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Cementless total hip arthroplasty with prophylactic femoral cable performed for completely displaced femoral neck fracture.
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Total hip arthroplasty (THA) is indicated for completely displaced femoral neck fractures (FNF) in elderly community ambulators. Compared to open reduction internal fixation (ORIF) and hemiarthroplasty (HA), THA has favorable outcomes in this population. Cementless fixation with prophylactic cabling is the technique of choice. THA is costlier for h...
Contexts in source publication
Context 1
... reported 73% of femoral neck fractures (FNF) present as displaced 4 ( Fig. 1), and multiple studies have found inferior outcomes when these fractures are treated with closed or open reduction versus arthroplasty. There is significant evidence that displaced intracapsular femoral neck fractures are best treated with either total hip arthroplasty (Fig. 2) or hemiarthroplasty (HA) [5][6][7][8][9] (Fig. 3A and B). Recently, THA has become more widely utilized for displaced femoral neck fractures due to the superior function and lower rates of reoperation it provides. 7 This review explores the current literature regarding total hip arthroplasty for the treatment of hip fracture through a ...
Context 2
... studies have suggested that uncemented stems are favored over cemented stems in patients with adequate bone stock. 29,30 A registry study of approximately 6500 THAs found that uncemented stems were associated with fewer revisions for aseptic loosening in patients less than 70 years of age (Fig. 2). With revision for any reason as the endpoint, survival was equivalent between cemented and uncemented femoral stems. 30 FNF patients have poor bone stock and are given a diagnosis of osteoporosis by virtue of the injury. The preponderance of recent evidence suggests cemented stem fixation is favored during HA in this population (Fig. ...
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... a cadaveric study, Herzwurm et al. found that prophylactic cabling of the proximal femur increases hoop stress resistance, theoretically decreasing the likelihood of intraoperative femur fracture during stem insertion 41 (Fig. 2). A biomechanical study found both braided polyblend suture and steel wire cerclage significantly decreased proximal femoral strain during femoral broaching. ...
Context 4
... reported 73% of femoral neck fractures (FNF) present as displaced 4 ( Fig. 1), and multiple studies have found inferior outcomes when these fractures are treated with closed or open reduction versus arthroplasty. There is significant evidence that displaced intracapsular femoral neck fractures are best treated with either total hip arthroplasty (Fig. 2) or hemiarthroplasty (HA) [5][6][7][8][9] (Fig. 3A and B). Recently, THA has become more widely utilized for displaced femoral neck fractures due to the superior function and lower rates of reoperation it provides. 7 This review explores the current literature regarding total hip arthroplasty for the treatment of hip fracture through a ...
Context 5
... studies have suggested that uncemented stems are favored over cemented stems in patients with adequate bone stock. 29,30 A registry study of approximately 6500 THAs found that uncemented stems were associated with fewer revisions for aseptic loosening in patients less than 70 years of age (Fig. 2). With revision for any reason as the endpoint, survival was equivalent between cemented and uncemented femoral stems. 30 FNF patients have poor bone stock and are given a diagnosis of osteoporosis by virtue of the injury. The preponderance of recent evidence suggests cemented stem fixation is favored during HA in this population (Fig. ...
Context 6
... a cadaveric study, Herzwurm et al. found that prophylactic cabling of the proximal femur increases hoop stress resistance, theoretically decreasing the likelihood of intraoperative femur fracture during stem insertion 41 (Fig. 2). A biomechanical study found both braided polyblend suture and steel wire cerclage significantly decreased proximal femoral strain during femoral broaching. ...
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Purpose : Treatment of patients with dementia and hip fracture is challenging. Total hip arthroplasty (THA) with dual mobility cup (DMC) has been designed to reduce the rate of dislocation by increasing the stability of the implant. This study aimed to compare the dislocation rates of DMC THA with hemiarthroplasty (HA) in elderly patients with disp...
Femur neck fractures in young adults account for 3-10% of all hip fractures, and management remains a challenge for the orthopaedic surgeon. Reoperation rates remain high after fixation of these fractures due to avascular necrosis, non-union, implant failure and removal of hardware. Complication rates are higher in displaced fractures, and patients...
Introduction:
Displaced femoral neck fractures (FNF) are complicated by high mortality rates and continue to represent an important cause of disability, having a negative impact on patient mobility and physical independence. The purpose of this study was to update and analyse current outcomes and evidence concerning hip hemiarthroplasty (HHA) vers...
Background: Femoral neck fracture in elderly continues to pose a treatment dilemma. Associated co-morbidities and high mortality (1-year mortality of 25–30% and only 25% survivorship at 10 years) often skews the surgical decision. The underlying treatment goal is minimum revision and maximum functional outcome. Lack of clear guidelines is reflected...
Background:
Elderly patients with femoral neck fractures are at a higher risk of dislocation after hip arthroplasty procedures. In comparison with total hip arthroplasty (THA), bipolar hemiarthroplasty (HA) and dual-mobility total hip arthroplasty (DM-THA) can be an effective alternative treatment which increases the effective head size and overall...
Citations
... Hip fractures have a significantly higher mortality rate in the elderly, with reported 1-and 2-year mortality rates of 29% and 38%, respectively, which are much higher than the mortality rates associated with other types of fractures in elderly patients, and have been described as the "last fracture of life" [5]. Studies have shown that even if the patient survives, there is a high risk of disability, and 80% of patients need to use a walker within 1 year after fracture, resulting in a serious decline in quality of life and a huge social burden [6]. ...
Background
Hip fractures in the elderly have significant consequences, stemming from the initial trauma and subsequent surgeries. Hidden blood loss and stress due to concealed injury sites could impact the whole osteoimmune microenvironment. This study employs scRNA-seq technique to map immune profiles in elderly hip fracture patients from post-trauma to the recovery period, investigating the dynamic changes of immune inflammation regulation subgroups.
Methods
We collected peripheral blood samples from four elderly hip fracture patients (two males and two females, all > 75 years of age) at three different time points (24 h post-trauma, 24 h post-operation, and day 7 post-operation) and applied scRNA-seq technique to analyze the cellular heterogeneity and identify differentially expressed genes in peripheral blood individual immune cells from elderly hip fracture patients.
Results
In this study, we analyzed the composition and gene expression profiles of peripheral blood mononuclear cells (PBMCs) from elderly hip fracture patients by scRNA-seq and further identified new CD14 monocyte subpopulations based on marker genes and transcriptional profiles. Distinct gene expression changes were observed in various cell subpopulations at different time points. C-Mono2 monocyte mitochondria-related genes were up-regulated and interferon-related and chemokine-related genes were down-regulated within 24 h post-operation. Further analysis of gene expression profiles at day 7 post-operation showed that C-Mono2 monocytes showed downregulation of inflammation-related genes and osteoblast differentiation-related genes. However, the expression of these genes in cytotoxic T cells, Treg cells, and B cell subsets exhibited a contrasting trend. GZMK⁺CD8⁺ cytotoxic T cells showed downregulation of chemokine-related genes, and Treg cells showed upregulation of genes related to the JAK/STAT signaling pathway. Furthermore, we examined interactions among diverse immune cell subsets, pinpointing specific ligand-receptor pairs. These findings imply cross-talk and communication between various cell types in the post-traumatic immune response.
Conclusions
Our study elucidates the notable alterations in immune cell subpopulations during different stages of hip fracture in elderly patients, both in terms of proportions and differential gene expressions. These changes provide significant clinical implications for tissue repair, infection prevention, and fracture healing in clinic.
... These numbers were significantly lower compared to the literature regarding THA surgery for MFNF [6], which reports an incidence of up to 16% of patients [23]. No dislocations were observed in our cohort, one of the most feared complications in post-traumatic THA [23][24][25][26] with rates up to 10% of patients [27]. No patients in our cohort had the implant of a dual mobility cup to reduce the risk of dislocation [25,28]. ...
Background
With the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery.
Methods
A total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77).
Results
Group A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041).
Conclusion
The use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population.
... It is possible to move while carrying weight upright thanks to the hip joint, which joins the head of femur to the pelvis. The proximal end of femur consists of the femoral head, neck, and greater and lesser trochanters, and these components are what make up the hip joint, which includes a ball and socket [4] . ...
... Operative modalities considered for comparison of 30-day and oneyear survival rates included hemiarthroplasty, intramedullary nail (IMN) and dynamic hip screw (DHS) whereas patients managed with cannulated hip screws (CHS), total hip replacement (THR) and nonoperative management were excluded from this analysis. This is because patients managed with CHS and THR are usually younger and highly independent whereas the majority of patients managed with nonoperative management are extremely frail and moribund [9][10][11]. In addition, for analysing one-year survival outcomes, patients were allocated to high and low NHFS groups (high NHFS=5 or above, low NHFS=4 or below). ...
Introduction
Hip fracture is commonly seen in elderly patients because of low-energy trauma. It carries significant morbidity and mortality. Scoring systems such as the Nottingham hip fracture score (NHFS) have shown a good correlation with increased mortality as the value of these scores increases. In our study, we aim to ascertain the hip fracture mortality in our population, compare the mortality in hip fractures compared to previously reported figures in literature and nationally reported figures during the first year of the COVID-19 pandemic, and also ascertain the usefulness of NHFS in predicting mortality in hip fractures.
Methods
We gathered mortality data on hip fracture patients admitted to our unit from January 1, 2020 to December 31, 2020. NHFS was calculated for all patients and the 30-day mortality rate was compared to previously reported hip fracture mortality rates using the standard mortality ratio (SMR). One-year mortality was stratified by placing patients in high and low NHFS groups. The log-rank test was used to compare hip fracture survival at one month and at one year in the high NHFS (NHFS >4) group and low NHFS group (NHFS value 4 or below). Additionally, a log-rank test was used to compare one-month and one-year survival in hip fractures managed with hemiarthroplasty, dynamic hip screw and intramedullary nail.
Results
In 2020, 388 patients were admitted with hip fractures to our unit. The crude mortality rate was 3.9% at 30 days and 20.88% at one year. Compared to the National Hip Fracture Database report for 2020, the incidence risk ratio for mortality was 0.46 (p-value<0.05). The SMR at 30 days was 0.34 (CI=0.17-0.51) and the SMR at one year was 0.63 (CI=0.49-0.77). The survival rate was higher at 30 days and one year in the low NHFS group compared to the high NHFS group (p-value<0.01). The survival rate at one month and one year were similar in groups managed with hemiarthroplasty, dynamic hip screws, and intramedullary nails (p-value>0.05).
Conclusions
Hip fracture mortality has been decreasing steadily and we noted a lower rate of hip fracture mortality compared to figures reported previously as per NHFS studies even though the study was conducted during the COVID-19 pandemic period. We also noted lower 30-day mortality in our hospital as compared to the national 30-day mortality rate for hip fracture patients in 2020.
... It is of great significance to carry out predictive nursing mode in artificial cemented hemiarthroplasty. According to the complex condition of patients, comprehensive analysis is carried out, and targeted measures are formulated to effectively avoid or reduce the occurrence of cemented bone syndrome [10]. ...
Femoral neck fractures (FNF) are the most frequent fractures in the older population and are also of high socioeconomic importance due to the high risk of mortality. The diagnostics are based on the clinical examination and imaging procedures. The classification systems used in the routine clinical practice are oriented towards the prognosis and are therefore a valuable aid in making decisions for the selection of the treatment procedure. Early surgery is decisive for the success of treatment. Older patients (> 60 years) with arthritically damaged hips and a high degree of fracture dislocation benefit from prompt hip replacement (bipolar systems, total hip arthroplasty, dual mobility systems). In contrast, joint-preserving surgery by osteosynthesis is indicated in younger patients with a low degree of dislocation. This article summarizes the clinically relevant aspects of FNF and gives an overview of current treatment strategies with inclusion of the scientific literature.
Introduction
Due to demographic changes, the annual incidence of femoral neck fractures (FNF) in patients reaching the 9th and 10th decade of life is increasing. Although active and cognitively intact elderly patients could benefit from total hip arthroplasty (THA) in case of a FNF, there is no clear consensus on whether THA should be performed in this particular subgroup of patients with very advanced age. The purpose of this study was to report the complication rate, mortality, clinical outcomes and quality-adjusted life year (QALY) gained in patients treated with total THA for FNF, while having exceeded the mean life expectancy at the time of surgery, compared to a younger control group.
Materials and Methods
Patients treated with THA through a direct anterior approach (DAA) for FNF and exceeding the average life expectancy in Switzerland (age ≥ 83 y, n = 45) were matched for gender, body mass index (BMI) and ASA score with patients under the age of 83 (age = 65-83, n = 45). Perioperative complications, clinical and radiologic outcomes, as well as mortality were compared between groups.
Results
Total complication rate did not differ significantly with 22.2% in the older group compared to 17.8% in the control group. The 30-day and 1-year mortality was slightly but not significantly higher in the older group (2.2% and 8.9% vs. 2.2% and 2.2%). The average QALY gained was 3.4 years and 4.1 years for the older group and their younger counterparts, respectively.
Conclusion
THA through the DAA for FNF in cognitively intact and active patients might be a credible and safe option even after reaching mean life expectancy with excellent functional outcomes and similar surgery-related complications compared to patients younger than 83 years. Our results imply that an advanced age should not be considered a contraindication for THA in case of a FNF.
