Treatment of periprosthetic femoral fractures with modular stems.

PURPOSE: The purpose of this study was to analyse the efficacy of modular femoral stems for the treatment of certain post-operative periprosthetic fractures in patients with hip arthroplasty. METHODS: Of a total series of 61 modular revision stems, 17 were used to address periprosthetic femoral fractures and 12 of these are the object of this study. The average follow-up was 3.7 years (range 1-14 years). The evaluations were performed at three and six months, and then annually using the HHS score and radiographic studies for the assessment of loosening, subsidence and bone integration of the stem. RESULTS: Seven cases had type B2 fractures and five type B3 ones. All patients walked freely, eight of them using canes. HHS improved to a post-operative mean of 78 (range 72-83). Radiographically, fracture healing was observed at three months in nine cases. In six cases stem subsidence of a mean of 3.9 mm (range 2-12 mm) was observed, which stabilized a year following implantation and did not need revision surgery. In two cases a subsequent dislocation (at three and seven months after surgery) occurred, which were treated with constrained acetabular systems. In nine cases hypotrophy of the cortex in the diaphyseal area was noted, which did not alter the patients' clinical course. CONCLUSION: Modular femoral stems are an acceptable treatment in type B2 and B3 periprosthetic fractures.

Charnley low-friction arthroplasty of the hip. Five to 25 years survivorship in a general hospital.

BACKGROUND: Some studies have raised the question about whether the good results obtained with the Charnley prosthesis could be replicated at general hospitals when it comes to the frequency of early complications and failure rates, both of which would be higher than those published by centres devoted to hip arthroplasties. METHODS: We reviewed the results of 404 Low Friction Arthroplasties of the hip implanted between 1976 and 1993 in a general hospital by general orthopaedic surgeons. For the survival analysis, the end-point chosen would be the chirurgical revision of any of the prosthetic components for whatever reason. RESULTS: The complications were 16 dislocations (4%), 14 deep infections (3.5%), 2 neurological injuries (0,5%) and 5 clinical deep venous thromboses (1.2%) (2 pulmonary embolisms). The survival rate at 25 years, both for stem and cup, was 83%. Survival was higher in those arthroplasties implanted in patients older than 60 years, with statistical significance. CONCLUSION: Low Friction Arthroplasty undertaken at general hospitals by general orthopaedic surgeons feature similar outcomes to those found in centres devoted to hip surgery.

Total knee arthroplasty in the elderly. Is there an age limit?

The goal of this study was to compare the results of the total knee arthroplasty (TKA) in 2 study groups only differing by age. We have analyzed 218 TKA cases (138 women and 80 men) with at least 2 years follow-up. Mean age was 70 years (SD, 7.38 years; range, 43 to 98 years). An age cutoff point at 75 years defined the 2 study groups: 167 cases younger than 75 years and 51 older. Results were evaluated using the Hospital for Special Surgery Score. Mean score was raised from 53.43 (SD, 9.186) preoperatively to 85.57 (SD, 10.763) in 2 years follow-up (P < .001). The final score did not show significant differences between both groups (86.11 for the younger group and 83.8 for the older group). Differences in pain on walking, pain at rest, walk, range of motion, climbing stairs, transfer, muscle strength, or instability were not found between the patients younger and older than 75 years. We did not find any differences in TKA, functional score, or pain between the 2 studied groups.