Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial.
ABSTRACT We performed a four-year follow-up of a randomized controlled trial involving 120 elderly patients with an acute displaced femoral neck fracture who were randomized to treatment with either a bipolar hemiarthroplasty or a total hip arthroplasty. The difference in hip function (as indicated by the Harris hip score) in favor of the total hip arthroplasty group that was previously reported at one year persisted and seemed to increase with time (mean score, 87 compared with 78 at twenty-four months [p < 0.001] and 89 compared with 75 at forty-eight months [p < 0.001]). The health-related quality of life (as indicated by the EuroQol [EQ-5D(index)] score) was better in the total hip arthroplasty group at the time of each follow-up, but the difference was significant only at forty-eight months (p < 0.039). These results confirm the better results in terms of hip function and quality of life after total hip arthroplasty as compared with hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck.
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ABSTRACT: Displaced fracture of the femoral neck has been a common clinical problem, especially in aged patients. However, the optimal treatment choice remains controversial. The purpose of this study is to conduct a systematic review of randomized clinical trials assessing the results of hemiarthroplasty and total hip replacement in patients undergoing either alternative using meta-analysis.PLoS ONE 01/2014; 9(5):e98071. · 3.53 Impact Factor
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ABSTRACT: To investigate the clinical and radiological outcome in elderly patients suffering from an acetabular fracture operated with an acute primary acetabular reinforcement ring, autologous bone graft and a total hip arthroplasty. Prospective cohort study. Tertiary care university hospital. Fifteen elderly patients (7 females) with a mean age of 76 years and a displaced acetabular fracture after a low-energy trauma were included. The fractures involved the anterior column, but no patients with associated both column fractures were included. All patients were able to walk independently prior to the fracture. Primary operation with a Burch-Schneider reinforcement ring, autologous bone graft and a total hip arthroplasty. Patients were reviewed at 4, 12, 24 and 48 months after the fracture. Outcome assessments included complications, reoperations, ADL-function, functional scores (Harris hip score and SMFA), health related quality of life (EQ-5D index score) and radiological evaluation. There were no prosthetic dislocations, periprosthetic fractures, deep infections or other adverse events. There were no radiological signs of loosening of the reinforcement ring or the prosthesis components at any of the follow-ups and the autologous bone graft was well incorporated in all patients at the final follow-up. At 48 months the mean Harris hip score was 88, the mean SMFA dysfunction score 30, the bother score 25 and the mean EQ-5D index score 0.65. All patients were able to walk independently at the final follow-up. Treatment of displaced anterior column, anterior column posterior hemitransverse and transverse acetabular fractures in elderly patients using a primary reinforcement ring, autologous bone graft and a THA appears to be a safe option with good functional and radiological outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.Journal of orthopaedic trauma 10/2013; · 1.78 Impact Factor
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ABSTRACT: Pain after hip fracture repair is related to worse functional outcomes and higher fracture care costs than that for patients with no or less pain. However, to our knowledge, few studies have examined the roles of hip fracture type or surgical procedure as factors influencing postoperative pain or opioid analgesic requirements. Our goal was to determine whether the type of hip fracture or hip fracture repair affects postoperative pain or opioid analgesic requirements in the elderly patient. We conducted a retrospective review of 231 patients ≥65 years old admitted to a hip fracture center for surgical repair. Fracture patterns were classified into femoral neck (FN) versus intertrochanteric (IT), stable versus unstable, and type of surgical repair. Demographic and intraoperative variables, postoperative pain scores, and opioid analgesic use data were collected and analyzed according to the type of hip fracture and type of surgical repair. There were no differences in postoperative pain when comparing FN versus IT fractures, stable versus unstable fractures, or type of surgical repair. Patients with FN fractures had higher analgesic requirements on postoperative days 1, 2, and 3. There was no difference in postoperative analgesic requirements among patients with stable versus unstable fractures or type of surgical repair. Otherwise, there were no differences in postoperative pain or opioid analgesic use based on the surgical repair or fracture type. Overall, patients with hip fracture experienced low levels of pain.Geriatric orthopaedic surgery & rehabilitation. 12/2013; 4(4):103-8.