Hip Score Research Articles

Clinical application of augmented antibiotic-loaded cement spacer in two-stage infected total hip arthroplasty with acetabular bone defect

Objective To investigate the clinical outcomes and complications of augmented antibiotic-loaded cement spacer in two-stage infected total hip arthroplasty with acetabular bone defect. Methods The periprosthetic infection (PJI) patients with acetabular bone defect were retrospectively reviewed from January 2007 to June 2016 in our hospital. A total of 26 patients (11 males and 15 females) were eligibly included in the present study. The mean age was 46.7 years old. The two-stage revision arthroplasty included implants removel, meticulous debridement, implantation of antibiotic-loaded cement spacer in first-stage. After systemic therapy of antibiotics, the prosthesis was implanted in the second-stage. The supra-acetabular antibiotic cement shelf with screws was used to improve hip stability with acetabular wall defect. The handmade acetabular spacer was able to prevent femoral spacer into pelvis in patients with acetabular internal wall defect. The clinical outcomes and complications (spacer dislocation, spacer fracture and acetabular wear) were measured. Results The positive rate of bacteria culture was 80.8% (21/26) and 57.7% (15/26) patients were cultured with staphylococcus. The others were 2 fungus, 2 Gram-positive rod, 1 brucella, 1 pseudomonas aeruginosa, 1 escherichia coli, 1 enterococcus faecalis, 1 defective probiotics, 1 serratiamarcescens and 1 Kocuriaroseus. Moreover, 19.2% (5/26) patients were mixed infection. There was one patient with spacer dislocation and two with spacer fracture. No patients were recurrent infection. Infection was controlled, and two-stage revision was successfully performed in 24 patients. Twenty-two patients were followed averaging 4.1 years (1-8) and the Harris Hip Score was significantly improved from 40.9±14.0 to 81.2±11.2 at the final follow-up (P<0.05). Conclusion The application of augmented antibiotic-loaded cement spacer has satisfactory clinical outcomes in PJI patients with acetabular bone defect. It can provide joint mobility and increase additional joint stability with decreased iatrogenic bone defect caused by acetabular wear. Key words: Arthroplasty, replacement, hip; Prosthesis-related infections; Reoperation; Osteolysis

Hip arthroscopy for the intra-articular sequelae after Thompson-Epstein type I-II traumatic hip dislocation: A 2-year minimal follow-up

Background: Traumatic hip dislocation is a usually high-energy injury and often leads to serious intra-articular pathologies. Hip arthroscopy is an increasingly popular minimally invasive procedure for intra-articular conditions. Purpose: This study was designed to review the arthroscopic diagnosis and treatment for mechanic hip symptoms after traumatic hip dislocation and evaluate clinical outcomes. Methods: Seven consecutive patients treated with arthroscopy for mechanical hip symptoms after traumatic hip dislocation between 2005 and 2014 were enrolled in the study. We use Tonnis classification for evaluation of hip osteoarthritis by preoperative and the last follow-up plain radiography. Visual analogue scale (VAS), modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item short-form (SF-12) were obtained for clinical outcome assessment. All patients were followed up for a minimum of 2 years. Results: The average age of the patients when undergoing hip arthroscopy was 32.7 years. The interval from injury to arthroscopy ranged from 3 days to 2 years, with a mean of 353 days. The mean operative time was 165 mins. Loose bodies were found in 6 patients. Four patients had labral tears, five had ligamentum teres lesions and six had chondral injuries at the femoral head or acetabulum. All preoperative clinical functional scores improved at last follow-up. The mean length of postoperative hospital stay was 2.6 days. No patients had surgery-related complication. Conclusion: Hip arthroscopy is a powerful tool to detect loose bodies or intra-articular fragments after traumatic hip dislocation and provides good-to-excellent clinical outcomes. For patients with mechanic hip symptoms after traumatic hip dislocation, early referral for hip arthroscopy surgeon is recommended.

Cementless Mallory Head HA-coated femoral prosthesis in primary total hip arthroplasty: Clinical and radiological results of a four to nine year prospective study.

We prospectively studied 152 hips in 126 patients with a proximally porous and hydroxyapatite coated double tapered straight femoral prosthesis. The follow-up period was 4.2 to 9.6 years. All but two prostheses showed osseo-integration. The mean Harris hip score (HHS) increased from 40 to 92 points and 97% of the patients had no or only mild pain. Limping and the use of walking aids decreased substantially after the operation. The morphology of positive bone remodelling with either endosteal bone formation or periosteal bone formation was correlated with the stem fit in the medullary canal (p=0.0001). Negative bone remodelling features could not be demonstrated. There was no correlation between the clinical parameters and the radiological phenomena. (Hip International 2002; 4: 345-56).

Impaction allografting for femoral revision hip arthroplasty. Mid-term results after minimum five year follow-up in 46 cases.

Previously, only short-term follow-up results after femoral revision using impacted allograft and cemented stems the exchange technique have been published. We present the results of 46 femoral exchange revision procedures performed on 42 patients with five to nine years follow-up. At follow-up, five patients had died and two patients did not complete follow-up. Two patients were re-revised. One patient underwent re-revision due to early collapse of the impaction construct. In another patient, stem loosening due to acetabular revision occurred and a full re-revision of the impaction area was performed. One patient suffered late post-operative femoral fracture and three patients experienced hip dislocations. Ninety percent expressed satisfaction with the result. Harris Hip Score (HHS) improved from 36 to 82 (p < 0.001). Radiographically, one patient demonstrated stem subsidence of greater than 5mm. Eighty-six percent demonstrated signs of graft incorporation and only one patient demonstrated signs of loosening. Our results after a minimum of five years follow-up of patients surgically treated with the exchange femoral revision technique demonstrated good clinical and radiological results. With a re-revision rate of 4.3%, one case with subsidence exceeding 5 mm and one case with diaphyseal fracture, we did not observe the problems of subsidence and femoral fractures described in previous studies. (Hip International 2002; 4: 357-64).

Bipolar versus total hip arthroplasty in the treatment of avascular necrosis of the femoral head in young patients.

The authors evaluate medium-term results of bipolar and total hip arthroplasty as a treatment for avascular necrosis of the femoral head. Between 1990 and 2000, 57 hips (45 patients) were treated with a bipolar (BHA: 37 hips) or total hip arthroplasty (THA: 20 hips) depending on the radiographic and macroscopic aspect of the acetabulum. At surgery, all patients were under 65 years of age (average: 45.09 years). All had the same cementless hydroxylapatite coated femoral stem inserted through an anterolateral approach. The BHA were followed during a mean of 4.49 years. One BHA was lost to follow-up. Seven out of 36 hips (19.44%) were considered failures: three due to a poor functional result (Harris Hip Score (HHS) <70) and four which needed conversion to THA for groin pain. Two hips were revised for periprosthetic fracture. Twenty BHA (55.56%) had a good or excellent result (HHSY80). The THA were followed for a mean of 4.32 years. One THA was lost to follow-up. Four out of 19 hips (21.05%) were considered as failures. Three due to a poor functional result (HHS<70) and one which needed cup revision for recurrent dislocation. Fifteen THA (78.95%) had a good or excellent functional result (HHSY80). BHA as a treatment of avascular necrosis of the femoral head in young patients preserves bone stock for later revisions and can lead to excellent results. But the outcome seems less predictable than after THA. Groin pain associated to BHA can be treated successfully with conversion to THA if necessary. (Hip International 2002; 2: 142-9).

Total hip arthroplasty in skeletal dysplasia

This study presents the results of 38 hip prostheses in 24 people of short stature (under 152 cm). A retrospective clinical and radiological study recording the diagnosis, age at reconstruction, height, weight, type of prostheses, length of follow-up, radiological appearances and patient satisfaction was performed. Harris hip scores were used to assess activities of daily living (1). All patients were under 152cm and their diagnoses included achondroplasia, spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, developmental dysplasia of the hip and juvenile chronic arthritis. The mean height of these patients was 135 cm (range: 109cm to 150cm). The mean age was 38 years (range: 19 to 75 years) with mean follow-up 67 months (range: 12 to 406 months). Only one patient, who is now aged 69 years (though 65 years at revision surgery), has required revision surgery to date. The results were excellent for 33 hips (Harris hip score between 80–100), good in three (Harris hip score between 70–80), satisfacto...

Comparison of percutaneous compression plate and cannulated compression screw in treatment of undisplaced femoral neck fracture in the elderly

Objective To compare the efficacy between percutaneous compression plate (PCCP) and cannulated compression screw for undisplaced femoral neck fracture among the elderly. Methods A retrospective case-control study was made on 46 elderly patients with undisplaced femoral neck fracture between August 2011 and September 2015. There were 14 males and 32 females, with the age of(76.9±12.1) years (range, 60-85 years). The fracture types included GardenⅠ in 12 patients and GardenⅡ in 34. These patients were divided into PCCP group (PCCP for undisplaced femoral neck fracture in 23 patients) and cannulated screw group (three cannulated compression screws for undisplaced femoral neck fracture in 23 patients), according to different surgical fixations. The following data were compared between two groups, namely, operation time, intraoperative blood loss, postoperative hemoglobin decline, postoperative length of hospital stay, postoperative partial time of weight-bearing and full weight-bearing, fracture healing time, Harris hip score (HHS) as well as postoperative complications. Results All 46 patients were followed up, with follow-up duration for (34.6±15.3)months (range, 12-60 months) in PCCP group and for (32.9±17.3) months (range, 12-60 months) in cannulated screw group (P>0.05). There were no statistically significant difference between two groups in terms of operation time, intraoperative blood loss, postoperative hemoglobin decline, postoperative length of hospital stay, fracture healing time, and postoperative full weight-bearing time (P>0.05). The partial weight-bearing time of patients in PCCP group was earlier than that in cannulated screw group (P 0.05). There was no statistically significant difference in the incidence of postoperative complications between PCCP group (9%) and the cannulated screw group (13%) (P>0.05). Conclusions Usage of PCCP or cannulated compression screw can obtain satisfactory clinical results for the undisplaced femoral neck fracture among the elderly. But PCCP has the advantages of earlier partial weight-bearing time and faster recovery. Key words: Femoral neck fractures; Fracture fixation, internal; Bone plates

Hinged versus fixed arthrodiastasis in late-onset Perthes’ disease

Background Late-onset Perthes’ disease occurs in patients older than 8 years and constitutes approximately 20% of cases and is known for its aggressive course and poor outcome with chronic hip pain and stiffness. The best treatment is still unknown, and various surgical treatment options have been proposed, but they have some inherent drawbacks. Arthrodiastasis had been introduced as a treatment method for late-onset Perthes’ disease. Patients and methods This is a prospective study performed in Suez Canal University hospitals during the period from October 2010 to December 2014. Twenty hips were divided into two groups. Group I consisted of 10 hips treated by hinged arthrodiastasis. Group II consisted of 10 hips treated by fixed arthrodiastasis. Arthrodiastasis was done by external ring fixator. At the end of the follow-up period, patients were evaluated clinically and radiologically. Results At the end of the follow-up period, which ranged from 24 to 30 months, with a mean of 27.6 months for group I, and a mean of 26.2 months for group II, preoperative and postoperative clinical features and outcome scoring systems in both groups showed improvement and statistically significant relationship in values of limb length discrepancy, total hip range of motion, modified Harris hip score, and epiphyseal index. Comparing postoperative clinical features and outcome scoring systems between both groups at final follow-up showed values in group I better than group II, but there is no statistically significant relationship. Conclusion Arthrodiastasis either hinged or fixed using ring external fixator combined with adductor tenotomy is an excellent and reliable method for treatment of late-onset Perthes’ disease, where prognosis is usually poor and conventional methods of treatment are not reliable.

Total hip arthroplasty with structural bone graft of superolateral acetabulum for developmental dysplasia of the hip

Objective To assess the mid- or long-term clinical outcomes of the structural bone graft of superolateral acetabulum in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). Methods Thirty-three patients with DDH (33 hips) were treated by THA with the structural bone graft of superolateral acetabulum technique between April 2002 and December 2011. There were 28 females and 5 males with the mean age at surgery 54.0±14.5 years (21-76 years). The degree of dislocation was graded preoperatively as Crowe II in 12 patients, Crowe III in 8 patients, and Crowe IV in 13 patients. The following outcomes were assessed, Harris hip score (HHS), the leg-length discrepancy, the height and horizontal distance of center of hip rotation, rate of cup coverage, the coverage ratio of bone graft, periprosthetic osteolysis, bone ingrowth, and cup loosening. Results The average follow-up was 9.3±3.3 years (5-15 years). The HHS improved from 40.9±13.7 preoperatively to 93.6±7.8 at the final follow-up (t=21.483, P=0.000). The leg-length discrepancy decreased from 24.2±17.1 mm pre-operatively to 3.7±3.5 mm at post-operative 3 months (t=6.747, P=0.000). The height and horizontal distance of center of hip rotation decreased from preoperative 45.9±16.0 mm and 42.9±8.7 mm to postoperative 23.8±5.8 mm and 23.6±2.9 mm (t=7.460, P=0.000; t=12.090, P=0.000) at post-operative 3 days, respectively. The cup coverage and coverage ratio of bone graft was 100% and 27.1%±6.9%, respectively. All grafts appeared to be incorporated without evidence of resorption and collapse. The mean time of incorporation was 7.6±2.8 months. The coverage ratio of bone graft >25% have a significantly long time of incorporation than that <25% (9.4±2.3 months versus 6.3±2.4 months, t=5.357, P=0.000). At the final follow-up, all hips showed bone ingrowth fixation of the acetabular cup and stem. Five hips showed osteolysis, two hips in acetabular zone II, three hips in femur zone I and five hips in femur zone VII. The main complications were intraoperative femoral fractures (61%) without neurological damage, nonunion and dislocation. Conclusion The structural bone graft of superolateral acetabulum in THA for DDH can achieve satisfactory mid- or long-term outcomes. The superolateral acetabular deficiency can be reconstructed by bone graft. The bone graft coverage less than 25% is conducive to fusion of bone graft and acetabular bone. However, intraoperative femoral fracture is common complication. Key words: Bone diseases, developmental; Bone transplantation; Arthroplasty, replacement, hip

Total hip arthroplasty in treating acetabular protrusion secondary to rheumatoid arthritis

Objective To investigate the clinical outcomes of total hip arthroplasty in treatment of severe acetabular protrusion secondary to rheumatoid arthritis. Methods From January 2011 to November 2014, eighteen patients (20 hips) with severe acetabular protrusion secondary to rheumatoid arthritis were treated with total hip arthroplasty (THA), including 6 males (6 hips) and 12 females (14 hips). The age ranged from 37 to 68 years (average, 45.8±8.3 year). According to the classification of Sotelo-Garza and Charnley, there were 15 cases (17 hips) of type II (acetabular protrusion 6-15 mm) and 3 cases (3 hips) of type III (acetabular protrusion >15 mm). During the surgery, the femoral heads were moved out through retrograde method after the osteotomy of femoral neck by posterolateral approach. All patients underwent THA with autogenous bone graft by impacting technique for reconstruction of acetabula, and the cementless cups were planted with press-fit skills (Tantalum trabecular metal cup in 16 cases and Titanium porous coating cup in 4 cases). The hip function was evaluated by using Harris hip score. Radiographic measurement was performed with X-ray films to assess the restoration of the hip rotation center, graft incorporation and sign of prostheses loosening in follow-up duration. Results The mean operation duration and intraoperative blood loss were 89.5±8.1 min (range 55-131 min) and 295±10.9 ml (range 165-480 ml) respectively. The average amount of bone graft was 33.7±6.8 cm3 (range 32.5-61.2 cm3) in reconstruction of protrusion acetabulum. The mean follow up duration was 4.5±1.7 years (range 2.5-6.0 years). The horizontal distance between the center of femoral head and the Kohler's line was increased from preoperative 8.87±3.9 mm (range -11.11 -12.78 mm) to 23.55±2.5 mm (range 21.23-25.57 mm) postoperatively, and the vertical distance between the center of femoral head and the line joining the bilateral ischial tuberosities was decreased from preoperative 87.45±3.5 mm (range 74.75-96.97mm) to postoperative 77.83±4.1 mm (range 68.22-90.40 mm) with statistically significant difference. The bone incorporation was achieved at 6 months postoperatively in radiological film. No loosening of acetabular components was found in final fellow-up. At last follow-up, Harris hip score was significantly improved from 55.3±9.5 points preoperatively to 92.2±12.7 postoperatively (t=51.569, P=0.000). The range of flexion of the hip significantly improved from 41.5°±6.7° preoperatively to 102.3°±14.5° at finial follow-up (t=64.865, P=0.000), and the range of extension of the hip improved from 8.2°±3.5° preoperatively to 29.8°±6.6° at finial follow-up (t=51.161, P=0.000). The discrepancy was significantly decreased from 23.7±0.82 mm preoperatively to 4.7±0.39 mm postoperatively (t=19.761, P=0.000). Mild thigh pain was reported in two hips, which typically occurred only with prolonged activity without disabling and not requiring medication. Conclusion Total hip arthroplasty with impaction bone grafting and cementless modular cup can recover the acetabular center of rotation and achieve satisfactory short-term outcomes in treating patients severe protrusion acetabula secondary to rheumatoid arthritis. Key words: Arthroplasty, replacement, hip; Arthritis, rheumatoid; Acetabulum; Bone transplantation; Transplantation, autologous

Pauwels cannulated screws versus DHS-blade plus anti-rotation screw for treatment of Pauwels type III femoral neck fractures

Objective To compare the curative effects of Pauwels cannulated screws (PCS) and DHS-blade plus anti-rotation screw +anti-rotation screw(DHSA+AS) in the treatment of Pauwels type Ⅲ femoral neck fractures. Methods From December 2013 to December 2015, 46 patients with fresh Pauwels type Ⅲ femoral neck fracture were treated with internal fixation at our department. They were divided into 2 groups according to different fixation methods. In the DHSA+AS group of 25 patients, 13 were male and 12 female, with an average age of 49.2±8.2 years, and there were 3 cases of Garden type Ⅱ, 4 cases of Garden type Ⅲ and 18 cases of Garden type Ⅳ. In the PCS Group of 21 patients, 11 were male and 10 fe-male, with an average age of 48.7±6.2 years, and there were 2 cases of Garden type Ⅱ, 6 cases of Garden type Ⅲ and 13 cases of Garden type Ⅳ. The 2 groups were compared in terms of operation time, intraoper-ative blood loss, reduction quality, hospital stay, union time, postoperative complications and Harris hip score. Results DHSA+AS group needed significantly longer operation time (54.0±7.3 minutes) and incurred significantly more intraoperative blood loss (102.3±10.5 mL) than PCS group (46.3±5.4 minutes & 77.4±9.1 mL, respectively) (P 0.05). DHSA+AS group and PCS group obtained an average follow-up of 14.1±1.6 months and 13.7±1.2 months, respectively. For DHSA+AS group and PCS group, the rate of postoperative complications was respectively 12.0%(3/25) versus 4.8%(1/21), and the Harris hip score at the last follow-up respectively 83.6±5.4 versus 85.1±5.5, showing no significant dif-ferences between the 2 groups (P >0.05). Conclusions DHSA+AS and PCS are both suitable in-ternal fixation options for patients with Pauwels type Ⅲ femoral neck fracture when reduction is fine. Com-pared with DHSA+AS, PCS may need less operation time and incur less intraoperative blood loss. Key words: Femoral neck fractures; Fracture fixation, internal; Bone nails; Pauwels’ angle

Comparison of intramedullary nailing combined with minimally invasive cerclage versus simple in-tramedullary nailing for femoral long oblique subtrochanteric fractures

Objective To compare intramedullary nailing assisted by minimally invasive cerclage with simple intramedullary nailing in the treatment of femoral long oblique subtrochanteric fractures. Methods From April 2010 to September 2015, our department treated 39 patients with femoral long oblique subtrochanteric fracture. Of them, 16 were treated by cephalomedullary nailing combined with minimally invasive cerclage (observation group of 11 males and 5 females with an average age of 42.8±13.2 years) and 23 by simple cephalomedullary nailing (control group of 17 males and 6 females with an average age of 46.2±10.1 years). Their operation time, intraoperative blood loss, radiologic results (union time and alignment) and functional results [Visual Analog Scale (VAS) and Harris hip score] were compared between the 2 groups. Results The 39 patients were followed up from 12 to 30 months (average, 15 months). For the observation group, the varus angle (2.2°±1.4°) was significantly smaller than for the control group(4.1°±2.2°), the VAS scores at 1 and 3 months postoperatively (3.43±1.54, 1.13±1.20) were significantly lower than for the control group (5.61±1.41, 3.34±1.82), and the clinical union ratio at 3 months postoperatively(87.5%, 14/16) signifi-cantly higher than for the control group (47.8%, 11/23) (P 0.05). Conclusions Cephalomedullary nailing is effective for the treatment of femoral long oblique subtrochanteric fractures no matter it is assisted by minimally invasive cerclage or not. However, since minimally in-vasive cerclage has the advantage of improving reduction and mechanical stability, combination of minimally invasive cerclage and cephalomedullary nailing may be more advantageous in early pain-relieving and functional recovery. Key words: Femoral fractures; Fractures, comminuted; Fracture fixation, intramedullary; Bone nails; Surgery, minimally invasive

Cementless total hip replacement with femoral calcar reconstruction for unstable intertrochanteric fractures combined with femoral head necrosis

Objective To explore the feasibility and therapeutic effects of total hip replacement (THR) for intertrochanteric fractures combined with late necrosis of the femoral head. Methods From June 2010 to October 2015, 8 patients underwent THR for intertrochanteric fractures combined with necrosis of the femoral head. They were 6 males and 2 females, with an average age of 53.5 years (from 45 to 67 years). According to the Evans-Jensen classification, 2 fractures were type ⅠB, 5 type ⅡA and one type ⅡB. All the 8 fractures were complicated with late femoral head necrosis, 5 cases of which were ischemic. According to the Ficat classification, the ischemic necrosis was type Ⅲ in one and type Ⅳ in 5 cases. In the other 3 cases, the necrosis secondary to the hip osteoarthrosis was type Ⅲ according to the Tonnis classification. The necrotic femoral head was removed after osteotomy of the femoral neck via the posterolateral approach; after reduction of the femoral calcar, the intertrochanteric fracture was reduced and fixated in a press-fit manner through antegrade implantation of a biological stem prosthesis. Functional assessment of the affected hip was carried out at the final follow-up using Harris scoring. Results The 8 patients were followed up for an average of 25.5 months (from 12 to 45 months). After operation, biological press-fit and initial stability of the femoral stem were achieved in all the patients. The X-ray films showed bone ingrowth fixation in all the 8 hips at 3 months postoperatively. The Harris hip scores at the final follow-up averaged 92.3(from 89 to 98). The pa-tients showed fine subjective satisfaction. Follow-ups revealed no infection, prosthetic failure, osteolysis, dislocation or articular instability. Conclusion In treatment of intertrochanteric fractures combined with necrosis of the femoral head, THR can lead to fixation and reduction of the intertrochanteric fracture and re-placement of the necrotic femoral head at one stage, promoting functional recovery of the affected hip. Key words: Hip fractures; Arthroplasty, replacement, hip; Femoral head necrosis

Learning Curve for Surgical Treatment of Acetabular Fractures: A Retrospective Clinical Study of a Practical and Theoretical Training Course.

BackgroundSurgical treatment of acetabular fracture and the anatomic reconstruction of the hip joint are difficult to achieve due to the complex pelvic anatomy, and surgical training requires a prolonged and steep learning curve. The aim of this study was to evaluate the effects of an applied training course, including cadaveric dissection, for the surgical treatment of acetabular fractures.Material/MethodsThis retrospective study included 35 patients who underwent surgical treatment for acetabulum fractures between 2012–2016. Patients were divided into three groups during two training courses, for the first two years and second two years. The surgical treatment was performed through single or combined standard approaches, according to the fracture pattern. The radiological outcome was evaluated using Matta’s criteria to grade postoperative reduction and final radiological outcome and the restoration of the hip joint center (HJC). The clinical outcome was evaluated using the modified the Merle d’Aubigné-Postel (DAP) hip score.ResultsBoth post-course groups had statistically better functional and radiological outcomes compared with the pre-course group. Depending on the learning curve, the mean duration of surgery decreased from 153 minutes to 82.3 minutes. Although there was no statistical difference between groups in the vertical shift of the HJC, there was a statistically significant in the amount of horizontal shift of the HJC in the second two years of training, compared with the other groups.ConclusionsFunctional and radiological outcome of surgical treatment of acetabular fracture may be improved with increased training, depending on the learning curve.

An analysis of the effect of artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture

Objective To analyze of the effect of artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture. Methods 203 patients with stage I of unstable femoral intertrochanteric fracture were selected as the research object, and they were taken artificial lengthening femoral head replacement, among which 65caese were male, female in 138 cases.The Harris scoring, SF-36, VAS pain scores on admission, 2 weeks after operation, postoperative follow-up limb were counted, and the pain of the affected limb and the hip scores were compared amond 3 time periods. Results All 203 cases of senile patients with follow-up, average operation time was 83.64 minutes, the intraoperative blood loss was 355.41mL.The curative effect was evaluated according to the Harris score, SF-36 and VAS pain scoring criteria, and the Harris scores of the affected limbs at admission, at 2 weeks after the operation and after the follow-up were (28.26±5.50)points, (68.26±5.50)points, (93.13±5.31)points, respectively, the differences were statistically significant(t=-71.27, -1 397.55, -46.07, all P<0.01); The VAS pain scores were (8.19±0.48)points, (3.53±0.71)points, (0.23±0.42)points, respectively, the differences were statistically significant (t=88.06, 324.17, 60.84, all P<0.01). The sf-36 scores: physiological[(8.35±1.24)points, (15.23±2.17)points, (19.21±2.12)points], social/family[(7.01±1.13)points, (14.12±2.12)points, (19.85±2.24)points], emotional[(4.83±1.01)points, (10.12±1.22)points, (14.87±1.32)points], function[(6.35±1.21)points, (13.67±1.87)points, (16.81±2.12)points], additional focus[(8.85±1.45)points, (16.38±2.12)points, (20.21±2.42)points], total quality of life [(47.35±4.76)points, (74.69±5.87)points, (89.21±6.12)points], the differences were statistically significant(-39.77, -62.92, -20.21, -44.87, -71.89, -26.79, -45.04, -89.01, -38.25, -45.79, -63.41, -15.29, -45.20, -60.39, -17.54, -52.12, -76.49, -22.58, all P<0.01). Conclusion Artificial lengthening femoral head replacement in elderly patients with stage I of unstable femoral intertrochanteric fracture has good clinical effect, intraoperative high safety, less postoperative complications, postoperative limb functional recovery is good, and it is worthy of clinical promotion and application. Key words: Femoral fractures; Arthroplasty, replacement, hip; Aged

A 2- to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup

BackgroundTreatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell. MethodsWe retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated. ResultsFive cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent. ConclusionIBG combined with the compressing shell results in excellent results for this challenging condition.

Clinical and functional outcomes after augmented hip abductor tendon repair.

Introduction:Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome. Surgical studies are often reported in small cohorts and with limited information on functional improvement. This study reports the clinical and functional outcomes after HAT repair.Methods:112 patients with symptomatic HAT tears, diagnosed via magnetic resonance imaging, underwent open bursectomy, V-Y lengthening of the iliotibial band, debridement of the diseased tendon, decortication of the trochanteric foot-plate and reattachment of the tendon with suture anchors, augmented with a LARS ligament through a trans-osseous tunnel. Patients were evaluated pre-surgery and at 3, 6 and 12 months post-surgery using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, hip range of motion, 6-minute walk and 30-second single leg stance tests. Maximal isometric hip abduction strength (HAS) was assessed and limb symmetry indices (LSIs) were calculated between the operated and non-operated limbs. Patient satisfaction and perceived global rating of change (GRC) was evaluated. Analysis of variance evaluated improvement over time.Results:There was a significant improvement (p<0.05) in all clinical and functional measures. HAS significantly improved over time (p<0.002) and all LSIs were >85% at 12 months. At 12 months, a mean GRC score of 3.5 (range -1 to 5) was reported, while 96% of patients were satisfied with their surgical outcome. There was a 2.7% (n = 3) failure rate at 12 months.Conclusions:HAT reconstruction, augmented with a synthetic ligament, demonstrated significantly improved clinical and functional outcomes, high levels of patient satisfaction and a low failure rate to 12 months post-surgery.

Proximal femur locking plate fixation for the treatment of unstable femoral intertrochanteric fractures in elderly patients

Objective To explore the efficacy of proximal femur locking plate(PFLP) for the treatment of unstable femoral intertrochanteric fractures in elderly patients. Methods Data of 120 cases of patients with unstable femoral intertrochanteric fractures who were treated by PFLP were retrospectively analyzed. There were 56 males and 64 were females, aging from 62 to 78 year-old (average, 69.4 year-old). 85 cases were left hip, and 35 cases right hip. According to AO fracture classification, there were 12 cases of A2.2, 23 A2.3, 34 A3.1, 29 A3.2, and 22 A3.3. According to Evans intertrochanteric fractures classification: there were 93 cases of type III, 19 type IV, and 8 type V. Operation time, length of hospital stay, fracture healing time, postoperative complications and hip joint Harris scores were recorded. Results All patients were followed up for 8-14 months (average, 12.4 months). Their operating time were 51-80 min (average, 63.1 min); X-ray exposure were 8-15 times (average, 11.6 times); intraoperative blood loss were 70-120 ml (average, 92.7 ml); postoperative drainage volume were 50-100 ml (average, 61.7 ml), and length of hospital stay were 7-14 d (average, 10.2 days). The healing time ranged from 12 to 32 weeks (20.4 weeks average). 14 cases had delayed union, and healing time was 8-10 months. In addition, 4 cases had deep vein thrombosis (after thrombolysis therapy the vein was recanalized); 2 had internal fixation broken, who were then treated with PFNA II, and bone healed after 6 months; 5 had hip varus, who were then treated via hip replacement, and no hip prosthesis fracture were found. No other complications occurred in the remaining patients. At the latest follow-up, according to Harris hip score: there were 38 cases with excellent results, 71 good, 9 fair, and 2 poor, and the rate of excellent and good was 90.8% (109/120). Conclusion PFLP for the treatment of unstable femoral intertrochanteric fractures has advantages of less invasion, less complication, reliable fixation and high fracture healing rate, thus it is suitable for unstable intertrochanteric fractures in elderly patients. Key words: Aged; Hip; Fractures, bone; Fracture fixation, internal

A comparative study between double-threaded compression screws and cannulated lag screws for fixation of Garden typeI/IIfemoral neck fractures

Objective To compare the results between double-threaded compression screws and cannulated lag screws for Garden type I/II femoral neck fractures. Methods Data of 56 patients with Garden type I/II femoral neck fractures who were treated with internal fixation from July 2012 to March 2016 were retrospectively analyzed. According to different fixation, the patients were divided into two groups: double-threaded screws group (group A) including 27 cases (7 males and 20 females, with an average age of 55.5±10.0 years, 14 cases Garden type I and 13 cases Garden type II, the proportion of osteoporosis 10/27; And lag screws group (group B) including 29 cases (8 males and 21 females, with an average age of 57.2±9.5 years, 11 cases Garden type I and 18 cases Garden type II, the proportion of osteoporosis 15/29. The 2 groups were compared with respect to bony fusion time, nonunion, avascular necrosis of femoral head, shortening of femoral neck and Harris Hip Score. Results The average follow-up time was 20.3±8.7 m in Group A and 24.5±7.9 m in Group B. The average bony fusion time was 5.3±0.6 m in Group A and 4.1±0.8 m in Group B, and there was significant difference between the groups (t=5.758, P=0.00). 1 avascular necrosis of femoral head was found in both groups. In group A, there were 3 cases of bone nonunion (11.1%, 3/27). There were one bone nonunion (3.4%, 1/29) case in group B, with no statistically significant difference between groups. Shortening of femoral neck occurred in both groups, the average horizontal shortening was 5.8±2.9 mm and vertical shortening 7.0±3.4 mm in Group A, which were lower than group B (8.2±3.1 mm, 9.4±3.6 mm), and the differences showed statistically significant (t=-2.94, P=0.005; t=-2.48, P=0.016) . In group A, the average Harris Hip score was 88.2±8.3, while that in group B was 89.9±7.2. There was no statistically significant difference between two groups. Conclusion It seems to us that in the treatment of Garden type I/II femoral neck fractures, double-threaded compression screws fixation could reduce femoral neck shortening, but there is no difference on functional outcome compared to cannulated lag screws fixation. On the contrary, double-threaded compression screws fixation is not conducive to fracture healing due to lack of sliding compression. Key words: Femoral neck fractures; Fracture fixation, internal; Bone screws

Treatment of elderly patients with acetabular fracture involving medial displacement of the quadri-lateral surface using internal fixation with dynamic anterior plate-screw system for quadrilateral area

Objective To investigate the clinical efficacy of open reduction and internal fixation with dynamic anterior plate-screw system for quadrilateral area (DAPSQ) in the treatment of elderly patients with acetabular fracture involving medial displacement of the quadrilateral surface. Methods Between January 2007 and December 2014, a series of 18 senile patients with acetabular fractures involving medial displace-ment of the quadrilateral surface were treated at our department. They were 13 men 5 women, with a mean age 67.8 years (range, from 61 to 78 years). By the Judet-Letournel classification, there were 4 anterior column fractures, 5 anterior column plus posterior hemitransverse fractures, 8 double column fractures and one T-shaped fracture. The delay from injury to surgery averaged 6.5 days. All were treated with the technique of DAPSQ. Screw internal fixation of the quadrilateral area followed plate moulding via a single ilioinguinal ap-proach. Fixation with lag screws for the posterior column was added if necessary. Results The 18 pa-tients were followed up for 12 to 35 months (mean, 26 months). By the Matta criteria for fracture reduction, 9 cases were rated as excellent, 6 as good and 3 as poor. Bone healing was achieved within 2 to 4 months (mean, 3.5 months). By the modified Merle d’Aubigne & Postel criteria, the affected hips scored 9 to 18 points (mean, 16.3 points) at the final follow-ups, giving 7 excellent, 7 good, 2 fair and 2 poor cases. By the Harris evaluation, the affected hips scored 58 to 98 points (mean, 87.6 points), giving 7 excellent, 8 good, one fair and 2 poor cases. The postoperative complications included urinary tract infection in one, lesion of lateral femoral cutaneous nerve in one, heterotopic ossification (Brooker Grade Ⅰ ) in one, and traumatic osteoarthritis in 5 cases 2 of whom had to receive total hip arthroplasty. Conclusion The technique of DAPSQ is suitable for the treatment of acetabular fractures involving medial displacement of the quadrilateral surface in elderly patients, because it can provide and maintain stable fixation of the fracture in the quadri-lateral area and preserve hip joint function, leading to fine outcomes. Key words: Acetabulum; Fractures, bone; Fracture fixation, internal; Bone plates; Aged