Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Objective To determine the change in humeral head anterosuperior migration after releasing the coracoacromial l igament in shoulders from cadavers with simulated intact or irreparable teared rotator cuff, to provide biomechanical basis for preserving the coracoacromial l igament or not during hemiarthroplasty. Methods Twelve freshfrozen cadaveric glenohumeral joints of adult preserving the scapula, upper 2/3 of the humerus, articular capsule and the coracoacromial l igament, were divided into 2 groups. The suprascapularis was preserved in group A (6 shoulders) and excised in group B (6 shoulders). Positioning the joint in a combination of 30° extension, 0° abduction and 30° external rotation, and imposing a 50 N axial compressive load to the humeral shaft, the anterosuperior displacement of the humeral head weremeasured before and after excising the coracoacromial l igament. Results In group A, the displacement of the humeral head was (5.96 ± 0.77）mm with intact coracoacromial l igament and (6.83 ± 0.84）mm after transecting the l igament. In group B, the displacement of the humeral head was (8.07 ± 2.46）mm with intact coracoacromial l igament and (9.92 ± 3.29）mm after transecting the coracoacromial l igament. So the mean increase of anterosuperior migration of the humeral head was (0.88 ± 0.34) mm (P lt; 0.01) in group A, and (1.85 ± 0.99) mm (P lt; 0.01) in group B, which was greater than the former (P lt; 0.05). Conclusion The coracoacromial l igament restrained anterosuperior translation of the humeral head, especially for patients with rotator cuff deficiency, so it should be preserved as far as possible during hemiarthroplasty.
ObjectiveTo evaluate the effectiveness of hemiarthroplasty combined with greater trochanter reattachment device for intertrochanteric fractures in elderly patients. MethodsA retrospective analysis was made on the clinical data of 34 patients (35 hips) with intertrochanteric fractures underwent hemiarthroplasty combined with greater trochanter reattachment device between February 2010 and April 2013.Of 34 patients,16 were males (16 hips) and 18 were females (19 hips),and the mean age was 85.6 years (range,77-95 years).All fractures were caused by falling.The left hip was involved in 20 cases,the right hip in 13 cases,and the bilateral hips in 1 case.There were 33 cases (34 hips) of fresh fracture,and 1 case (1 hip) of old fracture.Fractures were rated as type Ⅲ in 6 cases (6 hips),type IV in 11 cases (11 hips),and type V in 17 cases (18 hips) according to Evans-Jensen standard.All of the patients had different degree of osteoporosis and internal diseases. ResultsAll patients underwent surgery successfully.The operation time was 70-90 minutes (mean,76.6 minutes);the intraoperative blood loss was 260-400 mL (mean,301.5 mL);the postoperative drainage was 80-530 mL (mean,290.6 mL);and the hospitalization time was 10-12 days (mean,11.7 days).Postoperative infection of incision occurred in 1 case,which was cured after dressing;primary healing of incision was obtained in the other patients.No lower extremity deep vein thrombosis or other complications was observed.Twenty-six cases (27 hips) were followed up 12-48 months (mean,21.3 months).X-ray examination showed fracture healing,and the healing time was 2.5-3.5 months (mean,2.8 months).There was no dislocation,prosthesis loosening,dislocation,loosening of titanium cable,periprosthetic osteolysis,or other complications during the follow-up period.According to Harris hip score,the results were excellent in 8 hips,good in 15 hips,fair in 4 hips,and the excellent and good rate was 85.2% at 1 year after operation. ConclusionThe hemiarthroplasty combined with greater trochanter reattachment device is a feasible and effective method to treat intertrochanteric fractures in the elderly patients.It can allow early ambulation and improve quality of life,but it is necessary to strictly control the indications,and perioperative management should be paid attention.
ObjectiveTo compare the early clinical and radiographic outcomes of hemiarthroplasty by a minimal invasive Supercap approach and by a conventional approach for elderly displaced femoral neck fractures. MethodsBetween January and June 2015, 70 geriatric patients with displaced femoral neck fracture underwent cementless bipolar hemiarthroplasty by minimally invasive Supercap approach (group A, n=35) or by posterolateral approach (group B, n=35). One patient was excluded from the study in group B because of too wide femur cavity. There was no significant difference in gender, age, body mass index, fracture cause, time from fracture to operation, fracture side, fracture classification, and preoperative visual analogue scale (VAS), and hemoglobin-level between the 2 groups (P > 0.05). The operation time, intraoperative blood loss, incision length, and complications were recorded. The early clinical evaluations included timed up and go test (TUG), hemoglobin-level, VAS score, and satisfaction. The anteroposterior and lateral X-ray films were taken to measure the stem alignment, difference in leg length, and difference in femoral offset. ResultsAll the patients were followed up 6-11 months (mean, 7.32 months). No patients died during follow-up. There was no significant difference in operation time and intraoperative blood loss between the 2 groups (P > 0.05). The incision length of group A was significantly smaller than that of group B (P < 0.05). One patient had delayed union of incision in group A (2.86%); 2 patients had deep vein thrombosis in group B (5.88%); and there was no significant difference in the complication rate (χ2=0.764, P=0.512). The postoperative hemoglobin level showed no significant difference between the 2 groups (P > 0.05). Group A had lower VAS score and higher subjective satisfaction than group B, showing significant difference at 1, 5, and 14 days after operation (P < 0.05). The TUG of group A was significantly shorter than that of group B at 5, 14, and 30 days (P < 0.05). There was no significant difference in femoral offset or leg length on the X-ray films (t=1.273, P=0.851; t=0.409, P=0.327). The good rate of stem alignment was 82.86% (29/35) in group A, and was 85.30% (29/34) in group B, showing no significant difference (χ2=0.584, P=0.497). ConclusionBoth minimal invasive Supercap approach and conventional posterolateral approach are effective and safe for elderly displaced femoral neck fractures in hemiarthroplasty. Supercap approach has the advantages of less trauma, pain relief, and improvement of mobility and rapid rehabilitation.
Objective To compare proximal femur nailing and hemiarthroplasty in the treatment of intertrochanteric femur fractures in the elderly. Methods The study included 60 patients at the age of 75 or above who were diagnosed with intertrochanteric femur fracture between January 2011 and December 2013. After informed consent was obtained from the patients, they were randomized into two groups. Patients in internal fixation group (n=35) were internally fixated with proximal femoral nail, while patients in hemiarthroplasty group (n =25) were treated with cemented hemiarthroplasty. Complications, surgery time, hospital stay, postoperative function and blood loss during the surgery were recorded and functional results were evaluated using Harris Hip Score. Results Blood loss in the internal fixation group and the hemiarthroplasty group was respectively (124.7±23.4) and (207.5±19.4) mL, and the surgery time was (41.7±8.1) and (64.2±7.3) minutes, and the differences were significant (P<0.05). There was no significant difference in terms of complications between the two groups (P>0.05). Harris Hip Score analysis revealed that the difference between the patients treated with hemiarthroplasty and proximal femoral nailing was statistically significant in favor of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point (P>0.05), and even reversed at the 12th month postoperatively (P<0.05). Conclusions Internal fixation with proximal femoral nail displays a better level of activity in the end in the treatment of intertrochanteric femur fractures. It is helpful for the patients to improve their life quality with convenient operation and less invasion.
ObjectiveTo systematically review the postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture.MethodsCochrane Library, PubMed, Embase, China Biology Medicine Database, Chongqing VIP China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Database were searched to collect randomized controlled trials of postoperative infection-related complications between cemented and cementless hemiarthroplasty in elderly patients with femoral neck fracture from inception to January 2018. A systematic review was performed to compare the postoperative deep infection, superficial wound infection, pneumonia infection, and urinary tract infection between cemented and cementless hemiarthroplasty. Analyses were conducted using Review Manager version 5.2.0 software.ResultsA total of 11 studies were included in the Meta-analysis, including 1 533 patients. There was no significant difference in the incidence of deep infection [odds ratio (OR)=1.62, 95% confidence interval (CI) (0.66, 3.94), P=0.29], superficial wound infection [OR=1.17, 95%CI (0.56, 2.47), P=0.68], pneumonia infection [OR=0.73, 95%CI (0.47, 1.13), P=0.16], or urinary tract infection [OR=1.10, 95%CI (0.65, 1.86), P=0.73] between the two groups.ConclusionWhen selecting a fixation method for hemiarthroplasty to treat eldly patients with femoral neck fracture, infection-related postoperative complications are not the determinant factor to consider.