The Efficacy of Topical Tranexamic Acid in Femoral Neck Fractured Patients Undergoing Cemented Bipolar Hemiarthroplasty: A Randomized Double Blinded Controlled Trial / A eficácia do ácido tranexâmico tópico em pacientes com fraturas no pescoço femoral submetidos a hemiartroplastia bipolar cimentada: Um ensaio controlado duplo-cego randomizado

Abstract Objective Tranexamic acid (TXA) is an antifibrinolytic that is widely used for decreasing blood loss and blood transfusion rates in total hip arthroplasty. However, there is limited evidence of topical TXA usage in hip hemiarthroplasty for femoral neck fractures. The present study aimed to evaluate the effects of topical TXA on blood loss and on blood transfusions in femoral neck fracture patients who underwent cemented bipolar hemiarthroplasty. Methods Twenty-six patients with femoral neck fractures who were scheduled for bipolar cemented arthroplasty were randomized into two groups. The first group of 12 patients received topical TXA during their operation, whereas 14 patients in the second group received a placebo. Hematocrit was measured at 6 and 24 hours postoperatively. Blood transfusions and postoperative complications were also recorded. Results Total blood loss was not different between the TXA group and the control group (TXA group: 459.48 ± 456.32 ml, and control group: 732.98 ± 474.02 ml; p = 0.14). However, there were no patients within the TXA group who required a blood transfusion, while there were 4 patients in the control group who received allogenic blood transfusions (p = 0.044). There were no postoperative complications, such as wound complication, venous thromboembolism, or cardiovascular complications within either group. Conclusion Topical TXA could not decrease total blood loss but was able to reduce transfusion rates in patients who underwent cemented bipolar hip hemiarthroplasty in femoral neck fractures. Further studies in doses of topical TXA in a larger sample size would be beneficial. Level of Evidence II.

Resumo Objetivo O ácido tranexâmico (TXA) é um antifibrinolítico amplamente utilizado para diminuir as taxas de perda de sangue e de transfusão de sangue na artroplastia total do quadril. No entanto, há evidências limitadas de uso tópico de TXA na hemiartroplastia do quadril para fraturas no pescoço femoral. O presente estudo teve como objetivo avaliar os efeitos do TXA tópico na perda de sangue e transfusões de sangue em pacientes com fratura femoral que foram submetidos a hemiartroplastia bipolar cimentada. Métodos Vinte e seis pacientes com fraturas no pescoço femoral e programados para artroplastia cimentada bipolar foram randomizados em dois grupos. O primeiro grupo de 12 pacientes recebeu TXA tópico durante a operação; no segundo grupo, 14 pacientes receberam placebo. O hematócrito foi medido às 6 e 24 horas no pósoperatório. Também foram registradas transfusões de sangue e complicações pósoperatórias. Resultados A perda total de sangue não foi diferente entre o grupo TXA e o grupo controle (grupo TXA: 459,48 ±456,32 ml; e grupo controle: 732,98 ±474,02 ml; p = 0,14). No entanto, não houve pacientes dentro do grupo TXA que necessitaram de transfusão de sangue, enquanto 4 pacientes no grupo controle fizeram transfusões de sangue halogênicas (p = 0,044). Não houve complicações pós-operatórias, tais como complicação da ferida, tromboembolismo venoso ou complicações cardiovasculares dentro de qualquer grupo. Conclusão O TXA tópico não conseguiu diminuir a perda total de sangue, mas foi capaz de reduzir as taxas de transfusão, em pacientes submetidos a hemiartroplastia de quadril bipolar cimentada em fraturas no pescoço femoral. Outros estudos com doses de TXA tópico em um tamanho amostral maior seriam benéficos. Nível de Evidência II.

A medium term analysis on of therapeutic effects of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients / 中国骨伤

OBJECTIVE@#To retrospectively study medium term follow up outcomes effects of effect of bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients.@*METHODS@#Total of 32 elderly patients with the osteoporotic intertrochanteric fractures were treated with bio-lengthend stem hemiarthroplasty from Jan. 2016 to Jan. 2019 including 14 males and 22 females, aged from 85 to 95 years old with an average of (89.5±4.5) years old. According to classification of Evans, there were 12 cases with type Ⅲ, 11 with type Ⅳ and 9 with type Ⅳ. The time from injury to operation ranged from 0.5 to 9 days with an average of (4.5±3.9) days. The operation time, blood loss and postoperative complications were analyzed. Functional outcome was assessed by Parker Palmer mobility score(PPMS) and Harris hip score.@*RESULTS@#Four patients died within one year after operation, and the mortality was 12.5%. The follow up time for the rest 28 patients ranged from 24 to 60 months with an average of (28.5±4.5) months. The mean operative time was (54.2±22.5) min;the mean blood loss (hidden blood loss+obvious blood loss) was (450±140) ml;the first weight bearing was (3.35±1.35) days. No perioperative death occurred. PPMS were(6.63±1.25), (6.94±1.18), (7.11±0.83), (7.32±1.11) and Harris scores were(67.85±6.19), (71.42±5.57), (73.41±5.62), (77.32±5.24) respectively at 1, 3, 6 months and the final follow-up after operation. There were no significant difference in PPMS and Harris score at 1, 3, 6 months after operation and the final follow-up(P>0.05). There were no complications such as joint dislocation and prosthesis loosening occure at the final follow-up.@*CONCLUSION@#On the premise of strictly mastering the case selection criteria, the bio-lengthend stem hemiarthroplasty in the treatment of unstable osteoporotic intertrochanteric fractures in elderly patients has a satisfied medium term follow-up outcomes. It can restore hip function in the early stage and improve the quality of life of patients.

Comparison of early clinical effects between direct superior approach and posterolateral approach in hemiarthroplasty of femoral neck fracture in the elderly / 中国骨伤

OBJECTIVE@#To compare and analyze the early clinical effect of direct superior approach(DSA) and posterior lateral approach (PLA) in hemiarthroplasty for elderly patients with femoral neck fracture.@*METHODS@#The clinical data of 72 elderly patients with femoral neck fracture who underwent hemiarthroplasty from January 2020 to December 2021 were retrospectively analyzed. Among them, 36 patients were operated through minimally invasive DSA including 10 males and 26 females with an average age of (82.82±4.05) years old; the other 36 patients underwent traditional PLA including 14 males and 22 females with an average age of (82.79±3.21) years old. The perioperative related indexes and Harris scores during follow-up between two groups were compared.@*RESULTS@#Comparison of operation time between two groups, (79.41±17.39) min of DSA group was shorter than(98.45±26.58) min of PLA group;incision length (8.33±2.69) cm was shorter than (11.18±1.33) cm of PLA group;intraoperative blood loss (138.46±71.58) ml was less than (173.51±87.17) ml of PLA group, initial landing time (3.04±0.95) d was earlier than (4.52±1.10) d of PLA group, hospitalization time (8.70±1.89) d was shorter than (10.67±2.35) d of PLA group(P<0.05). There was no statistical difference in Harris score between two groups before operation(P>0.05), but Harris score in DSA group was higher than that of PLA group at 1 month after operation(P<0.05), but at 12 months after operation, the difference was not statistically significant between two groups(P>0.05).@*CONCLUSION@#Compared with PLA, DSA is superior in clinical indexes such as operation time, intraoperative blood loss, incision length, first landing time, length of hospitalization and Harris score in the first month after operation in hemi hip replacement, and has comparative advantages in promoting early postoperative rehabilitation of elderly patients with femoral neck.

Cemented Calcar Replacement versus Long Stem Cemented Hemiarthroplasty in Unstable Intertrochanteric Fractures in Octogenarians / Substituição do calcar cimentado versus hemiartroplastia de haste longa cimentada em fraturas intertrocantéricas instáveis em octogenários

Abstract Objective The aim of the present study was to compare functional results after Cemented Calcar replacement vis-a-vis Long stem Cemented hemiarthroplasty in patients aged more than 80 years with unstable intertrochanteric fractures. Methods The present prospective, randomized trial included 140 patients with AO/OTA type 31-A2, A3 intertrochanteric femur fracture, randomized into 2 treatment groups and followed-up for a minimum of 2 years. Sixty-seven patients in group A were treated with a cemented calcar replacing prosthesis, and 65 patients in group B were treated with a cemented long stem femoral stem prosthesis. The primary end points were hip functions at 2 years. The secondary end points were the complications encountered, mortality, surgical time, reoperation, blood loss, and activities of daily living. Results There were no major differences between the groups in terms of hip function, quality of life (health related), reoperation, mortality, and blood loss. However, the function in hip joint and activities of daily living deteriorated in both groups in comparison with prefracture levels. Conclusion In octogenarians with an unstable intertrochanteric fracture, cemented calcar replacing prosthesis has similar clinical results in comparison with long stem cemented hemiarthroplasty. Hemiarthroplasty with either implant is a good option in this subset of patients. Level of evidence: I

Resumo Objetivo O objetivo do presente estudo foi comparar os resultados funcionais após a substituição do Calcar cimentado em comparação com a hemiartroplastia cimentada de haste longa em pacientes com mais de 80 anos com fratura intertrocantérica instável. Métodos O presente estudo prospectivo e randomizado incluiu 140 pacientes com fratura de fêmur intertrocantérica, conforme classificação AO/OTA tipo 31-A2, A3, randomizados em 2 grupos de tratamento e acompanhados por um período mínimo de 2 anos. Sessenta e sete pacientes do grupo A foram tratados com uma prótese de substituição do calcar cimentada e 65 pacientes do grupo B foram tratados com uma prótese femoral de haste longa cimentada. Os desfechos primários foram as funções do quadril em 2 anos. Os eventos secundários foram as complicações encontradas, a mortalidade, o tempo cirúrgico, segunda cirurgia, perda de sangue e as atividades do cotidiano. Resultados Não houve grandes diferenças entre os grupos em termos de função do quadril, qualidade de vida (relacionada à saúde), segunda cirurgia, mortalidade e perda de sangue. No entanto, a função da articulação do quadril e as atividades da vida diária se deterioraram em ambos os grupos em comparação com os níveis pré-fratura. Conclusão Nos octogenários com fratura intertrocantérica instável, a prótese de substituição do calcar cimentada apresentou resultados clínicos semelhantes em comparação com a hemiartroplastia de haste longa cimentada. A hemiartroplastia comqualquer umdos implantes é uma boa opção nesse subgrupo de pacientes. Nível de evidência: I

Analysis of risk factors for readmission in elderly patients with hip fractures undergoing hip hemiarthroplasty / 中国骨伤

OBJECTIVE@#To explore the incidence and risk factors of readmission of elderly patients with hip fracture after hip hemiarthroplasty.@*METHODS@#A retrospective analysis of 237 elderly hip fracture patients who underwent hip hemiarthroplasty from February 2015 to October 2020 were performed. According to the readmission status of the patients at 3 months postoperatively, the patients were divided into readmission group (39 cases)and non-readmission group(198 cases). In readmission group, there were 7 males and 32 females with an average age of(84.59±4.34) years old, respectively, there were 34 males and 164 females with average age of (84.65±4.17) years old in non-readmission group. The general information, surgical status, hip Harris score and complications of patients in two groups were included in univariate analysis, and multivariate Logistic regression was used to analyze independent risk factors of patients' readmission.@*RESULTS@#The proportion of complications(cerebral infarction and coronary heart disease) in readmission group was significantly higher than that of non-readmission group (P<0.05), and intraoperative blood loss in readmission group was significantly higher than that of non-readmission group(P<0.05). Harris score of hip joint was significantly lower than that of non-readmission group(P<0.05). The proportion of infection, delirium, joint dislocation, anemia and venous thrombosis in readmission group were significantly higher than that of non-readmission group (all P<0.05). Multivariate Logistic regression analysis showed that the risk factors for readmission of elderly patients with hip fracture after hip hemiarthroplasty included cerebral infarction, infection, delirium, dislocation, anemia and venous thrombosis (all P<0.05).@*CONCLUSION@#The complications of the elderly patients who were readmission after hip hemiarthroplasty for hip fractures were significantly higher than those who were non-readmission. Cerebral infarction, infection, delirium, dislocation, anemia and venous thrombosis are risk factors that lead to patient readmission. Corresponding intervention measures can be taken clinically based on these risk factors to reduce the incidence of patient readmissions.

Eficácia, segurança e custo-efetividade comparada de tratamentos cirúrgicos e conservadores de fratura de úmero proximal: revisão rápida de evidências / Comparative effectiveness, safety and cost-effectiveness between surgical and conservator treatments for proximal humeral fracture: a rapid review of evidence

Tecnologia: Hemiprótese de ombro ajustável. Próteses de cabeça excêntrica reproduzem a anatomia da extremidade proximal do úmero. Indicação: Reconstrução da extremidade proximal do úmero no tratamento de fraturas complexas de úmero. Pergunta: o tratamento cirúrgico é superior ao tratamento conservador, para tratamento de fratura proximal de úmero, com melhores desfechos funcionais, menos complicações, menor mortalidade? Os efeitos terapêuticos da prótese de ombro excêntrica são superiores aos da prótese de ombro Neer II em pacientes com fratura proximal de úmero submetidos a hemiartroplastia de ombro nos desfechos de resultados funcionais e complicações cirúrgicas? Métodos: Levantamento bibliográfico foi realizado em bases de dados Pubmed, BVS e Google com estratégias estruturadas de busca. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR e para os estudos econômicos, foi utilizado o QHES checklist. Resultados: Foram identificados 485 registros nas bases de dados internacionais e nacionais. Após a remoção de duplicatas e exclusão dos não elegíveis, pela análise de título e resumo, foram selecionadas quatro revisões sistemáticas e um estudo econômico. Conclusão: Não há evidências suficientes de ensaios clínicos para informar qual a melhor escolha entre as intervenções (não cirúrgicas, cirúrgicas ou de reabilitação) para essas fraturas. Não foram encontrados estudos brasileiros sobre eficácia e custo-efetividade das diferentes abordagens cirúrgicas bem como os tipos e marcas de próteses entre si

Technology: Adjustable shoulder hemi prosthesis. Eccentric head prostheses reproduce the anatomy of the proximal extremity of the humerus. Indication: Reconstruction of the proximal extremity of the humerus in the treatment of complex humerus fractures. Question: Is surgical treatment superior to conservative treatment, for the treatment of proximal humerus fractures, with better functional outcomes, less complications, less mortality? Are the therapeutic effects of the eccentric shoulder prosthesis superior to those of the Neer II shoulder prosthesis in patients with proximal humerus fractures who underwent shoulder hemiarthroplasty in the outcomes of functional results and surgical complications? Methods: Bibliographic survey was carried out in Pubmed, BVS and Google databases with structured search strategies. The methodological quality of systematic reviews was assessed using the AMSTAR tool and for economic studies, the QHES checklist was used. Results: Were they identified 485 records in international and national databases. After removing duplicates and excluding the ineligible ones, by analyzing the title and summary, four systematic reviews and one economic study were selected. Conclusion: There is not enough evidence of clinical trials to inform which is the best choice between interventions (nonsurgical, surgical or rehabilitation) for these fractures. No brazilian studies were found about the efficacy and cost-effectiveness of the different surgical approaches, as well as the types and brands of prostheses between them

Incidence of epidural spread after Chayens approach to lumbar plexus block: a retrospective study / Incidência de dispersão peridural após bloqueio do plexo lumbar com técnica de Chayen: estudo retrospectivo

Abstract Background and objectives: The lumbar plexus block (LPB) is a key technique for lower limb surgery. All approaches to the LPB involve a number of complications. We hypothesized that Chayen's approach, which involves a more caudal and more lateral needle entry point than the major techniques described in the literature, would be associated with a lower rate of epidural spread. Method: We reviewed the electronic medical records and chart of all adult patients who underwent orthopedic surgery for Total Hip Arthroplasty (THA) and hip hemiarthroplasty due to osteoarthritis and femoral neck fracture with LPB and Sciatic Nerve Block (SNB) between January 1, 2002, and December 31, 2017, in our institute. The LPB was performed according to Chayen's technique using a mixture of mepivacaine and levobupivacaine (total volume, 25 mL) and a SNB by the parasacral approach. The sensory and motor block was evaluated bilaterally during intraoperative and postoperative period. Results: A total number of 700 patients with American Society of Anesthesiologists (ASA) physical status I to IV who underwent LPB met the inclusion criteria. The LPB and SNB was successfully performed in all patients. Epidural spread was reported in a single patient (0.14%;p < 0.05), accounting for an 8.30% reduction compared with the other approaches described in the literature. No other complications were recorded. Conclusions: This retrospective study indicates that more caudal and more lateral approach to the LPB, such as the Chayen's approach, is characterized by a lower epidural spread than the other approach to the LPB.

Resumo Justificativa e objetivos: O bloqueio do plexo lombar (BPL) é uma técnica fundamental para a cirurgia de membros inferiores. Todas as abordagens do BPL são associadas a uma série de complicações. Nossa hipótese foi de que a abordagem de Chayen, que envolve um ponto de entrada da agulha mais caudal e mais lateral do que as principais técnicas descritas na literatura, estaria associada a menor incidência de dispersão peridural. Método: Revisamos os prontuários médicos eletrônicos e em papel de todos os pacientes adultos submetidos à artroplastia total do quadril (ATQ) e hemiartroplastia do quadril devido a osteoartrite ou fratura do colo do fêmur empregando-se BPL associado ao bloqueio do nervo ciático (BNC), entre 1 de janeiro de 2002 e 31 de dezembro de 2017 em nossa instituição. Realizamos o BPL usando a técnica de Chayen e uma mistura de mepivacaína e levobupivacaína (volume total de 25 mL) e o BNC pela abordagem parassacral. Testes sensorial e motor bilaterais foram realizados no intra e pós-operatório. Resultados: Os critérios de inclusão foram obedecidos pelo total de 700 pacientes classe ASA I a IV submetidos ao BPL. Os BPL e BNC foram realizados com sucesso em todos os pacientes. A dispersão peridural foi relatada em um único paciente (0,14%; p < 0,05), representando uma redução de 8,30% quando comparada às outras abordagens descritas na literatura. Nenhuma outra complicação foi registrada. Conclusões: Este estudo retrospectivo indica que a abordagem mais caudal e mais lateral do BPL, como a técnica de Chayen, é caracterizada por menor dispersão peridural do que outras abordagens do BPL.

Resultados del tratamiento de la artrosis glenohumeral primaria mediante hemiartroplastía / Results of the treatment of primary glenohumeral osteoarthritis through hemiarthroplasty

Resumen: Introducción: La artrosis glenohumeral conlleva a una pérdida funcional y a una disminución de la calidad de vida de muchos pacientes. Actualmente, no existe consenso en cuanto al uso de la hemiartroplastía o la artroplastía total como tratamiento definitivo para este padecimiento. El objetivo es mostrar los resultados del tratamiento de la artrosis glenohumeral primaria mediante hemiartroplastía en nuestro servicio. Material y métodos: Revisamos 19 hemiartroplastías (14 pacientes) realizadas entre 2004 y 2013 en pacientes con artrosis glenohumeral primaria sin alteración morfológica glenoidea. Se recabaron los datos de ocho pacientes (11 hemiartroplastías), valorándose el estado funcional, el dolor y la realización de actividades de la vida diaria mediante las escalas Constant, ASES y DASH preoperatorias, a los cinco años de seguimiento mínimo (rango 5-11 años), así como las complicaciones presentadas. Se comparó el estado preoperatorio y al final del seguimiento. Resultados: Se encontró una mejoría estadísticamente significativa (p < 0.05) en todos los parámetros analizados en el estudio. La media del dolor en la escala EVA disminuyó de 8.89 a 2.67. La escala ASES mejoró de 13.51 a 63.51 puntos de media. El Constant aumentó de 20.11 a 65.11 puntos. La puntuación media preoperatoria en la escala DASH fue de 73.68 y la postoperatoria de 28.30 puntos. La supervivencia media del implante fue de 81.82% a los siete años de seguimiento medio. Conclusión: Obtuvimos buenos resultados funcionales con la artrosis glenohumeral primaria, presentándose pocas complicaciones. La causa del fracaso fue la erosión glenoidea.

Abstract: Introduction: Glenohumeral osteoarthritis leads to a functional loss and a decrease in the quality of life of many patients that suffers it. Currently there is no agreement on the use of hemiarthroplasty or total arthroplasty as definitive treatment. The objective is to show the results of the treatment of primary glenohumeral osteoarthritis through hemiarthroplasty in our service. Material and methods: We reviewed 14 patients (19 hemiarthroplasties) performed between 2004 and 2013 in patients diagnosed with primary glenohumeral osteoarthritis without glenoid morphological anomaly. We managed to collect data from eight patients (11 hemiarthroplasties), assessing functional status, pain, and performing activities of daily living using the Constant, ASES and DASH scores preoperatively and at five years of minimum follow-up (range 5-11 years), as well as related complications. The preoperative status was compared to the end of the follow-up. Results: A significant improvement was found in all the parameters analyzed in the study (p < 0.05). The average pain in EVA score decreased from 8.89 to 2.67. The ASES improved from 13.51 to 63. 51 half point. The Constant increase of 20.11 points to 65.11 points. The mean preoperative score in the DASH score was 73.68 and 28.30 postoperatively. The average survival of the implant was 81.82% in the seven years of average follow-up. Conclusion: Shoulder hemiarthroplasty obtains good functional results in the treatment of primary glenohumeral osteoarthritis with few complications. The cause of the failure were glenoid erosion in all the cases.

Meta-analysis of direct anterior approach and other approaches for hemiarthroplasty in elderly patients with femoral neck fracture / 中国骨伤

OBJECTIVE@#To systematically evaluate the clinical efficacy of high-quality direct anterior approach (DAA) and other approaches for the treatment of elderly patients with femoral neck fracture.@*METHODS@#Literatures published in English or Chinese about the direct anterior approach and other approaches for hemiarthroplasty in femoral neck fracture were searched on Cochrane Library, PubMed, EMBASE, Web of science, Wanfang, CNKI databases from their establishment to May 2019. According to the inclusion and exclusion criteria, two researchers independently screened the literatures, and extracted the data. The quality of RCT were evaluated by Cochrane Risk of Bias Assessment Tool, and non-RCT were evaluated by the NOS scale. Meta-analysis was performed using the RevMan 5.3 software.@*RESULTS@#A total of 9 articles were included with 901 cases, in which 429 cases used DAA, and 472 used other approaches. DAA had a significantly lower dislocation rate compared to subgroup of posterior and posterolateral approach [=0.19, 95%CI (0.06, 0.61), =0.005]. No significant differences were found between DAA group and subgroup of direct lateral and anterolateral approach[=1.08, 95%CI(0.20, 5.76), =0.93]. Also there were no relevant differences between the DAA group and control in infection rate[=1.07, 95%CI(0.47, 2.43), =0.88], perioperative fracture rate[=0.95, 95%CI(0.36, 2.50), =0.92], re operation rate[=0.76, 95%CI(0.30, 1.89), =0.55], overall complication rate [=0.88, 95%CI (0.63, 1.22), =0.44], mortality [=1.33, 95%CI (0.84, 2.11), =0.23], operative time[MD=1.43, 95%CI(-5.85, 8.71), =0.70].@*CONCLUSION@#The current evidenceindicates that the DAA was associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty. There was no significant difference in dislocation rate with the lateral and anterolateral approach.

Comparison of measurement methods of lower limb length in hip arthroplasty for femoral neck fracture / 中国骨伤

OBJECTIVE@#To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly, and to introduce a "shoulder to shoulder" anatomical location marking method for femur.@*METHODS@#From January 2017 to January 2019, 90 elderly patients with femoral neck fracture were treated with hip replacement, including 39 males and 51 females, aged 65 to 96(78.0±7.4) years, 56 cases of total hip and 34 cases of hemi hip. According to garden classification, there were 7 cases of typeⅡ, 63 cases of type Ⅲ and 20 cases of type Ⅳ. The patients were divided into three groups according to different measurement methods:contralateral contrast method (group A) of 19 cases, shuck test method (group B) of 28 cases, and "shoulder to shoulder" anatomical marker localization method (Group C) of 43 cases. The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging.@*RESULTS@#All patients completed the operation successfully. After total hip arthroplasty, the length of lower limbs in group A was(12.9±8.6) mm, and that in group B was(10.3±4.4) mm. After hemiarthroplasty, the length of lower limbs in group A was (13.2±7.2) mm, group B was (8.7±3.5) mm, and group C was (6.3±2.8) mm; the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1) mm in group A, (9.6±4.0) mm in group B and (6.6±2.6) mm in group C. The results of factorial analysis of variance showed that the differences among the three groups were statistically significant (@*CONCLUSION@#The "shoulder to shoulder" anatomic localization marking method can reduce the length of lower limbs simply, effectively and accurately in the elderly patients with femoral neck fracture hip replacement.

Research progress on joint replacement for hemiplegic femoral neck fracture / 中国骨伤

With China's aging society, the number of patients with hemiplegia caused by cerebrovascular accident is increasing gradually. The risk of hip fracture in the first year after the onset of this kind of patients is 4 times higher than that of ordinary people, and most of them occur in the side of hemiplegia. For senile femoral neck fracture, artificial joint replacement is almost the first choice of treatment, with mature operation technology and good curative effect. At present, it is considered that if the muscle strength of hemiplegic side can reach grade III after cerebral vascular accident, hip arthroplasty can be the first choice for hemiplegic patients with hemiplegic femoral neck fracture. However, the situation of hemiplegic patients is different from that of ordinary people. The hemiplegic limbs may have muscle atrophy, muscle strength imbalance, osteoporosis and other problems, which brings difficulties to the formulation of surgical plan. This paper mainly discusses the choice of surgical approach, the use of total hip arthroplasty or hemiarthroplasty, the use of cemented prosthesis or cementless prosthesis, and how to reduce the incidence of postoperative dislocation The purpose is to provide more reference evidence for orthopedic doctors in clinical decision-making.

Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis / 中华创伤杂志(英文版)

PURPOSE@#By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event.@*METHODS@#The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: "total hip arthroplasty", "hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration' stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event.@*RESULTS@#This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up.@*CONCLUSION@#Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.

Síndrome Postcementación Ósea. Serie de Casos / Bone Cement Implantation Syndrome. Case Series

Introducción El síndrome de implantación de cemento óseo (SICO) es una complicacion intraoperatoria frecuente y potencialmente devastadora en pacientes sometidos a artroplastia de cadera cementada. Objetivo Describir la frecuencia del SICO en pacientes llevados a artroplastia total o parcial de cadera, mayores de 50 años, en el Hospital de San José de Bogotá, entre el 1 de enero del 2012 al 31 de Enero del 2018. Metodología Estudio serie de casos. Se revisaron los registros médicos de pacientes adultos mayores de 50 años con indicación de Artroplastia o Hemiatroplastia. Se analizaron las variables perioperatorias a través del registro de Anestesia. Mediante la clasificación de Donaldson se determinó el grado de SICO. Se emplearon estadísticas descriptivas y análisis de correspondencias múltiples para explorar la relación entre las variables. Resultados Incluimos 49 pacientes con una media de edad de 78 años (DE +/- 9.9), 39 eran mujeres (79.6%) y 37 (75.5%) tuvieron una clasificacion ASA II. Documentamos la presencia de SICO en 8 pacientes (16.3%): de los cuales 5 correspondian a Grado 1, 2 Grado 2 y 1 a Grado 3 con requerimiento de UCI. 7 eran mujeres; todos tenían antecedente de hipertension arterial, 2 diabetes mellitus, 2 EPOC y 1 osteoporosis. Ninguno reportó ingesta de Warfarina. Conclusiones SICO es un fenómeno frecuente en la artroplastia y hemiartroplastia cementada, siendo mayor en el sexo femenino, documentandose la presencia de predictores de severidad clasificacion ASA II ­III y el antecedente de EPOC en nuestro hospital.

Background The bone cement implantation syndrome (BCIS) is a frequent and potentially devastating intraoperative complication in patients undergoing cemented hip arthroplasty. The objective of study is to describe the frequency of BCIS in patients undergoing total or partial hip arthroplasty. Methods Case series study. We reviewed the medical records of adult patients over 50 years of age with an indication for Arthroplasty or Hemiatroplasty. The perioperative variables were analyzed through the Anesthesia registry. The degree of SICO was determined by Donaldson classification. Descriptive statistics and multiple correspondence analysis were used to explore the relationship between the variables. Results We included 49 patients with an average age of 78 years (SD +/- 9.9), 39 were women (79.6%) and 37 (75.5%) had an ASA II classification. We documented the presence of SICO in 8 patients (16.3%): of which 5 corresponded to Grade 1, 2 Grade 2 and 1 to Grade 3 with ICU requirement. 7 were women; all were hypertensive, 2 diabetes mellitus, 2 COPD and 1 osteoporosis. None reported Warfarin ingestion. Discussion BCIS is a frequent phenomenon in the arthroplasty and cemented hemiarthroplasty, being higher in the female sex, documenting the presence of predictors of severity ASA II -III classification and the history of COPD in our hospital.

Resultados funcionales de hemiartroplastía bipolar en pacientes mayores de 65 años con fracturas intracapsulares de cadera / Functional results of bipolar hemiarthroplasty in patients over 65 years of age with intracapsular hip fractures

Resumen: Introducción: La hemiartroplastía bipolar (HA) es una alternativa para el tratamiento de las fracturas desplazadas de cuello femoral en pacientes de edad avanzada con baja demanda funcional y comorbilidades asociadas. El objetivo fue describir la funcionalidad en pacientes mayores de 65 años con fracturas intracapsulares de cadera tratados con HA. Material y métodos: Revisión retrospectiva de pacientes mayores de 65 años entre Enero de 2012 y Mayo de 2017. Se evaluó con la escala de Harris (HHS) y Oxford a los seis meses y al año posterior a la cirugía. Se documentaron las complicaciones y la mortalidad durante el primer año postquirúrgico. Resultados: 48 casos (12 hombres; 36 mujeres), edad promedio de 80.8 ± 7.7 años. Comorbilidades más frecuentes: hipertensión arterial (77.1%), osteoporosis (37.5%), diabetes (33.3%) e hipotiroidismo (29.2%). El porcentaje de complicaciones postoperatorias asociadas fue de 8.3% (cuatro casos). La mediana del HHS a los seis y 12 meses fue de: 90.5 (DE: 77.5-96.0) y 96 (DE: 92-98), respectivamente. La escala de Oxford fue de 45.5 (DE: 38.5-48.0) a los seis meses y de 47.0 (DE: 43.5-48) al año postoperatorio. El 4.2% (dos casos) fallecieron durante el primer año postquirúrgico y ninguno estuvo asociado al procedimiento. Discusión: La HA ofrece buenos resultados funcionales en pacientes mayores de 65 años, con una tasa baja de complicaciones. En nuestra serie y en el corto plazo no se observó mortalidad asociada al procedimiento quirúrgico.

Abstract: Introduction: Bipolar hemiarthroplasty is an alternative for the treatment of displaced femoral neck fractures in elderly patients with low functional demand and associated comorbidities. The goal was to describe functionality in patients over 65 years of age with intracapsular fractures of the hip. Material and methods: Retrospective review of patients over 65 years of age between January 2012 and May 2017. It was evaluated with the Harris Hip Score (HHS) and Oxford scale at six months and the year after surgery. Complications and mortality were documented during the first post-surgical year. Results: 48 cases (12 men; 36 women), average age of 80.8 ± 7.7 years. Most common diseases: high blood pressure (77.1%), osteoporosis (37.5%), diabetes (33.3%) hypothyroidism (29.2%). The percentage of associated postoperative complications was 8.3% (four cases). The median HHS at six and 12 months was: 90.5 (DE: 77.5-96.0) and 96 (DE: 92-98), respectively. The Oxford scale was 45.5 (DE: 38.5-48.0) at six months and 47.0 (DE: 43.5-48.0) per postoperative year. 4.2% (two cases) died during the first post-surgical year and none were associated with the procedure. Discussion: HA provides good functional outcomes in patients over 65 years of age, with a low rate of complications. No mortality associated with the surgical procedure was observed in our series and in the short term.

Intrapelvic Migration of the Lag Screw with Wedge Wing from Dyna Locking Trochanteric Nail: A Case Report and Literature Review / 대한고관절학회지

The intrapelvic migration of cervicocephalic lag screws is a rare complication after intertrochanteric fracture synthesis with an intramedullary nail. Only 15 cases of intrapelvic penetration by three different instrument systems have been described in the literature. However, to our knowledge, there is no report of intrapelvic migration of the lag screw with wedge wing designed to increase fixation power using the Dyna locking trochanteric (DLT) nail. We present a case of intrapelvic migration of the lag screw with wedge wing from DLT nail. The patient described herein underwent a two-staged operation of implant removal without intrapelvic approach followed by bipolar hemiarthroplasty. With intrapelvic migration conditions, although it is not uncommon to require an additional intrapelvic approach, this modification can lead to lethal consequences. For this reason, it is recommended to coordinate with the vascular surgery department due to the close proximity of the major vessels.

Clinical Outcomes of Bipolar Hemiarthroplasty versus Total Hip Arthroplasty: Assessing the Potential Impact of Cement Use and Pre-Injury Activity Levels in Elderly Patients with Femoral Neck Fractures / 대한고관절학회지

PURPOSE: This study was performed to analyze the potential impact of cement use and favorable pre-injury activity on clinical outcomes of bipolar hemiarthroplasty (BHA) compared with total hip arthroplasty (THA) in elderly patients with femoral neck fractures. MATERIALS AND METHODS: Systematic review and meta-analysis of 12 clinical studies (5 randomized controlled trials and 7 comparative studies). Subgroup analysis was performed based on type of fixation method (cemented vs. cementless) and in the patient with independent ambulation, respectively. RESULTS: A significantly higher dislocation rate was observed in patients treated with THA compared with those treated with BHA in individuals capable of independent ambulation before injury (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.62; P=0.05, Z=1.98). Also, the dislocation rate was significantly higher in patients treated with cemented THA compared with those treated with cemented BHA (OR, 0.18; 95% CI, 0.05–0.62; P=0.006, Z=2.73). EQ-5D was significantly higher in those treated with cemented THA compared with patients treated with cemented BHA. Lastly, HHS was significantly higher in patients treated with cementless THA compared with those treated with cementless BHA. CONCLUSION: An increase in the dislocation rate was observed when THA was performed in elderly patients with femoral neck fracture and who were pre-injury independent walkers. In addition, cemented THA was associated with a higher dislocation rate compared with cemented BHA. However, the dislocation rate in those treated with cementless THA were similar to patients treated with cementless BHA. With regards to functional score, THA was superior to BHA in both cementless and cemented fixation.

Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: To evaluate the success rate of fixation approaches for greater trochanter (GT) fracture types in those with unstable intertrochnateric fractures. MATERIALS AND METHODS: Forty-four patients who underwent arthroplasty for unstable intertrochanteric fractures between January 2015 and November 2017 and followed-up more than six months were included in this study. The fractures of GT were classified into one of four types (i.e., A, B, C, and D) and fixed using either figure-8 wiring or cerclage wiring according to fracture type. Fractures were type A (n=7), type B (n=20), type C (n=6), and type D (n=11). Type A and B, which are fractures located above the inferior border of GT were fixed using figure-8 wiring and/or adding cerclage wiring. On the other hand, all type C and D fractures, which were located below the inferior border, were fixed using cerclage wiring. Fixation failure was defined as breakage of wire and progressive migration of GT fragment greater than 5 mm on follow-up radiographs. RESULTS: The most common GT fracture types were B and D, both of which are longitudinal fractures. The success rates of fixation were 85.7% (6 out of 7 cases) for the treatment of type A, 90.0% (18 out of 20 cases) for the treatment of type B, and 100% for the treatment of types C (6 out of 6 cases) and D (11 out of 11 cases). CONCLUSION: We note high success rates following fixation methods were selected based on the GT fracture type.

Comparison of Functional Outcomes and Associated Complications in Patients Who Underwent Total Hip Arthroplasty for Femoral Neck Fracture in Relation to Their Underlying Medical Comorbidities / 대한고관절학회지

PURPOSE: In patients with independent mobility, full hip range of motion and sufficient muscle strength for daily life without cognitive impairment, treatment of a femoral neck fracture with total hip arthroplasty (THA) may be a better option compared to bipolar hip hemiarthroplasty. Here, functional outcomes and complications in patients who underwent THA for femoral neck fracture based on their comorbidity status were analyzed. MATERIALS AND METHODS: Between January 2013 and December 2018, 110 patients were treated with THA for femoral neck fractures at our institution. These patients were retrospectively analyzed for clinical outcomes at final follow-up (mean=24.4 months, range: 6–81 months) using the Harris hip score (HHS) and the presence or absence of two potential comorbidities: i) diabetes mellitus (DM; 35 with and 75 without) and ii) hypertension (HTN; 50 with and 60 without). RESULTS: The incidence of superficial infections at the surgical site in patients with DM was significantly higher compared with patients without DM (P=0.024). There were no significant differences in other potential complications based on DM status. HHS at final follow-up between patients with and without DM and with and without HTN were not significantly different (83.3 vs. 81.0, P=0.39 and 81.6 vs. 82.4, P=0.75, respectively). CONCLUSION: Superficial infections occurred more frequently in patients with DM compared with patients without DM. DM and HTN status are not correlated with HHS.

Hemiarthroplasty in the Hip Fracture Patient with Renal Impairment: To Cement or Not to Cement / 대한고관절학회지

PURPOSE: Patients with chronic kidney disease (CKD) have a higher risk of complications when undergoing hip hemiarthroplasty. The primary aim is to test the null hypothesis that there is no difference between cemented and uncemented stem loosening rates in patients with CKD who receive a hip hemiarthroplasty for femoral neck fractures. The secondary aim is to determine the effect of increasing severity of renal disease on the rate of stem loosening in this CKD patient subset. MATERIALS AND METHODS: A retrospective study of all patients with CKD who underwent a hip hemiarthroplasty for a traumatic femoral-neck fracture between 2003 and 2013 was performed. Patients with a minimum of two-year follow-up were included; those with pathological fractures or loosening due to infection were excluded. The outcome measure was radiographic aseptic loosening of the stem, defined as progressive radiolucency of more than 2 mm, progressive subsidence or migration of the implant. RESULTS: One-hundred and nineteen cases were included in this study. Loosening occurred in 11 cases (9.24%). A comparison between cemented and uncemented groups revealed no difference in the rate of loosening (P=0.079). In all cases, worsening renal function did not increase the rate of loosening (P=0.311). The rate of loosening did not increase with worsening renal function in either the cemented (P=0.678) or uncemented groups (P=0.307). CONCLUSION: There is no difference in the rate of loosening between cemented and uncemented hemiarthroplasty for femoral neck fractures in the elderly with CKD. The rate of loosening did not increase with worsening renal function. All patients with renal impairment, not just those with end-stage renal failure, warrant close follow-up as early loosening can occur throughout the entire spectrum of renal disease.