Primary hemiarthroplasty for treatment of unstable pertrochanteric femoral fractures (AO/OTA Type 31 A2.3) in elderly osteoporotic patients

Zhuri²,

Geriatr Orthop Surg Rehabil

et al. 2019

Self Cite

Background: Hip fractures are serious injuries associated with relatively high mortality rates and disabilities, commonly seen in elderly persons. There is an ongoing debate regarding the advantages of various hip arthroplasty devices. This study aimed to analyze the long-term advantages of 2 different surgical procedures and assess if the dislocation rate, Harris Hip Score (HHS), and functional independence measure (FIM) are more favorable in dual mobility (DM) than those in hemiarthroplasty (HA). Hypothesis: Dual mobility procedures provide better postoperative outcomes than HA in terms of HHS, FIM, and dislocation rate. Materials and Methods: The survey was a prospective, comparative interventional single-blinded study performed at the University Clinical Center of Kosovo, a tertiary health-care institution. A total of 94 patients underwent DM or conventional bipolar HA for repair of displaced femoral neck fractures within 2 weeks of injury. Primary outcomes were postoperative dislocation rate, FIM, and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, mortality rate, and postoperative infection rate. Results: There were no significant differences for most parameters between the groups. We found a significant difference in the dislocation rate between the 2 groups, wherein there were no dislocations in the DM group and 3 dislocations in the HHS group (0% vs 6.4%). In terms of postoperative HHS at 12 months and 3 years, DM provided better outcomes (<0.034 and <0.014, respectively). Discussion: Dual mobility compares favorably to HA in terms of dislocation rate and HHS, while no difference was found for FIM. In order to have a more complete overview, we recommend more intense long-term studies including several heterogeneous parameters to compare the clinical outcomes between DM and HA. Level of evidence (with study design): Level II.

Section: Discussionsupporting

confidence: 77%

Dual Mobility Acetabular Cup Versus Hemiarthroplasty in Treatment of Displaced Femoral Neck Fractures in Elderly Patients: Comparative Study and Results at Minimum 3-Year Follow-up

Zhuri²,

Geriatr Orthop Surg Rehabil

et al. 2019

Self Cite

J Orthop Surg (Hong Kong)

“…Treatment using cephalomedullary nailing of unstable IT fractures occurring in bones with poor quality shows high failure rates. 21 However, we did not observe a difference in reoperation rates between the two groups. The most important finding of the present study was that patients treated with HA showed superior functional outcomes, whereas those treated with PFN showed better health status scores at the 3-month follow-up.…”

Section: Discussioncontrasting

confidence: 58%

Section: Discussioncontrasting

confidence: 58%

See 1 more Smart Citation

Comparative evaluation of postoperative health status and functional outcome in patients treated with either proximal femoral nail or hemiarthroplasty for unstable intertrochanteric fracture

Üçpunar

Çamurcu

Cobden

et al. 2019

Purpose: This study aimed to compare functional recovery and change in morbidity status from the preoperative levels among patients who underwent two different surgical treatments for unstable intertrochanteric fracture. Methods: This retrospective comparative study enrolled 140 patients (aged >80 years) who were referred to two hospitals. Of these, 64 were treated using proximal femoral nail (PFN) and 76 were treated using hemiarthroplasty (HA). To evaluate functional recovery, primary outcome measures were cumulative illness rating scale (CIRS) score to evaluate changes in morbidity status, activity of daily living (ADL) index, and mobility scores. Results: The proportion of patients who experienced increased CIRS scores in the HA group was higher at the 3-month follow-up (p ¼ 0.02) but similar at the 6-month followup (p ¼ 0.2) in comparison to the PFN group. Treatment with HA, American Society of Anesthesiologists scores of 3-4, and lower, preoperative ADL indexes were the major predictors of increased postoperative CIRS score. Impaired ambulatory ability and the need for walking aids were significantly higher in the PFN group at the 3-month follow-up (p ¼ 0.01 and p ¼ 0.02, respectively) but similar at the 6-month follow-up with respect to the HA group. PFN treatment and high patient body mass index were the major predictors of decreased ambulatory ability at postoperative 3 months. Conclusion: HA has several advantages, including early mobilization and decreased dependency. However, it is associated with greater blood loss, a higher need for blood transfusion, and longer surgical duration than PFN, all of which are predisposing factors for significantly higher risk of reduced CIRS scores.

“…Han recomendado el reemplazo protésico para permitir la carga inicial de peso en pacientes adultos mayores con una fractura intertrocantérea inestable. Por su parte, Choi et al (2010) han demostrado resultados favorables en el seguimiento a corto plazo después de realizar artroplastía de cadera para fracturas intertrocantéricas inestables (Sidhu et al, 2010;Ukaj et al, 2017).…”

Section: Discussionunclassified

Artroplastía Parcial de Cadera con Banda de Tensión en Fracturas de Fémur Proximal en Pacientes Ancianos

et al. 2019

RESUMEN: Las fracturas intertrocantéricas en adulto mayor presentan gran dificultad para lograr una cicatrización ósea estable y una fijación en la artroplastía, para la recuperación completa y funcional del anciano. En pacientes adultos mayores sin stock óseo, se recomienda realizar anexo a la artroplastía de cadera, la colocación de una banda de tensión, con la finalidad de brindar mayor estabilidad a los fragmentos y sustentación a la artroplastía primaria, con el objetivo de lograr un retorno a la calidad de vida normal. A las cuatro semanas de la cirugía, se evidencia una mejora en la escala funcional alcanzando una puntuación media de 83, considerandose un buen resultado. En los controles subsecuentes se evidencia una media en la escala de Harris de 87. Los pacientes volvieron a su nivel de actividad preoperatoria, más de la mitad de los pacientes fueron capaces de caminar sin apoyos, y finalmente, no se reportaron complicaciones en los controles postquirúrgicos al seguimiento de un año.