Who Restores Hip Biomechanics More Effectively after a Femoral Neck Fracture? Comparison of Total Hip Arthroplasties Performed by Either Hip Surgeons or Orthopaedic Residents (original) (raw)
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Life, 2021
Introduction: The restoration of the preoperative biomechanics of the hip, in particular leg length and femoral offset, are critical in restoring normal function and diminishing the risk of dislocation following hip arthroplasty. This study compares the consistency of arthroplasty and non-arthroplasty orthopedic surgeons in restoring the normal biomechanics of the hip when performing a hemiarthroplasty for the treatment of a femoral neck fracture. Methods: We retrospectively reviewed the preoperative and postoperative digital radiographs of 175 hips that had a modular hemiarthroplasty for the treatment of a displaced femoral neck fracture at a Level 1 academic hospital. Fifty-two hips were treated by one of the three fellowship-trained arthroplasty surgeons (Group A), and 123 were treated by one of the nine non-arthroplasty fellowship-trained orthopedic surgeons (Group B). Results: Patients in Group A were more likely to have their femoral offset restored to normal than patients in ...
Femoral neck fracture following hip resurfacing: THE EFFECT OF ALIGNMENT OF THE FEMORAL COMPONENT
Journal of Bone and Joint Surgery - British Volume, 2008
A total of 20 pairs of fresh-frozen cadaver femurs were assigned to four alignment groups consisting of relative varus (10° and 20°) and relative valgus (10° and 20°), 75 composite femurs of two neck geometries were also used. In both the cadaver and the composite femurs, placing the component in 20° of valgus resulted in a significant increase in load to failure. Placing the component in 10° of valgus had no appreciable effect on increasing the load to failure except in the composite femurs with varus native femoral necks. Specimens in 10° of varus were significantly weaker than the neutrally-aligned specimens.
Study of radiological outcome of total hip arthroplasty in displaced neck of femur fracture
IP innovative publication pvt. ltd, 2019
Introduction and Objectives: The Purpose of this study is to assess the Radiological outcome of Total Hip Arthroplasty in Displaced fracture Neck of femur. Materials and Methods: 22 patients of displaced intracapsular neck of femur fracture were included in this study of which 14 patients managed through cemented and 8 managed through Uncemented Total Hip Arthroplasty, respectively. In this study patients operated with uncemented implants were assessed for radiological outcome by utilizing Andrew Whaley and Daniel et al and Engh’s criteria while patients operated with cemented implants were assessed for radiological outcome by utilizing De Lee and Charnley criteria and Gruen Zone Criteria. The Data was analyzed by SPSS 20.00 using Chi-square test. Results: In our study period no loosening of acetabular or femoral components were noticed. Acetabular cup inclination was normal in 77%, vertical in 14% and horizontal in 9%. Position of the stem of femoral component was neutral in 73% with 13.5% of varus and valgus each. No vertical subsidence and no migration of acetabular cup was seen in our study. There was 4.5% i.e., one patient developed Type II Heterotopic ossification. Conclusion: The results of this study shows that Total Hip Arthroplasty gave better results in Displaced Intracapsular Neck of femur fractures radiologically. Also there was no loosening of Acetabular component or migration of acetabular cup and cup position was normal in 77% cases. Femoral stem position was Neutral in 73% of cases with no vertical subsidence and no femoral component loosening.
The Journal of Bone and Joint Surgery (American), 2012
Background: Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of seventeen years.
Acta Radiologica Open
Background Restoration of a correct biomechanical situation after total hip arthroplasty is important. Purpose To evaluate proximal femoral symmetry of acetabular and femoral offset and femoral neck anteversion pre- and postoperatively in hip arthroplasty by semi-automated 3D-CT and to validate the software measurements by inter- and intraobserver agreement calculations. Material and Methods In low-dose CT on 71 patients before and after unilateral total hip arthroplasty, two observers used a digital 3D templating software to measure acetabular offset, true and functional femoral offset, and femoral neck anteversion. Observer agreements were calculated using intraclass correlation. Hip measurements were compared in each patient and between pre- and postoperative measurements. Results Preoperatively, acetabular offset (2.4 mm), true (2.2 mm), and functional global offset (2.7 mm) were significantly larger on the osteoarthritic side without side-to-side differences for true and functi...
International Journal of Research in Medical Sciences, 2016
Background: There is ongoing controversy about the relative merits of different types of arthroplasty among specific groups of patients. Paucity of quality data provides an opportunity for extension of this debate. The aim of this study was planned to evaluate merits (outcomes and complications) of total hip arthroplasty done for traumatic and non traumatic displaced fracture neck of femur. Methods: A comparative evaluation was undertaken among 50 patients who underwent total hip replacement at a tertiary care center. A retrospective cohort of fifty patients treated with total hip replacement for traumatic causes of displaced fracture neck of femur (25 patients) and non-traumatic causes of displaced fracture neck of femur (25 patients) were included in this study. The inclusion criteria's for the traumatic group were acute displaced fracture neck of femur above 50 years and fracture neck with fracture head with dislocation above 50 years. Patients having nonunion fracture neck of femur, failed cancellous screw fixation, intertrochantric fractures and associated acetabulum fractures were excluded from this study. Results: On clinical and functional evaluation, patients scored 84% excellent/good in non-traumatic group whereas 68% excellent/good score in traumatic group. 12% and 16% patients scored poor in non-traumatic group and in traumatic group respectively. In non-traumatic group, following complications were observed. Dislocation rate of 4% (one hip), 4% incidence of aseptic acetabular loosening (one hip), and 16% incidence of heterotrophic ossification (four hips). In traumatic group, we observed 2 (8%) dislocations, 4 (16%) heterotopic ossifications. Loosening of acetabulum and subsidence were observed in two (8%) patients. Conclusions: There are higher chances of dislocation among patients undergoing total hip replacement for a traumatic indications as compared to their non-traumatic indications. Chances of dislocation can be curtailed by keeping known factors in mind along with careful patient selection, adherence to postoperative protocol and use of a lateral approach with large head in high risk patients.
Journal of Bone and Joint Surgery - British Volume, 2006
We have compared the biomechanical nature of the reconstruction of the hip in conventional total hip arthroplasty (THA) and surface replacement arthroplasty (SRA) in a randomised study involving 120 patients undergoing unilateral primary hip replacement. The contralateral hip was used as a control. Post-operatively, the femoral offset was significantly increased with THA (mean 5.1 mm; −2.8 to 11.6) and decreased with SRA (mean −3.3 mm; −8.9 to 8.2). Femoral offset was restored within sd 4 mm in 14 (25%) of those with THA and in 28 (57%) of the patients receiving SRA (p < 0.001). In the THA group, the leg was lengthened by a mean of 2.6 mm (−6.04 to +12.9), whereas it was shortened by a mean of 1.9 mm (−7.1 to +2.05) in the SRA group, compared with the contralateral side. Leg-length inequality was restored within sd 4 mm in 42 (86%) of the SRA and 33 (60%) of the THA patients. The radiological parameters of acetabular reconstruction were similar in both groups. Restoration of the ...
Acta Orthopaedica, 2000
100 patients 75 years or older, with displaced femoral neck fractures, were randomly assigned to osteosynthesis with two parallel and percutaneously inserted screws (Olmed) or total hip arthroplasty (Lubinus IP). Mean age was 84 (75-101) years, 74% were women and 45% had mental dysfunction. General complications were commoner in the arthroplasty group but the mortality rates did not differ. In the osteosynthesis group, fracture complications were seen in 27/50 hips. In the arthroplasty group, dislocation was the main complication and occurred in 11/50 cases. At 3 months and after 1 year, the Harris Hip Scores were significantly better in the arthroplasty group. When mental dysfunction was present, the dislocation rate after arthroplasty was 32%, whereas the reoperation rate after osteosynthesis was 5%. The opposite pattern of complications was found in patients with normal mental function, 12% versus 60%. The 2-year mortality rate among those with mental dysfunction was 26/45, compared to 7/55 of those with normal function (p < 0.001). We conclude that total hip arthroplasty should be considered for a displaced femoral neck fracture in old patients with normal mental function and high functional demands. n Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures A prospective randomized study of 100 hips
Journal of orthopaedic surgery and research, 2016
The choice of primary hip hemiarthroplasty or total hip arthroplasty for displaced femoral neck fracture is still controversial. Revision hip arthroplasty not only increases risk and cost but also could result in worse outcome. Determining the risk factors for revision can help inform medical decision-making and aid in risk stratification of publicly reported outcomes. Therefore, we conducted a nationwide population-based study to identify the disease-related risk factors and construct a risk score nomogram to predict revision surgery. Records of all 68,030 femoral neck fracture patients receiving partial hemiarthroplasty (HA) in 2000-2010, with no total hip arthroplasty (THA) or revision HA history, were collected from the National Health Insurance Research Database. Cox proportional hazard regression was used to estimate the risk of revision hip replacement (RHA). The score of each risk factor was the quotient of the regression coefficient of the variable by the regression coeffic...
The Journal of Arthroplasty, 2008
The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed "Up & Go" Test. Forty subjects were enrolled. At 24 months, THA patients had significantly less pain on the SF-36 subscale than hemiarthroplasty patients (54.8 ± 7.9 vs 44.7 ± 10.5, P = .04) and scored significantly better on the SF-36 mental health subscale (54.9 ± 9.4 vs 40.9 ± 10.3, P = .006). Total hip arthroplasty patients also had superior WOMAC function scores (81.8 ± 10.2 vs 65.1 ± 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.