Postoperative Femoral Fractures Research Articles

OVERVIEW OF EARLY MOBILIZATION IN PATIENTS POST OPERATION FOR FEMUR FRACTURE AT NGUDI WALOYO WLINGI HOSPITAL

A fracture is a break in the continuity of a bone. The injury recovery process may not go perfectly if the patient cannot move after surgery. Of course, this condition will affect the length of time the patient is considered in the emergency clinic. The recovery that medical staff should be able to carry out in patients with post-operative femur fractures is to complete the initial assembly. Early mobilization is an effort to pursue freedom as quickly as possible by directing the victim to follow physiological capabilities. The motivation behind this study was to determine the impact of early preparation practices on postoperative femoral fracture patients. This research was conducted in the Surgery Room at Ngudi Waloyo Wlingi Regional Hospital. The technique used is a quantitative illustrative examination strategy with an overview type. The population was 5 respondents with post-operative femur fractures treated in the work room, who were examined using an all out examination procedure. Information is obtained through perception. Considering the side effects of the review, it was shown that most of the 60% of respondents with post-operative femur fractures were dependent on others. It stands to reason that there is an impact of movement practices in post-operative femur fracture patients that would encourage a longer stay in the emergency clinic. Patients who are recovering from surgery need to start mobilizing as soon as possible to ensure smooth blood flow, speed wound healing, and minimize hospitalization.words : Early mobilization, post-operative femur fracture, dependency

Analisis Asuhan Keperawatan pada Pasien Post Operasi Fraktur Femur dengan Masalah Keperawatan Nyeri Akut dengan Intervensi Inovasi Terapi Benson

This study aims to relieve or reduce pain to a level of comfort felt by postoperative femur fracture patients. The method used is descriptive analysis research design with case studies and the number of samples is 1 patient, the instrument is a format Medical surgical nursing care in accordance with the regulations in force at the institution. The results showed that the results obtained from the analysis of one of the patients who received Benson relaxation therapy, namely the patient said that after the Benson relaxation therapy was done, the patient said he felt more calm, less pain. This shows that gasoline relaxation is effective after surgery. Conclusion, based on research giving benson relaxation is very effective for reducing pain in postoperative femoral fracture patients.
 
 Keywords: Acute, Benson, Femur Fracture, Pain, Relaxation.

THE EFFECT OF EARLY MOBILIZATION EXERCISE ON THE LEVEL OF INDEPENDENCE ON PATIENTS AFTER POST OPERATIVE FRACTURE FEMUR

Background; Patients with postoperative femur fractures will experience limited motion in their knee function, weakness, immobility and disability as a result of limitations in caring for themselves and carrying out daily activities. This study is to determine the effect of early mobilization education on the level of independence in postoperative patients with femur fracture. Research methods; The study used a quasi-experimental design with pre and post control group design, with 36 respondents (18 experimental groups, 18 controls). Data collection using questionnaires and observation. The independent variable is early mobilization education, while the dependent variable is the level of independence. The sampling technique used consecutive sampling. The population in this study were patients with postoperative at Prof. Dr. R. Soeharso Surakarta. Data analysis using independent t-test and paired t-test. Research results; There is a significant difference in the level of independence in patients before and after being given early mobilization exercises of intervention group. The results of the independent t-test on the level of independence obtained p value (0.0001) <0.05, there is a significant difference in the level of independence in patients in the control group and intervention group. Conclusion; There is an increase in independence in patients after early mobilization education, and there is a difference in the level of independence in the control group and the intervention group.

Reducing Pain in Postoperative Femoral Fracture Patients with Spiritual-Based Relaxation Breathing

Background: Fractures occur due to trauma or physical activity with excessive pressure on the bone, including collisions, beatings, falls, irregular or tilted positions, dislocations, withdrawals, and abnormal bone weakness (pathological fractures). This study aims to analyze the effect of Breathing Relaxation spiritual-based on reducing pain scale in patients with postoperative femoral fractures. Methods: A quasi-experiment with a one-group pretest-posttest design technique constitutes the study design. Population All postoperative femur fracture patients at Mitra Medika Hospital Bondowosoof 30 people. The sample size is 24 respondents. The sampling technique is Consecutive Sampling. Intervention is given effect Breathing Relaxation spiritual based. The analysis used the Wilcoxon Signed Ranks Test with a significant value of ‎α <0.05. Results: The pre and post-pain scale test using the Wilcoxon Signed Ranks Test obtained a p-value of 0.000, which means the effect of Breathing Relaxation Spiritual-Based Changes in Pain Scale in Postoperative Femur Fracture Patients. Conclusion: Breathing Relaxations are spiritually based and effective in reducing Pain Scale in Postoperative Femur Fracture Patients. This method is very good when applied in hospitals to develop nursing knowledge.

NURSING CARE FOR CLIENTS WHO EXPERIENCE POST OPERATING FEMUR FRACTURES WITH ACUTE PAIN NURSING PROBLEMS IN THE BIMA ROOM, JOMBANG HOSPITAL

Background:Fracture is a break or damage to the continuity of bone tissue caused by an external pressure that is greater than can be absorbed by the bone. Method:The research design was a case study using 2 postoperative femur fracture clients as subjects with acute pain nursing problems, nursing care was carried out for 3 consecutive days using cold compress therapy. Result:The results of the study showed acute pain by administering cold compress therapy, the problem was resolved by reducing pain scale to mild pain scale. Analysis:The results of the evaluation carried out by the researchers during the three days of treatment on both clients with postoperative femoral fracture problems found the diagnosis of acute pain was resolved. Conclusion:Non-pharmacological management of postoperative fracture patients with pain is to use cold compress therapy. Giving cold compresses can reduce pain, increase the release of endorphins which block the transmission of painful stimuli.

Clinical outcomes of canine total hip replacement utilizing a BFX lateral bolt femoral stem: 195 consecutive cases (2013-2019).

To evaluate the clinical outcomes of total hip replacements (THR) utilizing a BFX lateral bolt stem in dogs with coxofemoral joint disease. Retrospective study. A total of 149 dogs representing 195 THR. Consecutive THRs utilizing a BFX lateral bolt stem were studied. Preoperative, immediate postoperative, 1-, 2-, 3-, 4-, and 12-month postoperative radiographs were performed. All major and minor complications, revisions, outcomes, subsidence, canal flare index (CFI) were recorded. An intraoperative complication rate of 11.8% was observed. The postoperative complication rate was 13.6%, with 9.2% major and 4.4% minor complications. Complications included: postoperative femur fractures (3.6%), coxofemoral luxation (3.6%), stem failure (0.5%), septic loosening (0.5%), aseptic loosening (0.5%), and acetabular fracture (0.5%). Three dogs underwent prophylactic plating after subjective assessment of cortical thickness. Five of 195 (2.6%) cases underwent explant of their prostheses (median=3months). Mean stem subsidence at 1 month postoperatively was 1.22 ± 0.16 mm. An increased CFI was associated with postoperative femur fractures (p < .05). A total of 190 of 195 (97.4%) cases returned to normal function in the long-term follow-up period. Use of the BFX lateral bolt stem resulted in minimal postoperative subsidence, a low femoral stem complication rate, and a high rate of achieving normal limb function. The BFX lateral bolt stem should be considered in canine THR as the femoral failure rate is low and the long-term success rate is high.

Evaluation of the Outcomes of Proximal Femoral Nail Antirotation II in the Treatment of Trochanteric Fracture in Elderly Patients.

BackgroundIntertrochanteric fractures are common injuries among the elderly population and those with osteoporosis. The study was conducted in order to evaluate the outcome of Proximal Femoral Nail Antirotation II (PFN-A2) in the treatment of these fractures in elderly patients.MethodsTwenty-five elderly patients (range 60 to 73 years) with trochanteric fractures who were treated with PFN-A2 at Government Medical College Amritsar were included in this prospective observational study. These patients were followed up regularly until six months post-operatively. The functional and radiological evaluations were done at six, 12, 16, and 20 weeks. The functional outcome was evaluated using the Harris Hip Score (HHS).ResultsThe mean age incidence for trochanteric fractures was 64 years. There were no cases of intra-operative and postoperative femoral fractures. The mean operating time was 85.6 minutes. Radiological union was seen in all of the 25 patients. The mean time for fracture union time in our study was 13.8 weeks. The average Harris Hip Score in our study was calculated at three months as 74.3 and at six months as 85.08. The p-value was highly significant (0.001) for this improved outcome. This study found PFN-A2 related secondary varus deformities in 8.0% of the patients (two patients). Only one patient (4%) developed surgical site infection (SSI).ConclusionPFN-A2 provides adequate functional results in terms of fixation and healing. This can be further enhanced by good pre-operative planning, correct technique of entry point, and meticulous placement of implant with a helical blade in both anteroposterior (AP), lateral view, and distal locking and non-acceptance of reduction in varus. A good reduction is required to achieve a good functional outcome. We conclude that the PFN-A2 has the benefit of closed reduction, short operative time, preservation of biology, less soft tissue damage, and early rehab.

Extended trochanteric osteotomy in revision hip arthroplasty: a case series study and systematic literature review

BackgroundExtended trochanteric osteotomy (ETO) in revision hip arthroplasty provides direct access to the femoral medullary canal and facilitates removal of implants and re-implantation. This study looks at objective outcomes of ETO from a systematic review of the literature and a case series of revision total hip arthroplasty (THA) cases with ETOs from the authors’ local institution.Methods(1) The National Institutes of Health (NIH) national library of medicine was searched for studies related to ETO and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) technique were followed.(2) Case series of 23 revision THAs with ETOs from University College London Hospital (UCLH) were retrospectively analyzed with a minimum of 2-year follow-up for radiological outcomes.Results(1) The main revision THAs diagnoses were aseptic loosening (880/1,386; 63.4%), prosthetic joint infection (PJI) (301/1,386; 21.7%) and periprosthetic THA fractures (78/1,386; 5.6%). Other diagnoses, including non-specified reasons for THA revision in the chosen studies, accounted for 9.2% (127/1,386). The total mean was a union rate of 95.2%, an infection eradication rate of 91.6%, a femoral stem subsidence rate of 16.6%, with the rate of subsidence more than 5 mm being 10.7%. ETO proximal migration was reported in 7.8% of ETOs; however, it rarely required re-attachment (0.9%). Intraoperative fracture during revision THA with ETO was reported to be at a rate of 5%; while postoperative femoral fracture rate was at 7.8%.(2) All 24 cases had radiographic union at 3 to 6 months and there was no reported femoral stem subsidence.ConclusionThe overall outcome of this literature review provides moderate-quality evidence indicating that ETO provides safe outcome for revision THAs in single and 2-stage revision surgeries with low ETO non-union, femoral stem subsidence, greater trochanter (GT) proximal migration and fracture rates in the different diagnoses groups of revision THA at over 2-year follow up. In the case series group, there was radiographic union of all ETOs with no reported femoral stem subsidence or periprosthetic fractures.

PEMBERIAN RELAKSASI BENSON TERHADAP PENURUNAN NYERI PASIEN POST OPERASI FRAKTUR FEMUR DI RUMAH SAKIT UMUM DAERAH MEURAXA BANDA ACEH

Pain in postoperative Femur Fracture patients must be addressed immediately because it has an impact on the patient's healing process, because it can affect psychological and physiological conditions. Benson relaxation is one of the methods that can reduce pain, this technique is able to reduce the activity of the sympathetic nerves that control pain, causing a feeling of calm and comfort and will affect the decrease in pain intensity. The purpose of this study was to determine the effect of Benson Relaxation on reducing pain intensity in post-femoral fracture surgery patients at Meuraxa Hospital Banda Aceh in 2019. The method used in this study was a quasi-experimental pre test and post test one group, the number of samples in this study was 14 respondents. Consecutive sampling sampling technique. The time of this research was carried out on June 04 to July 22, 2019. The data were processed using paired t-test and Independent t-test statistical tests. The results of the study used paired t-test statistical tests. It shows that there is a significant difference in pain intensity before and after Benson Relaxation in postoperative femur fracture patients with p value 0.000 (P &lt; 0.05), and the results of the study using the Independent t-test statistic test showed that there was a significant difference in pain intensity between the experimental group and the experimental group. control group of postoperative Femur Fracture patients with p value 0.010 (P &lt; 0.05), so it can be concluded that there is a significant effect on pain intensity after Benson Relaxation in postoperative Femur Fracture patients. It is hoped that patients and nurses can apply the Benson Relaxation Technique after Fracture surgery.

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach.

Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.

Do bicortical diaphyseal array pins create the risk of periprosthetic fracture in robotic-assisted knee arthroplasties?

BackgroundOptical array placement for robotic-assisted knee replacement introduces the rare, but real risk of periprosthetic fracture. The purpose of this retrospective study was to review the incidence of fracture with the conventional technique of bicortical diaphyseal pin placement. We also evaluated a modified method of unicortical periarticular pin placement to mitigate this risk.MethodsWe reviewed 2603 knee arthroplasties that were performed between June 2017 and December 2019. The conventional bicortical diaphyseal technique was used in 1571 knees (bicortical diaphyseal group) and the unicortical periarticular technique was used in 1032 knees (unicortical periarticular group).ResultsA more than 1-year follow-up revealed that 3 femoral shaft fractures (0.19%) occurred in the bicortical diaphyseal group and no fracture took place in the unicortical periarticular group. There was no array loosening in either group.ConclusionsThe modified unicortical periarticular pin placement is a reliable technique for computer-navigated and robotic-assisted knee arthroplasties. It may be associated with a lower incidence of postoperative femoral shaft fractures, compared to conventional bicortical diaphyseal pinning.

Calcar-collar contact during simulated periprosthetic femoral fractures increases resistance to fracture and depends on the initial separation on implantation: A composite femur in vitro study

BackgroundA calcar collar may reduce risk of periprosthetic fracture of the femur, through collar contact. We estimated the effect of collar contact on periprosthetic fracture mechanics using a collared fully coated cementless femoral stem and then estimated the effect of initial calcar-collar separation on the likelihood of collar contact. MethodsThree groups of six composite left femurs with increasing calcar-collar separation in each group, underwent periprosthetic fracture simulation in a materials testing machine. Fracture torque and rotational displacement were measured and torsional stiffness and rotational work prior to fracture were estimated. Calcar collar contact prior to fracture was identified using high speed camera footage. FindingsWhere calcar-collar contact occurred fracture torque was greater (47.33 [41.03 to 50.45] Nm versus 38.26 [33.70 to 43.60] Nm, p = 0.05), Rotational displacement was less (16.6 [15.5 to 22.3] degrees versus 21.2 [18.9 to 28.1] degrees, p = 0.07), torsional stiffness was greater (151.38 [123.04 to 160.42] rad.Nm−1 versus 96.86 [84.65 to 112.98] rad.Nm−1, p < 0.01) and rotational work was similar (5.88 [4.67, 6.90] J versus 5.31 [4.40, 6.56] J, p = 0.6).Odds ratio (OR) of not achieving collar contact (95% confidence interval) increased 3.8 fold (95% CI 1.6 to 30.2, p < 0.05) for each millimetre of separation in the regression model. 95% chance of collar contact was associated with a separation of 1 mm or less. InterpretationSurgeons should reduce calcar-collar separation at stem implantation to a maximum of 1 mm to increase the chance of calcar-collar contact during injury and reduce the risk of early post-operative femoral fracture.

Midterm Results of Primary Exeter Cemented Stem in a Select Patient Population.

Most North American surgeons predominantly use uncemented stems in primary total hip arthroplasties (THAs) and reserve cemented stems for selected older patients and those with poor bone quality. However, data on this "selective use" strategy for cemented stems in the population at risk for periprosthetic fracture and implant loosening are limited. The purpose of this study was to describe implant survivorship, complications, and radiographic results of a specific collarless, polished, tapered cemented stem (Exeter; Stryker) used selectively in a predominantly elderly population undergoing primary THA. We identified 386 patients who underwent a total of 423 primary THAs with selectively utilized Exeter stems for the treatment of osteoarthritis between 2006 and 2017. In the same time period, 11,010 primary THAs were performed with uncemented stems and 961 with non-Exeter cemented stems. The mean patient age was 77 years, 71% were female, and the mean body mass index was 29 kg/m2. Competing risk analysis accounting for death was utilized to determine cumulative incidences of revision and reoperation. The mean follow-up was 5 years (range, 2 to 12 years). The 10-year cumulative incidence of any femoral component revision in this patient cohort was 4%, with 10 stems revised at the time of the latest follow-up. There were no intraoperative femoral fractures. The indications for revision were postoperative periprosthetic femoral fracture (n = 6), dislocation (n = 3), and infection (n = 1). There were no revisions for femoral loosening. The 10-year cumulative incidence of reoperation was 10%. The 10-year cumulative incidence of Vancouver B periprosthetic femoral fracture was 2%. Radiographically, there were no cases of aseptic loosening or osteolysis. There was a significant improvement in median Harris hip score, from 53 preoperatively to 92 at a mean follow-up of 5 years (p < 0.001). The strategy of selectively utilizing a collarless, polished, tapered cemented stem produced a low (4%) cumulative incidence of stem revision at 10 years postoperatively and resulted in no cases of aseptic loosening. The use of the Exeter stem did not eliminate postoperative femoral fractures in this predominantly elderly, female patient population. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Finite element analysis of biomechanical effects of residual varus/valgus malunion after femoral fracture on knee joint.

Post-operative femoral shaft fractures are often accompanied by a residual varus/valgus deformity, which can result in osteoarthritis in severe cases. The purpose of this study was to investigate the biomechanical effects of residual varus/valgus deformities after middle and lower femoral fracture on the stress distribution and contact area of knee joint. Thin-slice CT scanning of lower extremities and MRI imaging of knee joints were obtained from a healthy adult male to establish normal lower limb model (neutral position). Then, the models of 3°, 5°, and 10° of varus/valgus were established respectively by modifying middle and lower femur of normal model. To validate the modifying, a patient-specific model, whose BMI was same to former and had 10° of varus deformity of tibia, was built and simulated under the same boundary conditions. The contact area and maximum stress of modified models were similar to those of patient-specific model. The contact area and maximum stress of medial tibial cartilage in normal neutral position were 244.36 mm2 and 0.64MPa, while those of lateral were 196.25 mm2 and 0.76MPa. From 10° of valgus neutral position to 10° of varus, the contact area and maximum stress of medial tibial cartilage increased, and the lateral gradually decreased. The contact area and maximum stress of medial meniscus in normal neutral position were 110.91 mm2 and 3.24MPa, while those of lateral were 135.83 mm2 and 3.45MPa. The maximum stress of medial tibia subchondral bone in normal neutral position was 1.47MPa, while that of lateral was 0.65MPa. The variation trend of medial/lateral meniscus and subchondral bone was consistent with that of tibial plateau cartilage in the contact area and maximum stress. This study suggested that varus/valgus deformity of femur had an obvious effect on the contact area and stress distribution of knee joint, providing biomechanical evidence and deepening understanding when performing orthopedic trauma surgery or surgical correction of the already existing varus/valgus deformity.

Intraoperative Complications and Early Return to the Operating Room in Total Hip Arthroplasty Performed Through the Direct Anterior and Posterior Approaches. An Institutional Experience of Surgeons After Their Learning Curve

BackgroundProponents of the direct anterior approach (DAA) for total hip arthroplasty (THA) claim a faster recovery, whereas critics claim an increased risk of early femoral complications. This study analyzed intraoperative and postoperative complications requiring reoperation within one year after THA through the DAA and posterior approach (PA). MethodsA total of 2348 elective, unilateral DAA THAs in patients with osteoarthritis performed between 2016 and 2019 were matched 1:1 for age (±5 years), gender, body mass index (±5), and femoral fixation with 2348 patients who underwent PA THA during the same period. Mixed-effects logistic regression was used. Odds ratios were reported for the occurrence of intraoperative femoral fracture, postoperative femoral fracture, infection, dislocation, and other etiologies requiring reoperation within one year. ResultsIntraoperative femoral fracture occurred in 12 DAA (0.5%) and 14 PA (0.6%) patients. Twenty-five patients (1.06%) in the DAA and 28 (1.19%) in the PA group underwent reoperation within the first year. Reoperations were due to periprosthetic fracture (40%), infection (28%), dislocation (23%), and other (9%). Regression analysis revealed no difference in intraoperative femoral fracture (odds ratio (OR): 0.86, 95% confidence interval (CI): 0.40-1.86, P = .69), postoperative femoral fracture (OR: 1.10, 95% CI: 0.47-2.60, P = .83), infection (OR: 1.50, 95% CI: 0.53-5.23, P = .44), or reoperation within one year for other reasons (OR: 1.50, 95% CI: 0.25-9.00, P = .65). DAA had fewer dislocations requiring reoperation (OR: 0.20, 95% CI: 0.04-0.91, P = .02). ConclusionThis comparative study did not find differences in intraoperative or postoperative fracture or infection between DAA and PA. DAA was associated with a lower likelihood of reoperation for dislocation within one year of surgery.

Satisfactory Outcomes in Patients Operated With Primary Total Hip Arthroplasty for Perthes-like Deformities: Results From a Surgical Technique Utilizing a Conical Stem, an Elevated Hip Center, and No Shortening Femoral Osteotomy.

BackgroundTotal hip arthroplasty (THA) performed on patients with Perthes-like deformities are technically challenging because of the patient’s abnormal hip anatomy. Patients with Perthes-like deformities are at a higher risk of revision, aseptic loosening, nerve injury, and intraoperative fracture after THA, especially if shortening osteotomies are performed. This analysis sought to examine the clinical and radiographic outcomes of a patient cohort with Perthes-like deformities receiving THA with a conical stem, an elevated hip center, and no shortening femoral osteotomy.MethodsTwenty-six patients (27 hips) received THA with MODULUS femoral stems, ceramic or metal femoral heads, and highly cross-linked polyethylene liners between April 2011 and March 2016. All patients were treated at a single center by 4 participating surgeons. Patients completed 2 questionnaires preoperatively and at the final follow-up visit (between 1 and 5 years postoperatively): Harris Hip Score and Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire. Differences in patient-reported outcome measures (PROM) scores were measured by paired t-tests. Preoperative and postoperative anteroposterior radiographs were analyzed to monitor patient outcomes.ResultsSignificant clinical improvements were observed in all individual subcategories of the Harris Hip Score and of the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire; the largest magnitude improvements were observed in the subcategory of pain relief for both questionnaires. No complications, including intraoperative and postoperative femoral fractures, nerve palsy, dislocations, or deep venous thrombosis, were observed.ConclusionThis study found that patients treated with an elevated hip center and low stem-positioning technique using a conical, modular implant system had good clinical outcomes and did not suffer complications at the mean follow-up from surgery of 2.8 years (range: 1-5 years).

Contemporary Mortality Rate and Outcomes in Nonagenarians Undergoing Primary Total Hip Arthroplasty

BackgroundNonagenarians (90-99 years) have experienced the fastest percent growth in primary THA utilization recently. However, there are limited data on this population. This study aimed to determine the mortality rate, implant survivorship, clinical outcomes, and complications of primary THAs in nonagenarians. MethodsOur institutional total joint registry was used to identify 144 nonagenarians who underwent 149 primary THAs for osteoarthritis only between 1997 and 2017. The mean age was 92 years, with 63% being female. Mortality, revision, and reoperation were assessed using cumulative incidence with death as a competing risk and Cox regression methods. Clinical outcomes were assessed using Harris hip scores (HHSs). Cemented femoral components were used in 68%. The mean follow-up was 4 years. ResultsThe mortality rates were 6%, 8%, 14%, and 49% at 90 days, 1 year, 2 years, and 5 years, respectively. The 5-year cumulative incidences of any revision and reoperation were 1% and 4%, respectively. The mean HHS improved significantly from 48 preoperatively to 76 at 5 years (P < .001). The 5-year cumulative incidence of any complication was 69%, with the most common being periprosthetic femur fracture (7) intraoperatively, delirium (25) early postoperatively, and periprosthetic femur fracture (10) later postoperatively. Uncemented stem fixation was associated with a higher risk for intraoperative femur fracture (Hazard ratio 5, P = .04) but not with a higher 5-year periprosthetic postoperative femur fracture risk (P = .19). ConclusionNonagenarians undergoing primary THA had substantial mortality rates at 90 days (6%) and 1 year (8%). While the cumulative incidence of any revision and reoperations were low at 5 years, the high complication rate is mostly due to periprosthetic fractures. Level of evidenceLevel IV, retrospective cohort.

Total Hip Arthroplasty in Patients With Osteopetrosis

BackgroundOsteopetrosis is an inherited bone disease associated with high risk of osteoarthritis and fracture non-union, which can lead to total hip arthroplasty (THA). Bone quality and morphology are altered in these patients, and there are limited data on results of THA in these patients. The goals of this study were to describe implant survivorship, clinical outcomes, radiographic results, and complications in patients with osteopetrosis undergoing primary THA. MethodsWe identified 7 patients (9 hips) with osteopetrosis who underwent primary THA between 1970 and 2017 utilizing our total joint registry. The mean age at index THA was 48 years and included two males and five females. The mean follow-up was 8 years. ResultsThe 10-year survivorship free from any revision or implant removal was 89%, with 1 revision and 1 resection arthroplasty secondary to periprosthetic femoral fractures. The 10-year survivorship free from any reoperation was 42%, with 4 additional reoperations (2 ORIFs for periprosthetic femoral fractures, 1 sciatic nerve palsy lysis of adhesions, 1 hematoma evacuation). Harris hip scores significantly increased at 5 years (P = .04). Five hips had an intraoperative acetabular fracture, and 1 had an intraoperative femur fracture. All postoperative femoral fractures occurred in patients with intramedullary diameter less than 5 mm at a level 10 cm distal to the lesser trochanter. ConclusionPrimary THA in patients with osteopetrosis is associated with good 10-year implant survivorship (89%), but a very high reoperation (58%) and periprosthetic femoral fracture rate (44%). Femoral fractures appear associated with smaller intramedullary diameters.

Clinical experience of the use of reamer irrigator aspirator in Japanese patients: A report of the first 42 cases

BackgroundA reamer irrigator aspirator (RIA) can be used to harvest substantial amounts of autologous bone and debride the intramedullary canal. Clinical experience using reamer irrigator aspirators in Japan is very limited. The applicability of the reamer irrigator aspirator head with a minimum diameter of 12 mm for Japanese people is often questioned as the Japanese are smaller than Americans and Europeans. There are no reports of complications in Japanese patients. This study aimed to retrospectively review clinical cases and describe reamer irrigator aspirator use in Japanese patients. MethodsAll patients for whom a reamer irrigator aspirator was used during surgery at our hospital between January 2014 and September 2018 were included. The patients’ clinical and radiographic data were retrospectively reviewed. ResultsData of 40 patients (42 cases) were collected. The reamer irrigator aspirator was used for bone graft harvesting in 32 cases, intramedullary debridement and irrigation in 9 cases, and reaming for exchange nailing in 1 case. The diameter of the reamer irrigator aspirator reamer head was 12 mm in 22 cases (53.7%), 12.5 mm in 4 cases (9.8%), 13 mm in 9 cases (22.0%), 13.5 mm in 1 case (2.4%), 14.0 mm in 1 case (2.4%), 14.5 mm in 1 case (2.4%), and 15 mm in 4 cases (9.8%). Mean intraoperative bleeding volume was 1158.6 mL (range, 100–3800 mL). We experienced no difficulty inserting the reamer irrigator aspirator into the intramedullary canals and no cases of insertion-related intraoperative fracture. Five cortical perforations (11.9%) were observed on postoperative computed tomography scans, although no patient was symptomatic. One case (2.4%) of postoperative femur fracture occurred. ConclusionsReamer irrigator aspirators can be used in Japanese patients. Smaller reamer head sizes were mainly used in our experience. We should manage complications as in previous reports from Western countries.

Predictors of Perioperative Vancouver B Periprosthetic Femoral Fractures Associated With the Direct Anterior Approach to Total Hip Arthroplasty

BackgroundThere is an association between intraoperative and postoperative femoral fractures and the direct anterior approach (DAA) to total hip arthroplasty (THA). The purpose of our study is to identify risk factors for Vancouver B fractures and to establish a predictable timeline for when these occur. MethodsWe retrospectively identified patients with Vancouver B periprosthetic femoral fractures (n = 49) after 11,509 elective primary cementless THA procedures through the DAA between 2012 and 2018 at a single institution. Fracture patients were matched to nonfracture patients (n = 267) by date of surgery and surgeon. Clinical and radiographic factors were collected for multivariable analysis to identify predictors of fracture. ResultsPeriprosthetic Vancouver B femoral fracture incidence was 0.4%. 48 (98%) fractures were postoperative. Fractures occurred at an average of 44 days after surgery (range: 1 to 653 days) with >85% of fractures occurring in the first 6 weeks postoperatively. Significant variables predictive of fracture included >3 degrees valgus and >5 degrees varus coronal stem malalignment, Dorr B and C femoral geometry, lower canal flare index (2.75 vs 3.20), advanced age, increased comorbidities, greater stem canal fill, and right-sided procedures. ConclusionDespite an overall low rate of Vancouver B perioperative periprosthetic femoral fractures, it is a devastating complication that typically presents within the first 6 weeks after DAA THA surgery. The risk is increased in patients with unfavorable proximal femoral geometry, coronal stem malalignment, advanced age, increased comorbidities, and right-sided procedures.