Importance of the gender and preoperative knee sagittal alignment to avoid unnecessary tibial resection in TKR.

BACKGROUND: Standard resections according to the TKR manufacturers can lead to unnecessary bone resections in some patients. The objective of this study was to determine in which patients is recommended to perform a minimal tibial resection (MTR) that could restore the joint line height (JLH). METHODS: Navigation records of 108 consecutive posterior cruciate-substituting TKR performed by one surgeon were analyzed. Optimal tibial resection depth to restore the JLH (0 mm) was calculated by an algorithm. Postoperatively, the knees were distributed in two groups: those in which a MTR (depth ≤ 8 mm) would have been enough to restore the JLH and those in which a standard resection depth would have been necessary. ROC curves and Youden index were used to determine the cutoff point of the coronal and sagittal mechanical axis that predicted a MTR restoring the JLH. Multivariate analysis was used to identify independent factors associated with requiring an MTR. RESULTS: A MTR could be required in 20 (18.5%) knees. In the ROC curve analyses, the cutoff points that best discriminated between minimal and standard tibial resection was ≤ 3° of varus and < 2° of flexion preoperative deformity. Multivariate analysis showed that female gender and preoperative flexion < 2° were significant predictors of requiring a MTR to restore JLH. CONCLUSION: A MTR with the JLH restoration could be possible in female patients with a preoperative sagittal deformity less than 2° of flexion. Preoperative coronal alignment had no influence to discriminate when a MTR is required.

Complications of computer-assisted navigation in total knee replacement: retrospective cohort of eight hundred and seventy eight consecutive knees.

PURPOSE: The main objective was to analyze the computer-assisted navigation (CAN)-specific complications that forced to switch to conventional procedure in primary total knee replacement (TKR). The secondary objective was to determine the influence of those complications on TKR short-term survival. METHODS: Retrospective study of 878 primary TKR in 753 patients. Two consecutive versions of the OrthoPilot navigation system (Braun Aesculap, Germany) were used during the study time. Specific complications of CAN were defined as those due to the instrumentation (hardware or software failures), which were classified in one of two categories according to whether they occurred during the registration or tracking process. RESULTS: There were 20 (2.3%) complications related to the navigation system use that forced to switch to conventional surgery: in 11 (1.2%) knees due to loosening of the tracking pins, and in the other nine (1.0%) there were information system failures. There was a trend for a higher conversion rate to conventional surgery with the use of the first version of the software. There were no fractures, infections, or nerve injuries at the pin site. We found no differences in the distribution of baseline variables among those with or without conversion to conventional surgery. There was no significant difference (p = 0.488) in the two year survival between patients with or without conversion. CONCLUSION: CAN for primary TKR is a safe method with few specific complications that forced to switch from the navigated to the conventional procedure. Conversion to conventional surgery did not affect the short-term survival of TKR.

Concomitant low back pain impairs outcomes after primary total knee arthroplasty in patients over 65 years: a prospective, matched cohort study.

INTRODUCTION: Knee osteoarthritis and low back pain (LBP) are two conditions with relatively high prevalence in patients over 65 years. The objective was to determine the effect of symptomatic LBP on the patient-reported outcome after primary TKA. MATERIAL AND METHOD: A cohort of 48 patients with concomitant LBP was prospectively matched 1:2 with patients without LBP for gender, age, body mass index and preoperative knee function. LBP severity was measured with the Oswestry Disability Index (ODI). Patient-reported outcomes were assessed with reduced Short-Form (SF12), Western Ontario and McMaster Universities score (WOMAC), and visual analogue scale (VAS) for satisfaction. Functional outcome was assessed with the Knee Society Scores (KSS). RESULTS: The mean postoperative follow-up was 3.2 years. At last follow-up, LBP cohort had significantly worse SF12, WOMAC, KSS and VAS scores than those patients without LBP. Preoperative ODI score was significantly correlated with outcomes. CONCLUSION: Worse functional and patient-reported outcomes were obtained in patients over 65 years with concomitant LBP, and this was related to the intensity of preoperative LBP. Despite successful outcome in the knee, the LBP usually remains after TKA and this may impair satisfaction and patient-reported outcomes. These patients should be properly informed about their potential outcomes.

Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis.

INTRODUCTION: Hip fracture usually occurs in older patients. These patients remain at risk for developing new medical complications even after discharge from the hospital. The objective of this study was to identify risk factors for hospital readmission 30 days after hip fracture and the prognosis of the readmitted patients. MATERIALS METHODS: A prospective, observational cohort study of 732 consecutive patients over 65 years surgically treated for hip fracture and discharged alive in 2010-2014 was conducted. The measurements were patient demographic characteristics, residential and discharge status, Katz Index, Merle D'aubigné Hip Score, Mini-Mental Test, comorbid conditions, Charlson Index, ASA group, type of fracture and repair, and postoperative complications. Patient characteristics were tested by bivariate and multivariate analyses. RESULTS: 8.3 % of patients were readmitted within 30 days (56.0 % of these within 2 weeks). Medical reasons were 13 times more frequent than surgical reasons. Diagnoses more prevalent for readmission were pulmonary disease, deep vein thrombosis, heart failure, and renal failure. Predictors of readmission were female gender (HR 1.9, 95 % CI 1.1-3.4), grade III-IV ASA (HR 2.1, 95 % CI 1.1-4.2), and pre-existing pulmonary disease (HR 5.3, 95 % CI 3.4-9.6). In-hospital mortality among readmitted patients was 22.9 %. In bivariate analyses, male gender, ASA III-IV, cognitive impairment, and more than two comorbidities were potential predictive factors for readmission, and in multivariate analysis only male gender and ASA III-IV. Mortality risk among readmitted patients was significantly higher compared to the in-hospital mortality in the overall cohort (OR 1.8, 95 % CI 1.5-2.3). CONCLUSIONS: Hospital readmissions after hip fracture were mainly due to medical complications and a fraction of these may be preventable. Readmission was associated with increased morbidity and mortality.

[Surgical wound dehiscence and exposed hardware. Infection foretold?] / Dehiscencia de herida quirúrgica y exposición material de osteosíntesis. ¿Infección segura?

INTRODUCTION: surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection. OBJECTIVE: presentation of an unusual case of an adult patient with surgical wound dehiscence and complete exposure of 20 cm of the ulnar plate after six years of surgery, without infection signs, with bone healing and skin behind the plate. CASE PRESENTATION: 39-year-old man with an open Gustilo II Monteggia fracture-dislocation multifracture. The patient had a history of drug dependence. He had an open reduction and internal fixation with an ulnar reconstruction plate. The patient did not have any follow-up. After six years of the surgery, there was a complete exposure of the plate (20 cm) without infection and healing of the fracture with misalignment. After removing the plate, we observed spontaneous epithelialization attached to the bone bed. Skin coverage was complete at two months. CONCLUSION: although unusual, bone consolidation without infection is possible in an open fracture with long-standing exposure to a forearm plate in the adult.

INTRODUCCIÓN: la dehiscencia de herida quirúrgica con exposición de material de fijación interna es un grave problema en cirugía ortopédica y un factor importante de infección. OBJETIVO: descripción del caso inusual de un paciente adulto con dehiscencia de la herida quirúrgica y exposición completa de 20 cm de largo de una placa de cúbito tras seis años de la cirugía, sin signos de infección, consolidación ósea y reepitelización debajo de la placa y adherida al hueso. CASO CLÍNICO: hombre de 39 años que sufrió una fractura-luxación de Monteggia, abierta grado II y multifragmentaria. El paciente tenía historia de drogodependencia en tratamiento con metadona. Fue tratado con fijación interna del cúbito mediante una placa de reconstrucción larga. Postoperatoriamente, el paciente dejó de acudir para evaluación. A los seis años de la cirugía presentaba una completa exposición de la placa (20 cm de longitud), sin signos de infección y consolidación con malalineación de la fractura. Tras el retiro de la placa se observó epitelización espontánea adherida al lecho óseo cubital. La cobertura cutánea fue completa a los dos meses. CONCLUSIÓN: aunque inusual, es posible la consolidación ósea y la ausencia de infección en una fractura abierta con exposición de larga evolución de una placa de antebrazo en el adulto.

Trend in Spain in the use of total ankle arthroplasty versus arthrodesis in the period 1997-2017. / Tendencia en España en el uso de artroplastia total de tobillo frente a artrodesis en el periodo 1997-2017.

OBJECTIVE: The main objective of this study is to compare proportionally the incidence of total ankle arthroplasty (TAA) versus ankle arthrodesis and to determine the variables that may have influenced its indication. The secondary objective is to analyse the trend in the use of TAA using a population-based analysis and to compare our results with those reported by national registries in other countries. MATERIAL AND METHOD: A retrospective review of the Minimum Basic Data Set from 1997-2017 was performed. Subjects were categorised according to surgical procedure. Their temporal evolution was analysed and hospital variables associated with the indication (age, sex, hospital complexity) were identified. In order to compare the trend in Spain with respect to other countries, the information was standardised as number of procedures per 100,000 inhabitants/year and a projection was made for the five-year period 2020-2025. RESULTS: In the period 1997-2017, 11,669 ankle arthrodesis and 1,049 TAAs were performed. The trend was increasing and significant for both procedures, however, in the last 10 years analysed the proportional trend of TAA decreased significantly. Being female (OR 1.32), being 65 years or older (OR 1.50) and being operated in a complex hospital (OR 1.31) were associated with the indication for a TAA. Compared to other countries, Spain has much lower rates of TAA utilisation, with minimal growth estimated for the year 2025. CONCLUSION: Although the use of TAA has increased, its growth has been lower than that of ankle arthrodesis and its current trend is proportionally decreasing, with female sex, age≥65 years and the patient being operated in a medium/high complexity hospital being associated with the indication for TAA. Compared with other countries, Spain has much lower rates of use and its projection over the next five years, although increasing, is expected to be minimal.

Internet searches by the Spanish population for unqualified information on the treatment of osteoarthritis. / Búsqueda en Internet de información no cualificada sobre el tratamiento de la artrosis por la población española.

OBJECTIVE: There is a current trend in the population to search the Internet for unqualified medical information that may affect the recommendations given in specialist consultation. The aim of this study was to analyse the tendency of the Spanish population to search the Internet for unqualified information on current treatments for osteoarthritis. MATERIAL AND METHOD: Google Trends was used analyse the information gathered from the Internet, combining potential key search terms related to the current treatment of osteoarthritis. For each term the relative search volume was calculated, and its trend between 2009 and 2019. Spearman's correlation was used to study the direction of the trend. RESULTS: All the infiltration methods had increasing trends and no statistically significant differences were found between them (P=.769). The term that showed the best correlation over time was «prp¼ with Spearman's correlation =.90, and the term with the highest relative search volume was «growth factors¼. Prosthetic treatment generated more interest than conservative treatments, where there was more interest in knee replacement than hip replacement (P<.001). CONCLUSION: In Spain, the search for unqualified information on the treatment of osteoarthritis has increased over the past 10 years. There is more interest in prosthetic treatment than the more conservative treatments. There is more interest in knee replacement than hip replacement. There are no differences with regard to the different methods of joint injections.

Using WhatsApp® in our clinical practice: a pilot study. / El uso del WhatsApp® en nuestra práctica clínica: estudio piloto.

OBJECTIVE: To evaluate the use of WhatsApp as a clinical tool and determine the perception of orthopaedic surgeons of its usefulness. MATERIAL AND METHODS: Orthopaedic surgeons attending a scientific meeting were invited to complete an anonymous and structured survey on the use of the application in the clinical setting. RESULTS: A total of 41 (38%) surveys were correctly completed. Of the respondents, 100% had been either senders or receivers of clinical information via the application. Ninety-three percent had used the application to consult in relation to a clinical case. Of the respondents, 78% belonged to a WhatsApp group in which clinical information is shared: 71% agreed that communication between clinicians through WhatsApp is a useful tool for making therapeutic decisions. CONCLUSION: The use of WhatsApp for clinical purposes by orthopaedic surgeons is widespread. Most consider it a useful tool in therapeutic decision making.

Prospective study on effectiveness and safety of arthroscopic Bankart using a single anterior portal for patients with anterior shoulder instability. / Estudio prospectivo de efectividad y seguridad de Bankart artroscópico utilizando solo un portal anterior para pacientes con inestabilidad de hombro anterior.

OBJECTIVE: To evaluate the effectiveness and safety of the arthroscopic Bankart repair technique using a single anterior portal in patients with anterior shoulder instability. PATIENTS AND METHODS: Prospective study of 82 patients who underwent arthroscopic Bankart repair using a single anterior portal. Comparison with a historical series of 69 patients treated with two anterior portals. The patients were evaluated by the Rowe scale, and DASH (Disability of the Arm, Shoulder and Hand) and OIS (Oxford Instability Shoulder) questionnaires, range of motion and visual analogue scales for pain and patient satisfaction. RESULTS: After a mean follow-up of 36 months, there were no significant differences between groups regarding clinical or functional scores, quality of life or patient satisfaction. Surgical time was significantly shorter in the 1-portal group. In group 1-portal there were 2 patients with neurapraxias and 2 re-dislocations, while in group 2-portals were 1 and 2, respectively. The worst functional results were associated with the presence of a type III SLAP lesion. CONCLUSIONS: Both techniques were satisfactory regarding functional outcomes and complications, except for type III SLAP lesions. Using only one anterior portal, the surgical time was shorter, and the costs were lower when dispensing with a second cannula and a suture passing instrument.

Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture. / Factores predictivos de la mortalidad al año en pacientes mayores de 80 años intervenidos de fractura del cuello femoral.

INTRODUCTION: In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60 to 102years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80years or older after a femoral neck fracture. MATERIAL AND METHOD: Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan-Meier method and the variables that affected it by Cox regression. RESULTS: Mortality one year postoperatively was 21.1% and mean survival 10.3months (95%CI: 9.7-10.9). The Cox regression showed that age >87years, Barthel score ≤85 and the combination of anticoagulants with INR ≥1.5 were significant predictors of mortality during the first year of follow-up. CONCLUSION: The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age>87years, physical dependence measured by a Barthel index score ≤85, and the use of anticoagulants with a INR ≥1.5 at admission.

Factors associated with the development of avascular necrosis of the femoral head after non-displaced femoral neck fracture treated with internal fixation. / Factores asociados al desarrollo de necrosis avascular de cabeza femoral tras fractura del cuello femoral no desplazada tratada con fijación interna.

OBJECTIVE: To identify the factors with influence on the development of avascular necrosis of the femoral head (ANFH) in patients with non-displaced femoral neck fractures treated with internal fixation. MATERIAL AND METHOD: Retrospective study of cases and controls. We included non-displaced femoral neck fractures treated with internal fixation, and that presented ANFH with a postoperative follow-up of at least 2 years. The baseline variables, active comorbidities of the patients, the time for surgery and the number of screws used for osteosynthesis were recorded. Comparisons were made between the groups, those that presented ANFH and those that did not. By area under the curve, the cut-offs of age and time for surgery were located. RESULTS: An association between sex, active comorbidities and number of screws used and the development of ANFH was not observed. The cut-off points for age and time for surgery were≤69 years and≤43hours, respectively. No significant correlation was observed for the cut-off time for surgery. In the multivariate analysis, age≤69 years was a significant predictor of the development of ANFH (OR 4.6; 95% CI 1.1 to 17.9; P=.028). CONCLUSIONS: The patients aged 69 years or younger were at increased risk of developing ANFH after undisplaced femoral neck fracture treated with percutaneous screws.

Dehiscencia de herida quirúrgica y exposición material de osteosíntesis. ¿Infección segura? / Surgical wound dehiscence and exposed hardware. Infection foretold?

Resumen: Introducción: la dehiscencia de herida quirúrgica con exposición de material de fijación interna es un grave problema en cirugía ortopédica y un factor importante de infección. Objetivo: descripción del caso inusual de un paciente adulto con dehiscencia de la herida quirúrgica y exposición completa de 20 cm de largo de una placa de cúbito tras seis años de la cirugía, sin signos de infección, consolidación ósea y reepitelización debajo de la placa y adherida al hueso. Caso clínico: hombre de 39 años que sufrió una fractura-luxación de Monteggia, abierta grado II y multifragmentaria. El paciente tenía historia de drogodependencia en tratamiento con metadona. Fue tratado con fijación interna del cúbito mediante una placa de reconstrucción larga. Postoperatoriamente, el paciente dejó de acudir para evaluación. A los seis años de la cirugía presentaba una completa exposición de la placa (20 cm de longitud), sin signos de infección y consolidación con malalineación de la fractura. Tras el retiro de la placa se observó epitelización espontánea adherida al lecho óseo cubital. La cobertura cutánea fue completa a los dos meses. Conclusión: aunque inusual, es posible la consolidación ósea y la ausencia de infección en una fractura abierta con exposición de larga evolución de una placa de antebrazo en el adulto.

Abstract: Introduction: surgical wound dehiscence with exposure of internal fixation material is a serious problem in orthopedic surgery and an important factor for infection. Objective: presentation of an unusual case of an adult patient with surgical wound dehiscence and complete exposure of 20 cm of the ulnar plate after six years of surgery, without infection signs, with bone healing and skin behind the plate. Case presentation: 39-year-old man with an open Gustilo II Monteggia fracture-dislocation multifracture. The patient had a history of drug dependence. He had an open reduction and internal fixation with an ulnar reconstruction plate. The patient did not have any follow-up. After six years of the surgery, there was a complete exposure of the plate (20 cm) without infection and healing of the fracture with misalignment. After removing the plate, we observed spontaneous epithelialization attached to the bone bed. Skin coverage was complete at two months. Conclusion: although unusual, bone consolidation without infection is possible in an open fracture with long-standing exposure to a forearm plate in the adult.

[Risk factors for total hip arthroplasty dislocation and its functional outcomes]. / Factores de riesgo de luxación de artroplastia total de cadera primaria y su resultado funcional.

OBJECTIVES: To evaluate risk factors for dislocation after primary total hip arthroplasty (THA), and its functional outcomes. MATERIAL AND METHODS: A retrospective study was conducted on 22 cases with dislocation and 431 controls without dislocation, all performed with lateral access. The data were collected prospectively with a minimum follow-up of 5 years. Patient related factors, from primary surgery, and position of components on simple radiographs were analyzed. Harris and Merle D'Aubigné hip scores, and short Womac questionnaire were used. RESULTS: Demographic, patient-related or surgical technique factors were not risk predictors of dislocation. With regard to position of components, an acetabular abduction >50° (p = 0.003) and anteversion lower or higher than 10°- 20° (p = 0.044) were risk factors. Controls and dislocation treated conservatively had similar outcomes, and in both were better than in those treated with surgical revision (p = 0.03). DISCUSSION: Factors relating to the patient and soft tissues status may influence the stability of the arthroplasty, but malposition of the acetabular component seems to be the most important and common risk factor for dislocation.

Debridement with prosthesis retention and antibiotherapy vs. two-stage revision for periprosthetic knee infection within 3 months after arthroplasty: a case-control study.

Sixty-four patients with periprosthetic infection within 3 months of index arthroplasty, of whom 39 underwent debridement with prosthesis retention and antibiotherapy (DPRA), and 25 underwent two-stage revision (2SR), were compared regarding control of infection and functional outcomes by use of Knee Society scores. Failure was defined as the need for subsequent surgery to control infection. The failure rate after DPRA was 61.5%, and that after 2SR was 12.0% (p 0.001). The failure risk was not significantly associated with the duration of symptoms (≤4 weeks). The only predictor of failure was isolation of Staphylococcus aureus or Staphylococcus epidermidis. Treatment with 2SR required fewer surgical operations, a shorter duration of hospitalization, and a shorter duration of treatment. All patients who required a second debridement ultimately underwent prosthesis removal. The functional outcome was significantly better for 2SR at the last follow-up.

Rotator cuff tear and acromioclavicular joint cyst.

A 58 year old man is described who developed a subcutaneous synovial cyst over the acromioclavicular joint. The cyst developed in association with a massive tear of the rotator cuff and the long head of the biceps, which was demonstrated by arthrography. A loose fragment of the acromion was found intraoperatively. The patient was treated surgically by a combination of excision of the cyst, acromioplasty, removal of the loose acromial fragment, and a duramater allograft to close the rotator cuff defect. The functional result was unsatisfactory.

[Cementless total hip arthroplasty after acute femoral neck fracture in active patients. Prospective matched study with a minimum follow-up of 5 years]. / Artroplastia total de cadera no cementada tras fractura cervical femoral aguda en pacientes activos. Estudio prospectivo emparejado con seguimiento mínimo de 5 años.

OBJECTIVES: To evaluate outcomes of cementless total hip replacement after acute femoral neck fracture in active patients. MATERIAL AND METHODS: A prospective matched study was conducted to compare the results between 76 patients with fractures and 76 patients with osteoarthritis. The Harris score, short-WOMAC and SF-12 were used for the clinical assessment. The mean follow-up was 7.3 years (range 5-11). RESULTS: There were no significant differences in medical or surgical complications between the 2 groups. Functional outcomes were similar, but more walking aids were used in fracture group. There were 6 revisions among the fractures group (one dislocation, 2 deep infections, 3 aseptic loosening), and 2 aseptic loosening among controls. There was no significant difference in arthroplasty survival at 10 years (88.7 vs. 96.1%, P=.15). The mortality rates at 2 and 10 years were similar. CONCLUSION: Cementless total hip replacement for treatment of acute femoral neck fracture showed similar results to those of elective surgery for osteoarthritis in these selected patients.

[Arthrodesis without bone fusion with an intramedullary modular nail for revision of infected total knee arthroplasty]. / Artrodesis sin fusión ósea con clavo modular intramedular para revisión de prótesis total de rodilla infectada.

OBJECTIVE: To evaluate the outcome of knee fixation without bone fusion using an intramedullary modular nail and interposed cement. MATERIAL AND METHODS: Retrospective study of 29 infected total knee arthroplasties with prospective data collection and a mean follow-up of 4.2 years (3-5). RESULTS: Complications included 2 recurrent infections, 1 peri-implant fracture, and 1 cortical erosion due to the tip of the femoral component. All of these were revised with successful results. The mean limb length discrepancy was 0.8 cm, with 24<1cm. Twenty-five patients reported no pain. The mean WOMAC-pain was 86.9, WOMAC-function 56.4, SF12-physical 45.1, and SF12-mental 53.7. Four patients needed a walking frame, and only two were dependent for daily activities. CONCLUSIONS: The Endo-Model Link nail is an effective method for knee fixation that restores the anatomical alignment of the limb with adequate leg length.

[Elective primary total hip arthroplasty in octogenarians. A case-control study]. / Artroplastia total de cadera primaria electiva no cementada en octogenarios. Estudio de caso-control.

OBJECTIVE: To evaluate the results and efficacy of cementless total hip arthroplasty (THA) in octogenarians with osteoarthritis. MATERIAL AND METHODS: Matched case-control study with ratio 1:2. Consecutive selection of 54 octogenarians (55 hips), and 106 control patients (110 hips) with age ranging from 70 to 79 years. Mean follow-up of 7 years (range: 5-12). Before 5 postoperative years, 1 and 4 patients, respectively, died and they were excluded. Clinical assessment was performed using ASA grade, comorbidities, and Harris and Merle D'Aubigné hip scores, and radiographic, complications, and mortality evaluations were made. RESULTS: There were no perioperative deaths in either cohort. The rates of postoperative medical complications (P=.601) and survival (P=.360) were similar. The survival at 7 years was 89.8% in octogenarian and 95.3% in controls, with no influence of the preoperative variables. There were no differences in postoperative functional outcomes (P=.761), but improvement respect to the preoperative was higher in octogenarian (P=.002). In octogenarians there were 2 intraoperative fractures, 2 dislocations and 2 unstable stems, and in control patients 1 deep infection, 1 peri-prosthetic femoral fracture, 2 unstable cups and 4 unstable stems. The rates of aseptic complications, the need for revision, and arthroplasty survival (94% at 7 years) were similar in both cohorts. DISCUSSION: Due to improvement in health status, the octogenarian may have a life expectancy of at least 10 years. The cost arguments and an arbitrary age should not influence the selection of candidates for cementless THA. CONCLUSIONS: Cementless THA has been shown to be safe and effective in octogenarian patients with osteoarthritis. The notable increase found in functional outcomes justifies the continued use in these patients.

Epidemiology of trochanteric fractures of the femur in Alicante, Spain, 1974-1982.

From 1974 until 1982, the cases of 1287 patients with trochanteric fractures of the femur were examined. The incidence of this injury (16.6 per 100,000 persons per year) was lower than in other countries and increased over time. The predominance of the injury in women was 2:1 and the average age was 76.6 years. Women had a higher average age, but there was a progressive increase in age among men. There were no seasonal differences in the frequency of the injury. Seventy-seven percent of the cases were due to moderate trauma; most injuries occurred in the home. Sixty-four percent of the patients had associated diseases. Radiologic morphometry, using the Singh index and a modified method of the cortical-shaft index, was used in 246 patients older than 60 years of age; 84% of these patients had poor bone quality. There was no correlation between the degree of osteopenia and sex, although there was a correlation between osteopenia and fracture type.