Management of Fragility Hip Fractures: Our Institutional Experience

Introduction: Approximately 320 000 fragility hip fractures are sustained in the United States annually, resulting in substantial morbidity and mortality as well as significant economic burden on the health-care system. Nevertheless, a majority of these patients are not screened and do not receive treatment for osteoporosis. The objective of this study was to evaluate rates of osteoporosis screening and treatment in our institution and compare them to those reported in the literature. Methods: This was a retrospective cohort study of 191 patients ages 50 and older who sustained osteoporotic hip fractures. Primary outcome measures were percentage of patients who (1) underwent bone health laboratory workup during admission, (2) were started on vitamin D, calcium, and/or a bisphosphonate, (3) received bone mineral density testing, and (4) followed up with a primary care doctor or endocrinologist. Secondary outcomes measures were (1) whether gender, race, or age influenced our primary outcomes and (2) whether obtaining in-hospital laboratory workup led to increased rates of further screening and treatment. Results: Fifty-six (29.3%) patients received full laboratory workup, 48 (25.1%) were prescribed vitamin D and calcium, 11 (5.7%) were prescribed a bisphosphonate, 13 (6.8%) underwent bone mineral density testing, and 41 (21.5%) followed up with primary care or endocrinology. Discussion: Women were more likely to be treated with vitamin D and calcium. Outcomes were similar regardless of race. Younger patients were more likely to undergo laboratory testing, bisphosphonate therapy, and bone mineral density testing. Initiating workup during admission did not lead to increased rates of outpatient treatment. Conclusion: Despite nationwide efforts to improve, rates of osteoporosis screening and treatment following hip fracture are suboptimal. Rates at our institution are similar to those reported in previous studies. There were disparities between gender and age groups. Future studies are needed to evaluate whether more recently implemented policies lead to better osteoporosis screening and management

Inflammatory demyelinating polyneuropathy after total hip arthroplasty

Inflammatory demyelinating polyneuropathy is a rare but devastating condition. Guillain-Barré syndrome is the most common cause with acute inflammatory demyelinating polyneuropathy being the most common subtype that follows a monophasic course and does not recur. Chronic inflammatory demyelinating polyneuropathy occurs when symptoms persist for greater than 8 weeks. With many proposed etiologies, few reports have described acute inflammatory demyelinating polyneuropathy after total joint arthroplasty. To our knowledge, this is the first case report of chronic inflammatory demyelinating polyneuropathy developing after total hip arthroplasty that was further complicated by dislocation. Keywords: Guillain-Barré syndrome, Acute inflammatory demyelinating polyneuropathy, Chronic inflammatory demyelinating polyneuropathy, Inflammatory demyelinating polyneuropathy, Total hip arthroplasty, Dislocatio

Association of rapidly destructive osteoarthritis of the hip with intra-articular steroid injections

Background: To assess the relationship between rapidly destructive osteoarthritis (RDOA) of the hip and intra-articular steroid injections. Methods: Coding records from 2000 to 2013 were used to identify all subjects who had a fluoroscopy-guided intra-articular hip injection to treat pain associated with primary osteoarthritis. Radiographic measurements from preinjection and postinjection imaging were evaluated with Luquesne's classification of RDOA to determine diagnosis (greater than 50% joint space narrowing or greater than 2 mm of cartilage loss in 1 year with no other forms of destructive arthropathy). Demographic information, health characteristics, and number of injections were collected and analyzed as other potential explanatory variables. Patient outcome assessed by need for total hip arthroplasty (THA) after injection was also recorded. Results: One hundred twenty-nine injection events met the inclusion criteria in a total of 109 patients. From this sample, 23 cases of RDOA were confirmed representing a 21% incidence of RDOA. Twenty-one of the patients (91%) with RDOA had a THA at a median time of 10.2 months (interquartile range: 6.5-11.2) compared with 27 (31%) of those without RDOA at a median time of 24.9 months (interquartile range: 15.3-65.3). Older patients, patients with more severe osteoarthritis, and patients who identified themselves as white were more likely to have a diagnosis of RDOA (P = .008; P = .040; P = .009, respectively). Conclusions: The potential for RDOA and faster progression to THA raises questions about the use of intra-articular steroid injections for hip osteoarthritis and should be discussed with patients. Additional studies are needed to define a true relationship