Quality of life and functionality after total hip arthroplasty: a long-term follow-up study

<p>Abstract</p> <p>Background</p> <p>There is a lack of data on the long-term outcome of total hip arthroplasty procedures, as assessed by validated tools.</p> <p>Methods</p> <p>We conducted a follow-up study to evaluate the quality of life and functionality of 250 patients an average of 16 years (range: 11-23 years) after total hip arthroplasty using a validated assessment set including the SF-36 questionnaire, Harris Hip Score, WOMAC score, Functional Comorbidity Index, and a study specific questionnaire. Models of multiple stepwise linear and logistic regression analysis were constructed to evaluate the relationships between several explanatory variables and these functional outcomes.</p> <p>Results</p> <p>The SF-36 physical indexes of these patients compared negatively with the normative values but positively with the results obtained in untreated subjects with severe hip osteoarthritis. Similar results were detected for the Harris Hip Score and WOMAC score. There was a 96% rate of post-surgical satisfaction. Hip functionality and comorbidities were the most important determinants of physical measures on the SF-36.</p> <p>Conclusions</p> <p>Patients who had undergone total hip arthroplasty have impaired long-term self-reported physical quality of life and hip functionality but they still perform physically better than untreated patients with advanced hip osteoarthritis. However, the level of post-surgical satisfaction is high.</p

La sonicazione di spacers in cemento antibiotato come metodica diagnostica complementare nelle infezioni protesiche

I batteri responsabili di infezione delle protesi articolari sono spesso produttori di biofilm, una struttura extracellulare aderente agli impianti ortopedici che rende i microrganismi stessi difficilmente isolabili con le comuni metodologie colturali e resistenti alle terapie antibiotiche. L'utilizzo di colture di un bagno ultrasonico degli spaziatori in cemento antibiotati espiantati nel corso di una revisione protesica in due stadi può agevolare il rendimento diagnostico delle comuni metodologie analitiche microbiologiche

Rapporto tra protesi dolorosa ed infezione tardiva

Il dolore riferito in sede di impianto può rappresentare l'unico sintomo di un'infezione subdola di un' artroprotesi

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

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

The determinants of mortality and morbidity during the year following fracture of the hip: a prospective study

Several studies have reported the rate of post-operative mortality after the surgical treatment of a fracture of the hip, but few data are available regarding the delayed morbidity. In this prospective study, we identified 568 patients who underwent surgery for a fracture of the hip and who were followed for one year. Multivariate analysis was carried out to identify possible predictors of mortality and morbidity. The 30-day, four-month and one-year rates of mortality were 4.3%, 11.4%, and 18.8%, respectively. General complications and pre-operative comorbidities represented the basic predictors of mortality at any time interval (p < 0.01). In-hospital, four-month and one-year general complications occurred in 29.4%, 18.6% and 6.7% of patients, respectively. After adjusting for confounding variables, comorbidities and poor cognitive status determined the likelihood of early and delayed general complications, respectively (p < 0.001). Operative delay was the main predictor of the length of hospital stay (p < 0.001) and was directly related to in-hospital (p = 0.017) and four-month complications (p = 0.008)

Studio prospettico su mobilità ed autonomia personale dopo frattura del femore prossimale

Objectives: To assess the change in ambulatory ability, need for walking aids and activities of daily life (ADL) attributable to hip fracture and to examine determinants of these functional outcomes. Design: A prospective observational cohort study. Setting: Multicenter study involving one university hospital and 2 community hospitals. Patients: A consecutive cohort of 552 patients 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: There was significant decrease in ambulatory ability and ADL Index as well as increase in the need for walking aids in comparison with the pre-fracture status at both follow-up intervals. Ambulatory ability, but not ADL significantly recovered between 4-month and one-year follow-up. One year after fracture, the pre-fracture functional status was reached by 57 % of patients and approximately 13 % of formerly ambulating patients became unable to walk. At multivariate analysis, the pre-fracture status was the most important determinant of ambulatory ability, need for walking aids, and ADL. Comorbidities, a poor cognitive status and the non-weight bearing status after surgery were also negative predictors. The fracture pattern or its specific treatment were not predictive of any functional outcomes. Conclusions: almost half of the patients fail to recover their prefracture functional level and walking ability. Recovery of ambulatory ability can occur until one year postoperatively, but ADL appear to be determined within 4 months. The pre-fracture status is the most important determinant of all functional outcomes

Gamma nail versus percutaneous compression plate for the treatment of intertrochanteric hip fractures: a multicenter pair-matched study

Purpose: To compare functional outcomes, complication rates, and survival in patients with intertrochanteric fracture treated with percutaneous compression plate (PCCP) or gamma nail (GN). Methods: A retrospective study of prospectively collected data of patients treated with PCCP or GN for AO/OTA 31.A1 or AO/OTA 31.A2 fractures was conducted. Sixty-eight consecutive patients treated with PCCP between 2018 and 2020 were enrolled and matched with 68 patients with comparable characteristics treated with GN. The activities of daily living (ADL) index and specific scales for walking ability and need for walking aids at 4 months and 1 year after fracture fixation were chosen as primary outcomes. Postoperative complications and one-year survival were recorded and compared between the two groups. Results: Walking ability and ADLs index decreased and the need for walking aids increased in both groups compared to the prefracture state at both follow-up intervals (p < 0.001), regardless of the treatment received. There was no difference between the two implants in the rate of implant-related complications. One-year survival rate was 78.9% (95% CI 67.0-86.9) and 82.4% (95% CI 71.0-89.5) in patients undergoing PCCP or GN, respectively, with no significant difference between the two groups. Conclusions: Walking ability, ADLs, complication rate, and 1-year survival are not significantly different when patients undergoing PCCP or GN are compared. The choice of implant may not be decisive for the outcome of treatment of intertrochanteric fractures, provided that stable fixation is ensured