High Incidence of Intraoperative Fractures With a Specific Cemented Stem Following Intracapsular Displaced Hip Fracture.

BACKGROUND: To reduce costs of orthopedic implants, the government decided to standardize implants used across different specialties in a group of hospitals located in the same geographic area. The usual cemented stem used in the context of intracapsular displaced geriatric hip fractures was replaced by another stem. Abnormal intraoperative calcar and trochanteric fractures were noted. The purpose of this study is to determine the incidence of intraoperative periprosthetic fractures following an intracapsular displaced hip fracture treated with this specific cemented stem compared to the previous implant. METHODS: This is a retrospective cohort study comparing an historic cohort of hip fractures treated with the OmniFit EON (Stryker, Kalamazoo, MI) cemented stem with a new cohort of patients who received the Corail (DePuy Synthes, Warsaw, IN) cemented stem. Four orthopedic surgeons reviewed operative reports and postoperative radiographs. RESULTS: The treatment group included 348 patients who received the Corail stem. The control group included 77 patients. The 2 groups had similar baseline characteristics (P > .05) except for the presence of dementia. Incidence of intraoperative calcar or greater trochanteric fracture was 15.5% for the Corail group and 2.7% for the control group (P < .05). No patient-related factors or surgeon-related factors were related to a higher number of fractures in the treatment group (P > .05). CONCLUSION: The Corail cemented stem presents an abnormal number of iatrogenic intraoperative fractures following displaced femoral neck fracture in our geriatric population. No external factor seems to explain this high number of fractures. Implant design should be questioned. LEVEL OF EVIDENCE: III.

Negative Influence of femoral nerve block on quadriceps strength recovery following total knee replacement: A prospective randomized trial.

BACKGROUND: Postoperative pain is a major concern after total knee replacement (TKR) and can be relieved using different methods, including femoral nerve block (FNB). Quadriceps strength recovery (QSR) is the most sensitive objective indicator of functional recovery after TKR. The goal of this study was to compare the QSR following TKR between three approaches to analgesia. HYPOTHESIS: FNB delays QSR at short- and mid-term follow-up. METHODS: In this prospective randomized trial, with single-blind assessment involving 135 patients admitted for TKR in an academic center, the three following groups included were: (A) Continuous FNB 48h+PCA, (B) Single-shot FNB+PCA and (C) PCA alone. No intra-articular local anesthesia was carried out for all patients. Groups were comparable for demographic and surgical data. FNB was carried out and controlled (electric stimulation) by an expert anesthesiologist prior to the surgery. Follow-up was standardized in all groups using blinded assessors. Quadriceps strength was measured using a certified dynamometer at 6 weeks, 6 months and 12 months. Multivariate analysis (Kruskal-Wallis, Mann-Whitney) was used for the main outcome. RESULTS: A total of 135 patients were included. Two patients in group B were excluded due to a direct fall in the first postoperative week with extensor mechanism rupture and peri-prosthetic femoral fracture. QSR was significantly decreased in patients with FNB at all times (mean±SD): 6 weeks (A: 51.3±23.3%; B: 62.2±21.9%;C: 77.4±19.5%; p<0.01), 6 months (A: 65.4±22.9%; B: 82.1±24.2%;C: 95.7±20.7%; p<0.01) and 12 months (A: 87.8±17.6%; B: 97.8±26.9%;C: 104.8±25.2%; p=0.02). No significant difference between continuous or single-shot FNB was observed. CONCLUSION: FNB has a negative influence on QSR at short- and mid-term follow-up. FNB should not yet be recommended for analgesia after TKR. LEVEL EVIDENCE: I High-quality randomized controlled trial with statistically significant difference.