Complications following hemiarthroplasty for displaced intracapsular femoral neck fractures in the absence of routine follow-up

Introduction

Hemiarthroplasty is the most commonly performed surgery for displaced intracapsular femoral neck fractures. At present, it is not routine practice to follow up these patients despite the risk of all the complications associated with arthroplasty. This study aimed to determine the prevalence and nature of complications occurring following hemiarthroplasty that re-presented to this centre in the absence of routine postoperative follow-up.

Methods

Consecutive patients undergoing uncemented hip hemiarthroplasty for displaced intracapsular femoral neck fractures at a district general hospital between 2004 and 2009 were identified. Data were collected from the hospital database on all complications relating to the index procedure, further surgery performed and mortality.

Results

There were 490 hemiarthroplasties performed in 477 patients (mean age: 80 years, 75% female). Of these, 110 (22%) were referred postoperatively for specialist orthopaedic review. The prevalence of any complication following hemiarthroplasty was 12% (n=59) and the prevalence of hemiarthroplasty failure was 8% (n=40). The most common indications for failure were periprosthetic fracture (28%), aseptic femoral loosening (25%) and unexplained pain (25%). Persistent hip pain and poor mobility accounted for most complications not requiring further surgery (n=15). The mortality rate within 30 days and 1 year of hemiarthroplasty was 6% (n=31) and 29% (n=146) respectively.

Conclusions

In the absence of routine follow-up, complications were encountered frequently in patients undergoing hip hemiarthroplasty, with most requiring further surgery. Appropriate services should be implemented to allow timely referral for orthopaedic assessment, and enable the early identification and treatment of postoperative complications.     

Inotropic and vasodilating properties of amrinone depend on the mode of administration

Intravenous infusion of amrinone at increasing rates (10–100µg kg^–1 min^–1,N= 8) caused dose dependentdecreases in left ventricular filling pressure (up to 22%, P<0.05)andcardiac output (up to 16%,P<0.05), but had no effect onheart rate, max L VdP/dt or total systemic vascular resistancein anaesthetized open-chest pigs. Despite unchanged total systemicvascular resistance, tissue vascular resistance decreased significantlyin the heart, stomach, adrenals and kidneys. Although transmuralleft ventricular perfusion was not influenced by amrinone, coronaryblood flow was redistributed in favour of the epicardium, asendo-epi blood flow ratio decreased from 0.95±0.03 to0.82±0.03 (P<0.05). In the same model an intravenousbolus of 1 mg kg^–1 followed by a continuous infusion of50 µg kg^–1 min^–1 (N<8), caused immediatechanges (P<0.05) in left ventricular filling pressure (–35%),max LVdP/dt (+55%), heart rate (+15%) and total systemic vascularresistance (–15%). The changes in filling pressure andsystemic vascular resistance persisted during the next 25 minutes,but maxLVdP/dt returned gradually to baseline in spite of increasingplasma concentrations of the drug. In the conscious pig (N=4),administration of a 1 mg kg^–1 bolus in the pulmonary arteryled to similar increases in heart rate (15%) and max LVdP/dt(26%), while systolic left ventricular pressure was not affected.Direct infusion into the left anterior descending coronary artery(10–40 µg kg^ndash;1 min^–1, N=5) had negligibleeffects on overall haemodynamics and regional myocardial function.The only significant changes were a vasodilation in the coronaryvascular bed accompanied by dose dependent increases in thecoronary venous O₂-content. From our study it appears that abolus injection, as given in the clinical setting, is requiredto elicit an increase in max LVdP/dt and arterial vasodilationbut that the effect on left ventricular preload is not sensitiveto different modes of administration.     

A clinical review of the adaptive role of vasopressin in migraine

Vasopressin is a naturally available neuropeptide that subserves important vasomotor, antinociceptive, behavior control, fluid and electrolyte balance, platelet aggregation and blood coagulation functions. This review focuses on the clinical phenomena of migraine that are likely to influence vasopressin bioavailability or efficacy as well as the modulating influence of vasopressin itself. As part of a complex homeostatic adjustment to stress and pain, the intricacies of vasopressin metabolism may have particular relevance to the pathophysiology of migraine.     

Inadvertent But Asymptomatic Right Atrial Perforation with Epicardial Pacing in a Neonate: A Rare Complication of Temporary Transvenous Cardiac Pacing

We report a case of an asymptomatic right atrial perforation due to temporary cardiac pacing in a neonate.