Hip Arthroplasty After Surgical Treatment of Intertrochanteric Hip Fractures

Background

Although use of intramedullary hip screws (IMHS) for intertrochanteric (IT) hip fractures has become more common, limited data have suggested difficulties in conversion to hip arthroplasty. The present study investigates whether conversion of failed IT fracture fixation with an intramedullary vs extramedullary device leads to different rates or types of complications or decreased arthroplasty survivorship.

Cementless Bipolar Hemiarthroplasty Using a Hydroxyapatite-Coated Long Stem for Osteoporotic Unstable Intertrochanteric Fractures

Treating senile osteoporotic patients with unstable hip fractures remains a challenge. We evaluated the results of 87 cementless bipolar hemiarthroplasties using an extensively hydroxyapatite-coated long stem for unstable intertrochanteric fractures in senile patients. Sixty-one hips were followed for a minimum of 2 years (mean, 36 months) postoperatively. The mean Merle d'Aubigne and Postel hip score was 14.7 points (12-18). Two hips were reoperated because of infection. Of the remaining 59 hips, 48 were included in the radiographic analysis. Although cortical porosis around the stem was seen in 18 hips, there was no loosening or osteolysis. Cementless bipolar hemiarthroplasty using an extensively hydroxyapatite-coated long stem is a useful option for the treatment of unstable intertrochanteric fracture in senile patients with severe osteoporosis.     

Hemiarthroplasty for Unstable Intertrochanteric Hip Fractures: A Matched Cohort Study

BackgroundGeriatric intertrochanteric fractures remain a major public health concern due to the considerable disability, morbidity, mortality, and health care costs associated with these injuries. The underlying poor bone quality and unstable nature of these fractures makes them difficult to treat. The main purpose of this study was to evaluate the outcome of hemiarthroplasty for unstable intertrochanteric hip fractures when compared to the traditional treatment options of open reduction internal fixation (ORIF).MethodsA retrospective 1:1 matched cohort of 150 patients who had intertrochanteric fractures treated with either hemiarthroplasty or ORIF was developed using a local institutional database. Demographic, perioperative, and postoperative variables were collected with at least 1 year of patient follow-up. Statistical analyses were performed with use of Student’s t-tests, chi-square tests, and analysis of variance.ResultsUnstable intertrochanteric fractures treated with ORIF were associated with significantly more blood loss and an increased need for revision surgery. This effect was most pronounced in Arbeitsgemeinschaft für Osteosynthesefragen Orthopaedic Trauma Association classification type 31.A3 fractures, as patients treated with ORIF experienced significantly slower postoperative mobilization, increased blood loss, increased readmission, and revision surgery rates. Hemiarthroplasty was associated with an increased risk of greater trochanter escape, which did not appear to effect outcomes in this subset of patients.ConclusionHemiarthroplasty may improve outcomes for patients with unstable intertrochanteric fractures. The benefit of this technique is likely maximized in Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association type 31.A3 fractures. It remains a good option in the hands of experienced surgeons.     

Outcomes of Total Hip Arthroplasty for Healed Intertrochanteric Hip Fractures. A Matched Retrospective Cohort Study

BackgroundMany studies have analyzed the outcomes of total hip arthroplasty (THA) after failed intertrochanteric fracture fixation, but not after healed fracture. The objective is to investigate the influence of a prior healed intertrochanteric fracture fixation on the outcomes of a subsequent THA for osteoarthritis.MethodsThis is a matched retrospective cohort study of THA between 43 patients who suffered a prior intertrochanteric fracture successfully managed with internal fixation and 43 patients without prior hip fracture. Mean age was 73.6 vs 74.2 years. A conventional cementless THA was used in both groups. Functional outcome was assessed by the Harris hip score (HHS) and reduced Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Radiological assessment was also performed.ResultsMean follow-up was 6.6 (range, 5-8) years. The mean operative time and blood transfusion rate were significantly higher in the fracture group (P = .001), but there was no significant difference in the length of stay. HHS significantly improved in both groups. At final follow-up, HHS was significantly higher in nonfracture group (P = .008), but the rate of patients with excellent and good outcomes was similar (P = .616). Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow-up was not different between groups (P = .058). Complication rate was similar between groups. There were no revisions, dislocations, or loose implants in the study group.ConclusionCementless THA provided successful functional outcomes and implant durability at medium term in patients treated for osteoarthritis following healed intertrochanteric fracture fixation, comparable to those without prior fracture who underwent primary THA. Surgical complexity and complication rate were low.     

Comparison of Intra- and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures

IntroductionComparison was made of the clinical and radiological results of the surgical treatments of proximal femoral nail (PFN), dynamic hip screw (DHS) or proximal femoral locking compression plate (PF-LCP) in patients with AO 31A2.2/2.3 unstable intertrochanteric femoral fracture(ITF).MethodsEvaluation was made of a total of 91 patients in respect of age, gender, time from fracture to surgery, operating time, amount of blood replacement, total hospitalisation, follow-up period, time to full weight-bearing, time to union, complications and Harris hip scores(HHS).ResultsA statistically significant difference was determined between the groups in respect of perioperative operating time, blood replacement and hospitalisation period with the values of the PFN group seen to be superior to those of the other two groups (p < 0.001). No significant difference was determined beween the DHS and PFN groups in respect of time to union and in the long-term HHS, both groups were seen to be superior to the PF-LCP group (p < 0.001). Full weight-bearing was statistically significantly earlier in the PFN group (p < 0.001). The numbers of implant failures was statistically significantly higher in the PF-LCP group (p < 0.001).ConclusionThe new generation intra-medullar nails are easy to apply and have more successful clinical results compared to extra-medullar implants in the treatment of A2 unstable ITF. Due to the high rates of implant failure, PF-LCP should not be preferred in these fractures.     

Wagner SL股骨假体治疗复杂股骨近端骨折的疗效观察

目的探讨Wagner SL股骨假体治疗复杂股骨近端骨折的疗效。方法自2009-01—2015-05采用Wagner SL股骨假体治疗60例复杂股骨近端骨折,记录手术时间及出血量,采用髋关节功能Harris评分进行评价。结果手术时间45~200(95±27)min,术中出血400~1 500(600±240)ml,术后输血2~10 U悬浮红细胞。所有患者切口均一期愈合,术后假体位置佳。共50例获得随访2~68(34±19)个月,术前Harris评分35~75(58±10)分,末次随访Harris评分65~93(81±9)分,假体无明显松动,假体周围无透亮带、下沉。结论采用Wagner SL股骨假体治疗复杂股骨近端骨折疗效满意,值得临床推广。     

人工关节置换术治疗高龄股骨转子间骨折内固定失效

目的探讨人工关节置换治疗高龄股骨转子间骨折内固定失效的疗效。方法对2000年1月至2010年12月行人工关节置换术的28例70岁以上股骨转子间骨折内固定失效或骨折不愈合的患者进行回顾性分析。患者男10例,女18例;年龄70~86岁,平均76.5岁。随访期限6~60个月,平均24个月。应用H arris评分标准进行结果评价。结果患者均在术后15 d拄双拐下地负重行走,6~8周弃拐改用手杖,髋关节功能接近伤前水平,生活基本自理。髋关节功能按H arris评分标准,询问骨折前患髋功能及参照健侧予以评分84~97分,平均(90±4)分。人工关节置换术前40~48分,平均(45±3)分;术后82~95分,平均(89±3)分。结论人工关节置换治疗高龄股骨转子间骨折内固定失效或骨折不愈合可以有效减轻患者髋关节疼痛,降低并发症,提高生活质量,是高龄股骨转子间骨折内固定失效治疗的有效挽救手段。     

Results of Wagner SL revision stem with impaction bone grafting in revision total hip arthroplasty

Background:

As the number of total hip arthroplasties (THAs) performed increases, so do the number of required revisions. Impaction bone grafting with Wagner SL Revision stem is a good option for managing bone deficiencies arising from aseptic osteolysis. We studied the results of cementless diaphyseal fixation in femoral revision after total hip arthroplasty and whether there was spontaneous regeneration of bone stock in the proximal femur after the use of Wagner SL Revision stem (Zimmer, Warsaw, IN, USA) with impaction bone grafting.

Materials and Methods:

We performed 53 hip revisions using impaction bone grafting and Wagner SL Revision stems in 48 patients; (5 cases were bilateral) for variety of indications ranging from aseptic osteolysis to preiprosthetic fractures. The average age was 59 years (range 44-68 years). There were 42 male and 6 female patients. Four patients died after surgery for reasons unrelated to surgery. 44 patients were available for complete analysis.

Results:

The mean Harris Hip Score was 42 before surgery and improved to 86 by the final followup evaluation at a mean point of 5.5 years. Of the 44 patients, 87% (n=39) had excellent results and 10% (n=5) had good results. The stem survival rate was 98% (n=43).

Conclusion:

Short term results for revision THA with impaction bone grafting and Wagner SL revision stems are encouraging. However, it is necessary to obtain long term results through periodic followup evaluation, as rate of complications may increase in future.     

Mid-Term Survivals After Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

Background

Treatment of unstable intertrochanteric fracture in elderly patients remains challenging. The purpose of this prospective study is to determine clinical and radiological results of cementless bipolar hemiarthroplasty using a fully porous-coated stem in osteoporotic elderly patients with unstable intertrochanteric fractures with follow-up over 5 years.

骨水泥半髋关节置换治疗老年不稳定性股骨转子间骨折

目的 探讨应用骨水泥半髋关节置换术治疗老年不稳定性股骨转子间骨折的可行性和近期疗效.方法 回顾性分析2009年10月至2012年3月应用骨水泥半髋关节置换术治疗高龄不稳定性股骨转子间骨折21例,其中男9例,女12例;年龄76～91岁,平均81.6岁.骨折分类按Evans-Jensen分型,Ⅱ型4例,Ⅲ型13例,Ⅳ型4例.结果 手术时间40～60 min,平均48 min,出血量260～500mL,平均380mL,术后全部患者切口均一期愈合,住院时间21～35 d,平均28.6d.2例患者术后发生肺部感染,经过抗感染、化痰、雾化吸入等治疗后痊愈.术后全部患者随访12～18个月,平均15.8个月,术后2周患者可借助双拐下床活动,术后2个月,18例患者行走能力基本恢复至伤前水平,生活能自理.末次随访时Harris评分为50～90分,其中优5例,良13例,可3例,优良率85.7％.无一例出现髋臼磨损、假体下沉、感染等相关手术并发症.结论 应用骨水泥半髋关节术治疗高龄不稳定性转子间骨折是一种有效的方法,术后可早期下床活动,提高生活质量.     

Wagner SL股骨柄治疗陈旧性或伴髋关节炎的股骨粗隆间骨折疗效观察

目的 :探讨Wagner SL股骨柄治疗陈旧性或伴痛性髋关节炎的股骨粗隆间骨折的临床疗效。方法 :自2006年1月至2009年12月对8例陈旧性粗隆间骨折及21例伤前有痛性关节炎的粗隆间骨折使用Wagner SL股骨柄行全髋关节置换并重建粗隆,其中男18例,女11例;年龄43~58岁,平均49岁。术后临床随访,根据Harris评分、肢体长度差异、髋关节活动范围以及髋外展肌力进行评价。影像学随访包括对股骨柄假体周围骨溶解、假体松动、透光线等进行评价。结果:29例患者均成功完成手术,未出现与髋关节置换手术相关的严重并发症。术后均获得随访,时间6~10年,平均8.2年。均无不可接受的大腿疼痛主诉。8例陈旧性粗隆间骨折患者术后首次行走时均有"手术侧肢体过长"抱怨,随时间推移,这种抱怨在明显减少。术后3个月X线片提示21例伤前痛性关节炎的粗隆间骨折愈合,平均术后6个月(3~8个月)X线片提示8例陈旧性粗隆间骨折患者的植骨块与粗隆有明显骨痂连接,末次随访时X线片均未提示假体明显下沉。髋关节活动度基本恢复正常,无髋外展无力。根据Harris评分方法,手术后6年以上对患髋关节进行评价,优18例,良9例,可2例。结论:Wagner SL股骨柄在治疗陈旧性或伴痛性髋关节炎患者粗隆间骨折的初次全髋关节置换中可取得优良的临床疗效,粗隆重建,有利假体和关节稳定,同时增加骨储备。     

关节置换治疗股骨粗隆间骨折内固定失败的疗效观察

目的观察人工髋关节置换治疗股骨粗隆间骨折内固定失败患者的临床疗效。方法对2007年6月至2013年6月收治的21例股骨粗隆间骨折内固定失败的患者采用人工髋关节置换,并随访其疗效。本组21例21髋,其中20例采用全髋关节置换,1例采用人工双动股骨头置换。年龄40~79岁,平均62.8岁。无一例术中发生不良反应,术后均在2~3 d下床活动,无肺炎、褥疮等并发症发生。结果随访时间5~48个月,平均15.6个月。本组病例均伤口愈合良好,未发生假体下沉、松动现象,部分患者假体长度未超过远端螺钉孔,但无应力骨折发生。术后早期脱位1例,复位并行前方松解后未再次脱位。术后行走功能恢复正常(Harris评分平均术前43.2分,术后84.5分)。结论人工关节置换治疗股骨粗隆间骨折内固定失败患者,可早期下地功能锻炼,减少卧床时间及并发症的发生,有利于早期功能恢复,远期疗效需要进一步观察。     

The Association of Postoperative Osteoporosis Therapy With Periprosthetic Fracture Risk in Patients Undergoing Arthroplasty for Femoral Neck Fractures

BackgroundDisplaced femoral neck fractures in older adults are generally treated with hip arthroplasty. One concern following hip arthroplasty is the risk for periprosthetic fractures (PPFs). Most patients who have hip fractures are candidates for antiosteoporotic therapy, but the impact of this treatment on PPFs is unknown. Therefore, the primary objective of this study was to evaluate whether patients treated with antiosteoporotic medical therapy had lower odds of PPFs following arthroplasty for hip fracture.MethodsPatients at least 65 years old who underwent hip arthroplasty for femoral neck fractures from 2010 to 2020 were identified in a national database. Patients were stratified based on whether they initiated antiosteoporotic therapy within 1 year of hip arthroplasty. Minimum follow-up was 1 year, and maximum follow-up was 10.6 years. The primary endpoint was cumulative incidence of PPF as determined using Kaplan–Meier and Cox proportional hazards regression analyses. Overall, 2,026 patients who underwent arthroplasty for femoral neck fracture received antiosteoporotic medications within 1 year following surgery (mean follow up 4.8 years; range 1.0 to 10.6 years) and 33,639 patients did not (mean follow up 4.1 years; range 1.1 to 10.3 years).ResultsThe 10-year cumulative incidence of PPF for patients treated for osteoporosis was 3.88% compared to 5.92% for those who were untreated (P < .001). Adjusting for covariates, patients who received osteoporosis treatment had a significantly lower risk for PPF than those who were untreated (hazard ratio (HR): 0.663; 95% confidence interval (CI): 0.465-0.861; P = .038).ConclusionThe present study suggests that osteoporosis treatment is associated with lower incidence of PPF following hip arthroplasty for femoral neck fractures. Treatment of osteoporosis should be initiated in eligible patients who sustain a femoral neck fracture, especially those who undergo hip arthroplasty.     

Long-Term Survival and Reason for Revision of Wagner Resurfacing Hip Arthroplasty

The long-term survival of 270 Wagner resurfacing hip arthroplasties was determined. Two patients were lost to follow-up. Eleven hips remained unrevised at 15 to 22 years. Survival at 5, 10, and 16 years was 74%, 35%, and 17%, respectively. Survival in patients older than 55 years was better after 5 years than that for patients 55 years or younger (P = .0067). Femoral neck fracture occurred in 2% of the total cohort. Femoral component failure was an early and midterm complication. Acetabular component loosening was the most common reason for revision. The proportion of cases revised for acetabular component failure increased with time. These long-term data in this large series provide important historical results against which the relative benefits of contemporary designs may be evaluated.     

人工髋关节置换治疗内固定失败和高龄严重股骨粗隆间骨折

目的：探讨人工髋关节置换治疗高龄严重股骨粗隆问骨折和内固定失败病例疗效，初步总结分析此类手术的适应证及方法特点。方法：自1997年6月～2002年12月，收治股骨粗隆间骨折内固定失效8例，高龄严重粉碎移位股骨粗隆间新鲜骨折6例。采用全髋关节置换9例，双极人工股骨头置换5例，1例术中股骨近端骨折，加环抱器固定。结果：随访3个月～5年半，2例出现关节周围异位骨化，没出现感染、术后骨折、脱位、假体松动及血管栓塞等并发症，Harris评分，术前平均42分(24～56分)，术后平均86分(65～99分)。结论：股骨粗隆间骨折内固定失败及部分高龄严重移位股骨粗隆间骨折，人工髋关节置换是一种直接有效的治疗方法。     

Conversion Hip Arthroplasty in Failed Fixation of Intertrochanteric Fracture: A Propensity Score Matching Study

Background

Conversion hip arthroplasty is a salvage procedure for failed internal fixation of intertrochanteric fractures. However, the technical difficulties and perioperative morbidity of conversion arthroplasty are uncertain.

DHS与PFN治疗老年不稳定型转子间骨折

目的比较老年不稳定型转子间骨折采用动力髋螺钉和股骨近端髓内钉固定的手术疗效。方法62例不稳定型老年转子间骨折患者中,30例采用动力髋螺钉固定,32例采用股骨近端髓内钉固定,并对手术资料、术后并发症及髋关节功能进行临床随访分析。结果与DHS组相比,PFN组手术时间短,切口小,术中出血量及术后引流量少,骨折临床愈合时间短,且可早期下床负重而不增加术后并发症发生率。结论PFN技术创伤小、操作简单、固定牢靠、并发症少,是治疗老年不稳定型转子间骨折的理想方法之一。     

人工关节置换与内固定治疗骨质疏松性不稳定股骨粗隆间骨折的比较研究

目的比较人工关节置换和内固定治疗骨质疏松性不稳定型股骨粗隆间骨折的临床效果。方法回顾32例高龄骨质疏松性不稳定型股骨粗隆间骨折患者的疗效,11例接受人工关节置换,21例接受内固定。主要比较两组的卧床时间、围手术期并发症、Harris以及FRS评分下降情况。结果①内固定组的卧床并发症明显高于人工关节置换组(P<0.05);②人工关节置换组的卧床时间要明显短于内固定组(P<0.05);③术后Harris下降情况分别为(22.10±8.85)分和(29.42±8.36)分(P<0.05);术后FRS评分下降情况分别为(21.32±11.43)分和(37.55±23.24)分(P<0.05)。结论人工髋关节置换术治疗骨质疏松性不稳定型股骨粗隆间骨折,疗效优于内固定组。     

Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery

BackgroundHip fracture in older patients leads to high morbidity and mortality. Patients who are treated surgically but fail acutely face a more complex operation with conversion total hip arthroplasty (THA). This study investigated mortalities and complications in patients who experienced failure within one year following hip fracture surgery requiring conversion THA.MethodsPatients aged 60 years or more undergoing conversion THA within one year following intertrochanteric or femoral neck fracture were identified and propensity-matched to patients sustaining hip fractures treated surgically but not requiring conversion within the first year. Patients who had two-year follow-up (91 conversions; 247 comparisons) were analyzed for 6-month, 12-month, and 24-month mortalities, 90-day readmissions, surgical complications, and medical complications.ResultsNonunion and screw cutout were the most common indications for conversion THA. Mortalities were similar between groups at 6 months (7.7% conversion versus 6.1% nonconversion, P = .774), 12 months (11% conversion versus 12% nonconversion, P = .999), and 24 months (14% conversion versus 22% nonconversion, P = .163). Survivorships were similar between groups for the entire cohort and by fracture type. Conversion THA had a higher rate of 90-day readmissions (14% versus 3.2%, P = .001), and medical complications (17% versus 6.1%, P = .006). Inpatient and 90-day orthopaedic complications were similar.ConclusionConversion THA for failed hip fracture surgery had comparable mortality rates to hip fracture surgery, with higher rates of perioperative medical complications and readmissions. Conversion THA following hip fracture represents a potential “second hit” that both surgeons and patients should be aware of with initial decision-making.