, P = 0.005), all-cause revisions (13.3 vs. 2.0%, P = 0.015), revisions for peri-prosthetic fracture (6.7 vs. 0%, P = 0.002), and revisions for aseptic loosening (6.7 vs. 0%, P = 0.002). There were no significant differences in readmission or revision rates between ostomy patients undergoing TKA and a matched control group. Patients undergoing hip arthroplasties with an open stoma are at an increased risk of hospital encounters and revisions, whereas TKA patients with stomas are not at increased risk of complications. These findings emphasize the importance of recognizing and addressing the unique challenges associated with this patient population.

Hemoglobin level, degree of mobilization, and pneumonia are associated with the development of postoperative delirium in cemented hemiarthroplasty after femoral neck fracture.

The aim of this retrospective study was to identify independent prognostic factors for developing a postoperative delirium (POD) in patients suffering from a proximal femoral neck fracture and treated by implantation of a hemiprosthesis. A retrospective study, including patients with hip hemiarthroplasty due to a femoral neck fracture between 2011 and 2020 was performed. Demographic data, preexisting conditions, intra-/postoperative complications, mobilization and laboratory results were extracted from the patients' charts. The different parameters were analyzed comparing patients with and without POD. 412 patients, mean age of 81 ± 9.58 years were included, 66.5% (n = 274) were female, 18.2% (n = 75) of them developed a POD. Significantly higher incidence of POD was associated with older age (p < 0.001), lower level of haemoglobin (p < 0.001), higher post-surgery interleukin 6 (IL 6) level (p = 0.008), higher postoperative level of leukocytes (p = 0.01). Patients with POD received more units of packed red blood cells (PRBC) (p = 0.007). Patients with no mobility limitations pre-operatively developed POD less frequently (p = 0.01), whereas suffering from pneumonia (p = 0.03) or limited mobility postoperatively increased the risk of POD (p < 0.001). This study could help to identify patients with a risk for developing POD after a hemiarthroplasty in femoral neck fractures. As a consequence, frequent controls of Hb, IL 6 and leucocytes levels to avoid anemia and infections, as well as the well surgical treatment to guarantee a good postoperative outcome.

Can Large Language Models (LLMs) Predict the Appropriate Treatment of Acute Hip Fractures in Older Adults? Comparing Appropriate Use Criteria With Recommendations From ChatGPT.

Acute hip fractures are a public health problem affecting primarily older adults. Chat Generative Pretrained Transformer may be useful in providing appropriate clinical recommendations for beneficial treatment. To evaluate the accuracy of Chat Generative Pretrained Transformer (ChatGPT)-4.0 by comparing its appropriateness scores for acute hip fractures with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria given 30 patient scenarios. "Appropriateness" indicates the unexpected health benefits of treatment exceed the expected negative consequences by a wide margin. Using the AAOS Appropriate Use Criteria as the benchmark, numerical scores from 1 to 9 assessed appropriateness. For each patient scenario, ChatGPT-4.0 was asked to assign an appropriate score for six treatments to manage acute hip fractures. Thirty patient scenarios were evaluated for 180 paired scores. Comparing ChatGPT-4.0 with AAOS scores, there was a positive correlation for multiple cannulated screw fixation, total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails. Statistically significant differences were observed only between scores for long cephalomedullary nails. ChatGPT-4.0 scores were not concordant with AAOS scores, overestimating the appropriateness of total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails, and underestimating the other three. ChatGPT-4.0 was inadequate in selecting an appropriate treatment deemed acceptable, most reasonable, and most likely to improve patient outcomes.