HEMIARTHROPLASTY VERSUS TOTAL HIP ARTHROPLASTY FOR THE TREATMENT OF FEMORAL NECK FRACTURES. A PROSPECTIVE COMPARATIVE STUDY

Introduction: The treatment of femoral neck fractures may affect the postoperative functional outcome in the elderly. Objectives: This comparative prospective study was carried out to evaluate the outcome of total hip arthroplasty (THA) versus hemiarthroplasty for femoral neck fractures. Methods: We selected 80 patients (17 males and 63 females) who underwent hemiarthroplasty (40 cases; mean age 74,0 ± 5.5 years) or THA (40 cases; mean age 71,4 ± 6.5 years) for a femoral neck fracture at our Institutions between January 2011 and April 2012. These two therapeutic groups were carefully matched for their preoperative characteristics including age, gender, body mass index, ASA class, comorbidities (CIRS score), cognitive function (MMSE). Four- and twelve-month mortality, walking ability, and activities of daily living (ADL Index) were prospectively assessed in the two groups. Hip-related and general complications also were specifically noted. Models of multiple regression analysis were constructed to evaluate the effect of the surgical treatment (hemiarthroplasty or THA) on functional outcomes and mortality. Results: The mortality at 4 and 12 months was not significantly different in the two therapeutic groups. The walking ability at 4 months (P<0.05) and the ADL score at 4 months (P<0.01) and one year (P = 0.01) was superior in patients with THA as compared to those who underwent hemiarthroplasty. The pre-fracture functional level (P<0.001) and the use of THA versus hemiarthroplasty (P = 0.01) represented strong predictors of the four-month ambulatory activity and ADL Index. The use of THA versus hemiarthroplasty was not associated with a better one-year functional outcome. There was a higher risk of hip-related complications at four months in patients undergoing THA (P = 0.002). Conclusions: Despite more hip-related complications, THA can benefit patients with femoral neck fractures with higher four-month functional scores

Factors predicting mobility and the change in activities of daily living after hip fracture: A 1-year prospective cohort study

Objectives: To assess the change in ambulatory ability, need for walking aids, and activities of daily living (ADL) after femoral neck, intertrochanteric, or subtrochanteric fractures and to examine the determinants of these functional outcomes. Design: A prospective observational cohort study. Setting: A multicenter study involving 1 university hospital and 2 community hospitals. Patients: A consecutive cohort of 552 patients (mean age, 78.3 years; range, 50-105) who underwent surgery for a hip fracture. Main Outcome Measures: Ambulatory ability, need for walking aids, and ADL index, 4 and 12 months after surgery. Results: At both 4 months and 1-year follow-up time points, there was a significant decrease in ambulatory ability and the ADL index score and also an increase in the need for walking aids in comparison with the prefracture status. Ambulatory ability, but not ADL, significantly recovered between the 4-month and 1-year follow-up. One year after fracture, the prefracture functional status was regained by 57% of the patients, but approximately 13% of the formerly ambulating patients were unable to walk. The prefracture status was the most important determinant of ambulatory ability, need for walking aids, and ADL. Comorbidities, a poor cognitive status, and non-weight-bearing status after surgery were also negative predictors. Neither the fracture pattern nor its specific surgical treatment was predictive of any functional outcomes. Conclusions: Regardless of the type of fracture or surgical treatment used, 57% of the patients do not regain their prefracture ambulatory ability. Recovery of ambulatory ability can occur until 1 year postoperatively. The prefracture status and cognitive level are the most important determinant of all functional outcomes

Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture

The purpose of this study was to evaluate the results of open reduction and internal fixation in a large series of posterior wall fractures of the acetabulum and to identify the factors that affect the outcomes in this case series. One hundred twenty-one patients who had undergone open reduction and internal fixation of a fracture of the posterior wall of the acetabulum were assessed at a mean of 53 months (range, 24-163) after surgery. The functional outcome was evaluated with use of the modified Merle d'Aubigne scoring system, the Harris Hip Score (HHS), and the Short Form-36 Health Survey (SF-36) questionnaire. Final follow-up radiographs were graded according to Matta's radiologic criteria. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional and radiographic outcome. The quality of fracture reduction on postoperative radiographs was anatomical in 115 hips (95.0%), satisfactory in 6 cases (5.0%), and unsatisfactory in none. Final modified d'Aubignè scores were excellent in 45 hips (40.2%), good in 52 (46.4%), fair in 7 (6.3%), and poor in 8 (7.1%). Mean HHS was 91.5±8.9 (48-100). The SF-36 scores were similar with respect to age and sex-matched norms, but physical domains in males remained lower in comparison with the normal population. The early reduction of an associated hip dislocation and quality of surgical reduction were strong positive predictors of functional and radiographic outcomes at follow-up, whereas associated injuries and the existence of pre-operative nerve palsy were negative predictors of patients' functionality. This study of surgically treated fractures of the posterior wall of the acetabulum has shown that functional and radiographic results are satisfactory in most patients, provided that prompt reduction of an associated hip dislocation and anatomical reduction of the fracture are carried out. Associated injuries and nerve lesions affect the final functional outcome

Functional outcome and mortality after surgery for hip fracture

INTRODUCTION Hip fractures are associated with significant disability and mortality. A multicenter prospective study is currently ongoing at our institutions to investigate the mortality and functionality of patients with hip fracture. This is the report on the first 200 patients. OBJECTIVES 1) To evaluate the functional outcome and mortality after hip fracture 2) To identify predictors of mortality, functionality, and personal autonomy on variable follow-up intervals in patients who sustained hip fracture. METHODS Two-hundred consecutive patients (142 females and 58 males; mean age = 78.6 ± 13 years) admitted to our hospitals for hip fracture were telephonically interviewed 4 months and 1 year after the treatment. Personal and medical data were collected on hospital admission and were compared to the follow-up data of all patients, using a validated examination set dealing with daily life activities (ADL scale), cognitive status (MMSE Scale), comorbidity (ASA and CIRS scales), and personal mobility. Mortality data was also recorded. Possible outcome predictors were checked with multivariate regression analysis. SPSS software was used for database and statistics. CONCLUSION This ongoing prospective study is aimed to evaluate mortality and functionality after hip fracture as well as to identify possible outcome predictors to be used to improve and personalise the surgical treatment. This first report shows that the preoperative functional status and comorbidities are major determinants of 4-month and one-year postoperative mortality and functional status of subjects who sustained a hip fractur

Qualità della vita ed autonomia personale in pazienti con frattura collo femore trattati con protesi

Le fratture mediali di collo femore sono gravate da elevata mortalità e morbidità postoperatorie. La funzionalità di soggetti 4 mesi ed 1 anno dopo l'intervento di protesi d'anca per frattura di femore è fortemente influenzata dalle condizioni funzionali preoperatorie, dalle comorbidità, dalle complicazioni e dal livello cognitivo dei pazienti

Assessment of deep vein thrombosis using routine pre- and postoperative duplex Doppler ultrasound in patients with pelvic trauma : a prospective study

Aims: The aims of this study were to assess the pre- and postoperative incidence of deep vein thrombosis (DVT) using routine duplex Doppler ultrasound (DUS), to assess the incidence of pulmonary embolism (PE) using CT angiography, and to identify the factors that predict postoperative DVT in patients with a pelvic and/or acetabular fracture. Methods: All patients treated surgically for a pelvic and/or acetabular fracture between October 2016 and January 2020 were enrolled into this prospective single-centre study. The demographic, medical, and surgical details of the patients were recorded. DVT screening of the lower limbs was routinely performed using DUS before and at six to ten days after surgery. CT angiography was used in patients who were suspected of having PE. Age-adjusted univariate and stepwise multiple logistic regression analysis were used to determine the association between explanatory variables and postoperative DVT. Results: A total of 191 patients were included. A DVT was found preoperatively in 12 patients (6.3%), of which six were proximal. A postoperative DVT was found in 42 patients (22%), of which 27 were proximal. Eight patients (4.2%) had a PE, which was secondary to a DVT in three. None of the 12 patients in whom a vena cava filter was implanted prophylactically had a PE. Multivariate logistic regression analysis indicated that the association with the need for spinal surgery (odds ratio (OR) 19.78 (95% confidence interval (CI) 1.12 to 348.08); p = 0.041), intramedullary nailing of a long bone fracture (OR 4.44 (95% CI 1.05 to 18.86); p = 0.043), an operating time > two hours (OR 3.28 (95% CI 1.09 to 9.88); p = 0.035), and additional trauma surgery (OR 3.1 (95% CI 1.03 to 9.45); p = 0.045) were statistically the most relevant independent predictors of a postoperative DVT. Conclusion: The acknowledgement of the risk factors for the development of a DVT and their weight is crucial to set a threshold for the index of suspicion for this diagnosis by medical staff. We suggest the routine use of the DUS screening for DVT in patients with a pelvic and/or acetabular fracture before and six to ten days after surgery. Cite this article: Bone Joint J 2022;104-B(2):283-289