The uncemented bipolar hemiarthroplasty for displaced femoral neck fractures: 6-year follow-up of 171 cases

We report a study of 168 consecutive patients (171 prostheses) with a displaced femoral neck fracture and a physiologic age older than 75 years who were treated with an uncemented bipolar Monk hard-top hemiarthroplasty. Four prostheses dislocated postoperatively, but none after discharge. Two prostheses were later extracted. Five patients sustained an ipsilateral femoral fracture. Totally, 7 patients (4 percent) were reoperated on.

One year after the operation, 22 percent of the patients were dead. An increased mortality rate was recorded during the first 6 months after surgery. At follow-up 6 (3-9) years after the operation, 4 of the 62 patients alive had weight-bearing pain. Three had subsidence of the prosthesis, but none had protrusion of the acetabulum. Ninety-five percent of the patients were free from complications requiring a reoperation or outpatient evaluation.     

Is implantation of a unipolar femoral endoprosthesis obsolete?]

The authors are presenting a retrospective study of the long-term results of 702 femoral cephalic endoprostheses (451 unipolar and 251 bipolar prostheses). The mean age of the patients at operation was 80.1, in the majority of the cases the indication was a fracture of the femoral neck. The average follow-up was 33 months for the unipolar, and 24 months for the bipolar prostheses. The rate of reoperations is similar in both series, but the rate of dislocations is slightly lower for the unipolar prostheses. 82 patients (out of 120 surviving) have been controlled with an average follow-up of 6.51 and 4.76 years. The unipolar prostheses have a lower average New Mayo Hip Score (58.5 vs. 68.2). Radiologically, there are 7 acetabular protrusions in the group of unipolar prostheses and none in the other group. If both types of prostheses have their place in surgery of the hip, the authors recommend to implant bipolar prostheses in younger and more active patients, where a survival of many years is expected.     

Treatment of femur head necrosis using a total hip prosthesis following kidney transplantation

From 1972 to 1978 we implanted 30 total hip prostheses in 20 patients with kidney transplant and femoral head necrosis. All were patients who still had immune suppressing drug therapy. To reduce the infection risk the patients had a special preoperative treatment -- single room -- always the same surgeon, short operative procedure in the greenhouse of 45 minutes on an average and only 4 blood infusions. Thereby, we had no complications peroperative and none were observed during the following checks extending from 4 months to 6 years. Hence, we believe that the implantation of total hip prostheses in high risk patients with kidney transplants and femoral head necrosis is recommendable.     

髋关节置换术治疗股骨转子间骨折内固定失败

 目的 回顾性分析采用髋关节置换术治疗股骨转子间骨折内固定失败的临床效果。方法2004年7月至2006年6月,采用髋关节置换术治疗32例股骨转子间骨折内固定失败患者,男24例,女8例;行关节置换时的年龄为57～81,平均71岁;从骨折到行关节置换的时间为5～70个月,平均40个月。骨折内固定方式包括：滑动髋螺钉15例,髓内钉10例,钢板5例,多枚螺钉2例。失败原因：拉力螺钉切出股骨头8例,骨折不愈合9例,股骨头缺血性坏死7例,创伤性关节炎8例。采用全髋关节置换术28例（全部为生物型髋臼）,双极人工股骨头置换术4例。骨水泥型股骨柄12例,非骨水泥型股骨柄20例。标准股骨假体25例,长柄股骨假体7例。结果术后28例患者获得随访,随访时间4～6年,平均5年。28例患者术前H arris评分平均37分（32～45分）,末次随访时平均88分（84～95分）;优6例,良14例,可7例,差1例。末次随访时X线片显示假体位置正常,髋臼平均外展角为44°（42°～48°）,髋臼假体无松动。根据Harris标准评价骨水泥型股骨假体固定,1例为A级,9例为C级。根据Engh等标准评价非骨水泥型股骨假体的固定,18例均评价为骨长入。3例髋关节术后6个月复查时发现异位骨化,BrookerⅡ级2例,Ⅲ级1例。结论髋关节置换术是老年患者股骨转子间骨折内固定治疗失败后的一种有效挽救选择。     

人工股骨头置换治疗90岁以上患者髋部骨折

[目的]报告人工股骨头置换治疗90岁以上患者髋部骨折的疗效。[方法]本组23例（24髋），男7例，女16例：年龄90～100岁，平均94岁。骨折分类：股骨颈骨折10例，按Garden分型，Ⅲ型6例，Ⅳ型4例；股骨粗隆问骨折13例（1例为双侧），按Evans分型，ⅢA型6例，ⅢB型6例，Ⅳ型1例。除2例在室外被碰伤外，其余骨折均发生在室内。患者入院后暂用皮牵引制动患肢，然后抓紧时间进行各项必要的术前检查，了解患者的健康情况。争取在短时间内请有关科室联合会诊，对患者的全身情况评估，论证能否耐受手术。本组患者在骨折前均并存各种不同程度的内科疾病，但经过对症处理相对稳定，大部分都能生活自理，经过评估后认为无绝对手术禁忌证。手术均用气管插管全麻，术中心电监护仪监护。取侧卧位，髋后外侧切口，股骨颈骨折的手术操作与其他年龄段患者操作相同。股骨粗隆间骨折，需要将骨折分离的股骨大、小粗隆重新复位，用钢丝捆绑固定，股骨距部位的骨缺损用骨水泥充填、重塑。股骨粗隆问骨折患者术中适当输血，本组8例术中输血200～800ml，平均400ml：关节腔内置负压引流管，48～72h后拔除。[结果]23例均顺利通过手术，术后下床时间2～7d，平均4d，住院时间15～28d，平均21d。并发症：6例术后出现一过性精神障碍，经过治疗逐渐恢复；1例出现患肢轻度深静脉炎，对症处理后未影响治疗效果；1例95岁女性患者ⅢB型股骨粗隆问骨折，术后3周死于多脏器功能衰竭。16例（9例股骨粗隆间骨折，7例股骨颈骨折）有随诊结果，随访5～36个月，平均8个月。10例（6例股骨粗隆问骨折，4例股骨颈骨折）基本达到骨折前的状况，5例（2例粗隆间骨折，3例股骨颈骨折）生活部分自理，1例股骨粗隆间骨折患者术后6个月死于其他疾病。[结论]人工股骨头置换治疗90岁以上患者髋部骨折，疗效满意，可早下床活动，减少并发症，降低死亡率，改善生活质量，减轻家庭生活护理负担。     

立体影像学分析对组配式全髋关节置换术后股骨假体迁移的早期评估

目的 探讨立体影像学分析(roentgen stereophotogrammetric analysis,RSA)对全髋关节置换术后股骨假体迁移的评估价值.方法 2009年5月至2010年4月,行组配式全髋关节置换37例,男25例,女12例;年龄58～72岁,平均(60.23±5.64)岁.退行性骨关节炎32例,股骨颈骨折3例,髋关节发育不良2例.术后3、6、12、24个月采用Harris髋关节评分评估髋关节功能及RSA评估股骨假体的早期迁移度.结果 Harris髋关节评分从术前(26.36±10.56)分提高至术后不同随访时间点的(78.24±12.72)分、(84.51±16.05)分、(86.72±9.34)分及(87.55±8.97)分,与术前比较差异均有统计学意义.无假体翻修病例,3例有轻微的大腿痛.RSA评估发现早期迁移幅度个体差异较大,术后3～6个月存在较高的初始迁移.36例于术后24个月达到临床和生物学稳定,1例表现为假体进行性迁移.股骨假体向远端迁移(1.37±0.59) mm、向后迁移(1.37±0.54) mm,与术前差异有统计学意义.术后24个月内股骨假体向远端迁移与向后迁移呈正相关(r=0.3,P=O.O1),假体在横断面和矢状面上呈现出相对宿主骨界面稳定固定的趋势,股骨假体向远端及向后的倾斜或旋转移位主要发生在术后3个月内.不同尺寸的股骨头假体和不同偏心距的组配式股骨颈假体与发生在各个方向的迁移度无相关性.结论 RSA为组配式全髋关节置换术后股骨假体迁移度的早期评估提供了客观依据,可用于评估人工关节假体的早期稳定性.     

Résultats de la série GECO

301 hip prostheses were implanted in patients under the age of 50 years. All patients were followed for a minimal period of 3 years or until revision. The young age is due to the etiologies: femoral head necrosis, congenital hip dislocation, post-traumatic arthrosis. The implanted prostheses were of different types: both components were usually cementless; most bearing surfaces were alumina-polyethylene, with a head diameter of 32 or 28 mm. Patients were followed for 3 to 18 years after implantation (mean: 7 years). At the last follow-up, 59 prostheses (20%) had been exchanged; 232 cases had a good functional result according to Merle d’Aubigné (77% of the whole series and 96% of the surviving prostheses). The non revised patients mostly had an excellent result with regard to pain, range of motion and gait, and 85% returned to work.The final X-ray examinations of surviving prostheses showed 22% acetabular and 25% femoral radiolucent lines without loosening, 7% severe acetabular polyethylene wear. 3% of acetabular and 9% of femoral prostheses had migrated, mostly during the first months after cementless implantation with subsequent stabilisation.Revisions were performed after 6 months to 16 years. Main reasons were primary instability of a cementless implant (14 cases), secondary instability of a cementless implant (18 cases) and loosening of a cemented implant (18 cases). The global survival rate is 67% after 10 years, and 47% after 14 years. The survival rate of cemented cups was higher than screwed uncemented cups after 12 years (73% vs 59% - p<0,05), and there was no difference with uncemented press-fit cups after 7 years (95% vs 90%). The survival rate of cemented cups was higher than uncoated uncemented cups after 13 years(67% vs 53% -p<0,05), and there was no difference with hydroxyapatite-coated uncemented cups after 5 years (97% vs 93%). There was no difference between survival rates of cemented or cementless femoral prosthesis after 12 years (63% vs 54%) with respect to the presence or absence of hydroxyapatite. There was no difference between the survival rates of all bearing surfaces after 5 and 11 years, but none of the zirconia-polyethylene bearings had been revised after 5 years. There was no difference between survival rates of 28 mm and 32 mm heads after 8 years (86% vs 78%).Cemented prostheses are clearly indicated for patients under 50. Screwed uncemented cups are no longer indicated. Uncemented prostheses showed no better survival than cemented ones. Zirconia-polyethylene bearings could lead to a better survival rate than alumina-polyethylene or steel-polyethylene bearings.     

老年患者不同部位的髋部骨折对预后的影响

目的:研究骨折部位对老年髋部骨折预后的影响。方法:自2012年1月至2014年12月,共收治髋部骨折患者667例,根据骨折部位将髋部骨折分为股骨转子间骨折组和股骨颈骨折组,其中股骨转子间骨折组304例,男96例,女208例,平均年龄(80.33±7.94)岁;股骨颈骨折组217例,男74例,女143例,平均年龄(79.82±9.33)岁。比较两组患者入院资料、术后死亡率及独立生活能力的差异。结果:两组年龄、性别、合并症、ASA分级、麻醉方式差异不明显,但入院至手术等待时间、手术时间、术中出血量、术后引流量以及输血量差异有统计学意义。股骨转子间骨折术前、术后1、3、5 d白细胞计数较高,血红蛋白、白蛋白较低。股骨转子间骨折住院期间、术后1、3、6、12个月内死亡率较股骨颈骨折高,但差异无统计学意义。在存活患者中,出院时、术后1、3个月股骨颈骨折患者日常生活能力较股骨转子间骨折患者恢复更为满意,术后6、12个月,两组患者相比,日常独立生活能力差异无统计学意义。结论:尽管股骨转子间骨折对机体应激较大,但排除年龄、性别、合并症等因素的影响后,股骨转子间骨折和股骨颈骨折术后1年内死亡率差异不明显。和股骨转子间骨折患者相比,股骨颈骨折关节置换后早期功能恢复良好,但手术后1年,两者功能恢复差异不明显。     

Fractures of the femoral neck treated with cemented bipolar hemiarthroplasty

Seven of 59 (12%) bipolar hemiarthroplasties for displaced femoral neck fracture were classified as failures at the 3-year follow-up examination. Two prostheses dislocated, 4 had loose femoral stems, and 1 was revised to a total hip arthroplasty because of pain. No patients developed acetabular erosion or deep infection. Only four of 15 patients examined by fluoroscopy shared movement between outer metal/cartilage and inner metal/polyethylene surfaces. All movement occurred at the outer metal/cartilage surface in the remaining nine patients. We conclude that the low failure rate, which compares favorably with the best results after internal fixation, is caused by the optimal selection of patients for this operation (high age, low activity level) and the use of bone cement. The bipolar design is less important, since most of these prostheses function as ordinary unipolar prostheses after some time.     

儿童股骨干骨折手术治疗的探讨

目的：探讨儿童股骨干骨折的三种内固定手术治疗效果,方法：对50例儿童股骨干骨折的手术治疗方法及结果进行回顾性总结。结果：髓内针固定16例,钢板螺钉固定23例,多枚螺钉固定11例,所有骨折于术后4－8周临床愈合,1例术后6个月钢板断裂,其他病例均于术后4－12个月（平均6．5个月）骨性愈合后取出内固定物,随访时间1－8年（平均奖4．5年）,与手术有关的并发症有钢板断裂,再骨折,晚期扁平髋各1例,占6％,结论：髓内针固定操作简单,适于股骨上,中段骨折,但选择时需慎重,钢板螺钉固定对骨折复位满意,固定确切,适于复杂股骨干骨折,但创伤大,多枚螺钉固定适于长斜行或螺旋形股骨干骨折。     

人工肱骨头置换治疗肱骨近端复杂骨折18例疗效分析

目的探讨人工肱骨头置换治疗肱骨近端复杂骨折的疗效。方法 2005年1月-2011年1月,采用骨水泥型人工肱骨头置换治疗18例肱骨近端复杂骨折。男8例,女10例;年龄52～84岁,平均71岁。致伤原因:摔伤11例,交通事故伤3例,砸伤4例。伤后至入院时间为2 h～3 d,平均1.5 d。根据肱骨近端骨折Neer分型标准:三部分骨折8例,四部分骨折7例,肱骨头劈裂性骨折3例。合并肩关节半脱位5例,股骨骨折2例,桡骨骨折1例,骨质疏松症11例。结果手术时间60～180 min,平均80 min;术中出血量100～400 mL,平均200 mL。患者术后切口均Ⅰ期愈合,无感染、神经及血管损伤等早期并发症发生。16例患者获随访,随访时间1～6年,平均3年。X线片检查示无假体松动、脱位及异位骨化等并发症发生。术后1年肩关节功能按照Neer评分系统进行评价,获优5例,良8例,可2例,差1例,优良率81.2%。结论人工肱骨头置换治疗肱骨近端复杂骨折能有效解除疼痛、重建关节功能,尤其适宜于术后活动要求不高的老年患者。     

髋关节置换术治疗老年髋部骨折内固定失败

目的 评价采用髋关节置换术治疗老年髋部骨折内固定失败的临床效果.方法 回顾性分析2003年7月至2011年6月,采用髋关节置换术治疗老年髋部骨折内固定失败并获得完整随访资料者22例,男12例,女10例;行髋关节置换术的年龄为65～82岁,平均72岁;从骨折到行髋关节置换的时间为8～71个月,平均41个月.骨折内固定方法是多枚螺钉12例,滑动髋螺钉6例,股骨近端髓内钉2例,股骨近端钢板2例.失败原因是拉力螺钉切出股骨头7例,骨折不愈合6例,股骨头缺血性坏死5例,创伤性骨关节炎4例.术前患髋Harris评分平均37分(32～45分),采用非骨水泥型全髋置换l1例,骨水泥型全髋置换4例,非骨水泥型半髋置换4例,骨水泥型半髋置换3例.标准柄股骨假体1 5例,长柄股骨假体7例.结果 22例均获随访,随访时间1～5年,平均2.5年.末次随访时Harris评分平均88分(84～95分),优7例,良11例,可3例,差1例,优良率81.8％.无假体松动和下沉.结论 髋关节置换术是治疗老年髋部骨折内固定失败后的一种有效挽救关节功能的选择.     

THA for a Fractured Femoral Neck: Comparing the Revision and Dislocation Rates of Standard-head,Large-head,Dual-mobility,and Constrained Liners

BackgroundTHA is a reasonable surgical option for some patients with fragility fractures of the femoral neck, but it has the risk of prosthesis dislocation. The prosthesis combination that reduces the risk of dislocation and the rate of revision surgery is not known.Questions/purposesIn patients receiving primary THA for a femoral neck fracture, does (1) the rate of all-cause revision or (2) the reason for revision and rate of revision for dislocation differ among THA with a standard head size, large head size, dual mobility (DM), or constrained liner? (3) Is there a difference in the revision risk when patients are stratified by age at the time of surgery?MethodsData were analyzed for 16,692 THAs performed to treat fractures of the femoral neck reported in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from January 2008 to December 2018, as this included the first use of DM prostheses. The AOANJRR includes information on more than 98% of arthroplasty procedures performed in Australia. Most patients were female (72%) and the mean age was 74 years ± 11. There were 8582 standard-head prostheses, 5820 large-head prostheses, 1778 DM prostheses, and 512 constrained prostheses identified. The cumulative percent revision (CPR) was determined for all causes as well as CPR for dislocation. The time to the first revision was described using Kaplan-Meier estimates of survivorship, with right censoring for death or closure of the database at the time of analysis. The unadjusted CPR was estimated each year of the first 10 years for standard heads, 10 years for large heads, 8 years for constrained liners, and 7 years for DM prostheses, with 95% confidence intervals using unadjusted pointwise Greenwood estimates. The results were adjusted for age, sex, femoral fixation, and head size where appropriate and were considered by age groups < 70 and ≥ 70 years.ResultsWhen adjusted for age, sex, femoral fixation and head size, there was no difference in the rate of all-cause revision at 7 years for any of the four groups. There was no difference in the rate of all-cause revision when patients were stratified by < 70 or ≥ 70 years of age. Dislocation was the most common reason for revision (32%). When analyzing revision for dislocation alone, large-head THA had a lower rate of revision for dislocation compared with standard head (HR 0.6 [95% CI 0.4 to 0.8]; p < 0.001) and DM prostheses had a lower rate of revision for dislocation than standard head for the first 3 months (HR 0.3 [95% CI 0.1 to 0.7]; p < 0.004) but not after this time point.ConclusionThe Australian registry shows that there is no difference in the rate of all-cause revision for standard-head, large-head, DM prostheses or constrained liner THA after femoral neck fractures for all patients or for patients stratified into younger than 70 years and at least 70 years of age groups. Dislocation is the most common cause of revision. Large-head prostheses are associated with a lower revision risk for dislocation and DM prostheses have a lower rate of revision for dislocation than standard heads for the first 3 months only. Surgeons treating a femoral neck fracture with THA might consider a large head size if the diameter of the acetabulum will allow it and a DM prosthesis if a large head size is not possible. The age, life expectancy and level of function of patients with femoral neck fractures minimizes the potential long-term consequences of these prostheses. The lack of significant differences in survival between most prosthesis combinations means surgeons should continue to look for factors beyond head size and prosthesis to minimize dislocation and revision surgery.Level of EvidenceLevel III, therapeutic study.     

Change of daily life activity after femoral hip fracture in elderly patients

Hospital mortality after hip fracture in elderly patients has decreased significantly in previous years. However, patients often show reduction of daily life activity. The aim of the following study was to assess clinical and radiological results nine months after operation of hip fracture. A total of 127 patients (mean age 77.2 years) were stabilized by arthroplasty because of femoral neck fractures or by gamma locking nail because of trochanteric fractures. Modified Harris-Hip-Score as well as social situation at time of follow-up compared to pretrauma situation were evaluated. Hospital mortality was 3.2 percent. Follow-up could be performed in 78 patients clinically and radiologically by examination in the hospital. At time of follow-up 19.7 percent of patients had already died independent of the operative procedure. Only 65 percent of patients were able to live at home. Modified Harris-Hip-Score at follow-up was decreased significantly by 16 points compared to the situation before the trauma. The reduction of the score was caused mainly by deterioration of hip function and less by femoral or hip pain. In future the main scope after hip fracture must be an improvement of rehabilitation of elderly patients.     

85岁以上股骨粗隆间骨折三种手术方式比较

目的研究探讨85岁以上股骨粗隆间骨折行人工关节置换术、PFNA内固定术、非手术治疗的优缺点,为临床超高龄股骨粗隆间骨折的治疗提供参考。方法对132例85岁以上的股骨粗隆间骨折的治疗进行了前瞻性的控制研究,9例预计寿命短于半年的患者剔除研究,12例患者失访,111例最终得到观察,41例行骨水泥型加长柄双极人工股骨头置换术,37例行PFNA内固定术,33例行胫骨结节牵引非手术治疗。结果随访6个月到4年,111例中有12例半年内死亡,其中9例是非手术治疗组,人工关节置换组与PFNA内固定组的关节功能,并发症及死亡率均优于非手术治疗组。结论在85岁以上超高龄股骨粗隆间骨折患者全身情况得到有效控制后,应尽快进行手术治疗。人工股骨头置换术后可以得到即刻的髋关节功能,尤其适应于超高龄骨质疏松性不稳定性股骨粗隆间骨折。     

Assessment of the survival and the clinical results of Stanmore total knee replacements

We review 210 Stanmore knee replacements in 163 patients to assess the survival of the prostheses and the long-term results. The annual rate of failure reached a maximum of 4.6% in the fourth year after operation; thereafter it declined to reach zero by the eighth year. Between two and eight years after operation, 66.3% of the surviving knees were completely free of pain and 30.2% had mild retropatellar pain. Fixed flexion deformities present before operation were completely corrected in 73% of the knees, and varus or valgus deformities were invariably corrected. Stability was always restored to unstable knees and 80.8% of knees flexed to 90 degrees or more after replacement. Aseptic loosening (8.1%), prosthetic infection (4.3%) and femoral fracture (2.9%) led to 8.5% of the prostheses being revised or removed over eight years. Modifications in prosthetic design and operative techniques have been introduced to minimise such complications in the future.     

Large diameter metal on metal total hip replacement for femoral neck fractures with neurological conditions: A retrospective assessment

Background:

Patients with Parkinson''s disease and poliomyelitis can have a femoral neck fracture; yet, the optimal methods of treatment for these hips remains controversial. Many constrained or semi-constrained prostheses, using constrained liners (CLs) with a locking mechanism to capture the femoral head, were used to treat femoral neck fractures in patients with neurological disorders. We retrospectively studied a group of patients with Parkinson''s disease and poliomyelitis who sustained femoral neck fractures and were treated by total hip arthroplasty using an L-MoM prosthesis.

Materials and Methods:

We retrospectively reviewed 12 hips in 12 patients who underwent large-diameter metal-on-metal (L-MoM) total hip replacement between May 2007 and October 2009. Eight of the 12 patients (8 hips; 66.7%) had Parkinson''s disease and 4 patients (4 hips; 33.3%) were affected with poliomyelitis.

Results:

The followup time was 5.2 years (range 3.6-6.0 years). At the latest followup, all the patients showed satisfactory clinical and radiographic results, with pain relief. No complications, such as dislocation or aseptic loosening occurred.

Conclusion:

We believe the use of L-MoM can diminish the rate of instability or dislocation, after operation. The L-MoM is an option for patients with Parkinson''s disease and poliomyelitis with femoral neck fracture.     

Total hip replacement after femoral neck fractures in elderly patients : Results of 8,577 fractures reported to the Norwegian Arthroplasty Register

Background?A total hip arthroplasty (THA) is often used as treatment for failed osteosynthesis of femoral neck fractures and is now also used for acute femoral neck fractures. To investigate the results of THA after femoral neck fractures, we used data from the Norwegian Arthroplasty Register (NAR).

Patients and methods?The results of primary total hip replacements in patients with acute femoral neck fractures (n = 487) and sequelae after femoral neck fractures (n = 8,090) were compared to those of total hip replacements in patients with osteoarthrosis (OA) (n = 55,109). The hips were followed for 0–18 years. The Cox multiple regression model was used to construct adjusted survival curves and to adjust for differences in sex, age, and type of cement among the diagnostic groups. Separate analyses were done on the subgroups of patients who were operated with Charnley prostheses.

Results?The survival rate of the implants after 5 years was 95% for the patients with acute fractures, 96% for the patients with sequelae after fracture, and 97% for the OA patients. With adjustment for age, sex, and type of cement, the patients with acute fractures had an increased risk of revision compared to the OA patients (RR 1.6, 95% CI: 1.0–2.6; p = 0.05) and the sequelae patients had an increased risk of revision (RR 1.3, 95% CI: 1.2–1.5; p < 0.001). Sequelae hips had higher risk of revision due to dislocation (RR 2.0, 95% CI: 1.6–2.4; p < 0.001) and periprosthetic fracture (RR 2.2, 95% CI: 1.5–3.3; p < 0.001), and lower risk of revision due to loosening of the acetabular component (RR 0.72, 95% CI; 0.57–0.93; p = 0.01) compared to the OA patients. The increased risk of revision was most apparent for the first 6 months after primary operation.

Interpretation?THA in fracture patients showed good results, but there was an increased risk of early dislocations and periprosthetic fractures compared to OA patients.     

Knee arthroplasty in rheumatoid arthritis. Four- to six-year follow-up study

A consecutive series of total condylar knee arthroplasties in patients with rheumatoid or related arthritis, with a 4-6-year follow-up period, was studied. Eighty-seven percent had an excellent or good overall result (score of 70 or more on the HSS knee rating scale). The median total score increased from 45 points before operation to 83 after operation. Sixteen complications, mostly minor, occurred in 14 patients. There were no early infections. Two prostheses were removed for deep infection, after 3 and 5 years. One patient had patellectomy for avascular necrosis. The crude prosthesis survival rate was 97%. Tibial radiolucencies were noted in 76% of cases; in 29% they were significant (2 mm or more in one or more of three zones). Two tibial components (2%) were believed to be mechanically loose, but no revisions for mechanical loosening were done. The presence of radiolucencies did not signify an inferior clinical result.     

老年人髋部骨折156例临床治疗分析

目的 报告老年人髋部骨折的临床治疗方法，分析老年髋部骨折特点及诊治注意事项。方法 自1997年1月－1999年12月共治疗60岁以上（60－93岁）髋部骨折156例。男性55例，平均年龄71．8岁；女性101例，平均年龄73．1岁。骨折类型：股骨颈骨折94例，男性20例，女性74例；股骨粗隆间骨折62例，男性35例，女性27例。本组接受非手术治疗41例；手术治疗115例，其中行各种内固定手术45例，人工股骨头置换68例，股骨头颈切除2例。部分病例同时给予骨质疏松药物治疗。结果 获得随访110例。随访时间0．5－3．5年。术后下肢静脉栓塞2例，股骨头缺血坏死2例，内固定物松动，滑脱2例，断裂1例，人工股骨头下沉致疼痛4例，术后近期死亡2例（死于心肌梗塞及呼吸道感染），97例（88．2％）恢复行走功能。结论 （1）老年人髋部骨折以女性多见，占64．7％；男性少见，占35．3％。这与女性绝经后骨折疏松症的发生密切相关。而老年股骨颈骨折多见于女性，股骨粗隆间骨折则多见于男性。70岁以后，老年髋部骨折发生率明显上升。这与老年性骨质疏松症的发生明显相关。说明随着年龄的增加，骨折的发生率明显增高，骨折危险性增加。（2）老年人髋部骨折属于骨质疏松性骨折，股骨粗隆间骨折一般都有明确外伤史；而股骨颈骨折常由轻微外力（扭转）所致，因此在诊断时须防止漏诊或误诊，影响治疗效果。（3）老年人多伴有心血管系统或呼吸系统疾病，骨折后长期卧床具致使的威胁，因此在治疗上如无禁忌应争取早期手术，早期下床活动。（4）在治疗骨折的同时，应注意对骨质疏松症的治疗，这对减轻全身骨痛，促进骨折愈合，防止再骨折均有重要意义。