A case-control study of 30-day mortality in periprosthetic hip fractures and hip fractures.

INTRODUCTION: There are increasing numbers of periprosthetic femoral fractures, which have high mortality rates. These fractures occur in a similar demographic to hip fractures. There has been limited research on mortality following these fractures. This study compared 30-day mortality in periprosthetic hip fractures with case-matched hip fractures. MATERIALS AND METHODS: Case notes of periprosthetic hip fractures between 1 January 2009 and 31 December 2015 were reviewed retrospectively at a single institution. There were 173 periprosthetic hip fractures over the seven years of the study. All hip fractures attending the same institution have data collected prospectively for the National Hip Fracture Database. Data were analysed from the Hip Fracture Database. A power calculation was undertaken; 173 periprosthetic hip fractures were matched to 865 hip fractures individually for age, sex, American Society of Anesthesiologists grade and capacity. RESULTS: The median wait to surgery was 88 hours for periprosthetic fractures and 23 hours for hip fractures (p < 0.00001); 22.5% of patients with periprosthetic fractures underwent surgery within 36 hours compared with 68.2% of those with hip fractures (p < 0.0001). The median length of stay was 16 days for periprosthetic fractures and 10 days for hip fractures (p < 0.00001). The 30-day mortality was 6.4% for periprosthetic hip fractures and 3.1% for case-matched hip fractures (odds ratio 2.11, 95% confidence interval 1.03-4.36; p = 0.043). CONCLUSIONS: Periprosthetic hip fractures have a significantly higher mortality than hip fractures. Further research should aim to improve outcomes in these patients.

Mortality in patients sustaining a periprosthetic fracture following a previous extracapsular hip fracture fixation.

BACKGROUND: Mortality rates following hip fractures are decreasing. As these outcomes improve, it increases the potential for further falls and the potential to sustain a periprosthetic fracture. The aim of this study was to analyse the 1 year mortality of periprosthetic fractures around an implant used to treat an extracapsular hip fracture. Secondary outcomes included 30 day mortality, complications and risk factors associated with mortality. METHODS: A retrospective case note and radiographic review of all patients who presented to a single institution with a periprosthetic femoral fracture around an implant previously used to treat an extracapsular hip fracture between 1st January and 2008 and 31st May 2015. RESULTS: 29 patients with a mean age of 75.8. 6 males and 23 females. 20 (69.0%) patients had capacity to consent for surgery. Pre-operatively 34.5% mobilised independently without any walking aids. 79.3% lived at home. 62.1% had a Charlson co-morbidity score of 0 or 1, 27.6% a score of 2 or 3, 6.9% a score of 4 and 5, and 3.4% a score of more than 5.3.4% was ASA grade 1, 13.8% ASA2, 65.5% ASA 3 and 17.2% were ASA 4. The previous implant a dynamic hip screw in 75.9% dynamic hip screws and an intramedullary nail in 24.1%. There were 4 (13.8%) in-patient deaths. The 30 day mortality 17.2% (5 patients) was and the 1 year mortality was 44.8% (13 patients). There were 0 complications that required return to surgery during admission. 1 patient with a revision intramedullary nail had dynamisation performed due to delayed union 7 months following surgery. 1 patient required removal of metalwork 2 years following surgery for infection. When comparing risk factors for mortality, there were no significant risk factors found in this study for 30 day and 1 year mortality. CONCLUSIONS: This paper suggests that periprosthetic fractures sustained after the surgical treatment of extra capsular neck of femur fractures have higher mortality rates than hip fractures. These patients should be given the same priority as these patients in there management.

Catastrophic failure of the Elite Plus total hip replacement, with a Hylamer acetabulum and Zirconia ceramic femoral head.

We report catastrophic early failure of a cemented total hip replacement comprising a modular femoral component with a Zirconia ceramic head and an acetabular component of cross-linked ultra-high molecular-weight polyethylene (Hylamer). Between 1995 and 1999 we implanted 29 hips in 26 patients with a mean age of 49.2 years. Survivorship analysis in this group revealed a failure rate of 67.6% at five years. All hips which failed did so because of aseptic loosening with progressive osteolysis or radiolucencies. We therefore recommend early and regular review of all patients with this combination of implants and early revision surgery in order to avoid massive bone loss.

Dual left anterior descending coronary artery: surgical revascularization in 4 patients.

Dual left anterior descending artery (or dual anterior interventricular artery) is a rare coronary anomaly. It is important to know the anatomic variants of this anomaly in patients with coronary artery disease who are undergoing either surgical myocardial revascularization or coronary angioplasty. We report the cases of 4 patients who had anatomic variants of dual left anterior descending coronary artery. These patients had developed coronary artery disease in the long or the short left anterior descending artery, or in both. The long left anterior descending artery was diseased in 1 patient, and the short left anterior descending artery was diseased in another In the 3rd and 4th patients, both the long and the short arteries were atherosclerotic and had developed severe stenosis. All 4 patients underwent successful myocardial revascularization. There was no electrocardiographic evidence of perioperative myocardial infarction. All patients were asymptomatic during the follow-up period, which ranged from 3 months to 1.5 years. Angiographers and surgeons alike must be aware of the variants of dual left anterior descending coronary artery, so that the diseased vessels can be correctly identified even if 1 of the dual arteries is 100% occluded.