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Jannelli E, Boggio E, Castelli A, Pasta G, Grassi FA, Mosconi M. Trabecular titanium acetabular cup in patients with medial femoral neck fracture: Survivorship analysis and clinical and radiological outcomes. World J Orthop 2025; 16:100481. [DOI: 10.5312/wjo.v16.i3.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 12/08/2024] [Accepted: 02/19/2025] [Indexed: 03/12/2025] Open
Abstract
BACKGROUND Clinical studies using Trabecular Titanium™ acetabular cups have shown promising short and medium-term results. This material, due to its macro and micro surface roughness, provides a substrate for osseointegration and enhances implant stability. However, there is a lack of evidence in the literature on the use of this material in patients with femoral neck fracture.
AIM To evaluate the short-term clinical-functional and radiographic outcomes in patients with femoral neck fractures undergoing total hip arthroplasty (THA) with Trabecular Titanium™ acetabular cup implants.
METHODS The study included 104 patients with medial femoral neck fractures who underwent THA between January 2020 and December 2020 with the Delta TT acetabular cup (Lima Corporate, Villanova di San Daniele del Friuli, Italy). The mean age of the patients was 69.57 ± 10.16 years (range: 36-85 years). The follow-up period ranged from a minimum of 3 to a maximum of 4 years. Three questionnaires (Harris Hip Score, Oxford Hip Score, and EQ5D) were administered along with radiographic evaluations. Statistical methods included the Student's t-test and one-way analysis of variance for comparisons (with significance set at 0.05), and the Kaplan-Meier curve for prosthetic implant survival.
RESULTS The mean follow-up was 41.5 months. The Harris Hip Score (HHS) showed a mean increase of 2.74 points (mean HHS 88.52 at 6 months postoperatively and mean HHS 91.26 at the last follow-up) with statistical significance. Similarly, the Oxford Hip Score demonstrated a statistically significant difference between follow-up groups. However, the EQ5D did not show statistically significant differences among the three groups (preoperative, 6-month follow-up, and last follow-up). Revision surgery was required in 6 patients. According to Moore's criteria, 96% of the acetabular components were radiographically stable and well-integrated at the last follow-up. The Kaplan-Meier curve showed a 96% survival rate.
CONCLUSION The clinical and radiographic results obtained in the short to medium term confirm the excellent performance of the Delta TT acetabular cup in terms of osseointegration, providing an optimal solution both for young patients with high functional recovery demands and for fragile patients requiring optimal stability of the acetabular component to reduce the risk of implant failure.
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Affiliation(s)
- Eugenio Jannelli
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Ester Boggio
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Alberto Castelli
- Department of Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Gianluigi Pasta
- Department of Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Federico Alberto Grassi
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
| | - Mario Mosconi
- Orthopedics and Traumatology Clinical Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Lombardy, Italy
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Huang J, Huang J, Ding H, Lyu J, Huang C, Chen Y, Wang Q, Li H, Wu B, Huang Y, Yang M, Fang X, Zhang W. Key Decision-Making in Post-Failed Internal Fixation of Intertrochanteric Fractures Hip Arthroplasty: A Multicenter Retrospective Study on Fracture Healing's Impact on Femoral Component Selection. Orthop Surg 2025; 17:470-481. [PMID: 39638635 PMCID: PMC11787966 DOI: 10.1111/os.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 11/07/2024] [Accepted: 11/10/2024] [Indexed: 12/07/2024] Open
Abstract
PURPOSE Following failed internal fixation of intertrochanteric fractures (FIF-ITF), the decision to use a long-stem or standard-stem femoral implant in hip arthroplasty is still debated. This study aimed to explore how the healing status of fractures after FIF-ITF failure affects the choice of femoral stem and clinical outcomes. METHODS Our retrospective cohort study reviewed 105 cases of patients with FIF-ITF who underwent hip arthroplasty at three tertiary Grade A hospitals between December 2012 and December 2022. We compared the clinical outcomes between patients with healed and unhealed fractures, focusing on the selection of femoral stems in relation to proximal medial support and the healing status of the greater trochanter. The primary outcomes measured were functional results, operative time, blood loss, and incidence of complications. A subgroup analysis was conducted to further evaluate the influence of the proximal medial buttress and greater trochanteric healing on femoral stem selection. Statistical analysis included binary and ordinal logistic regression to identify factors influencing the choice of femoral stems. Additionally, a decision tree model was developed to visually represent and explore the relationship between fracture healing status and the selection of femoral components. RESULTS The study included 38 patients with healed fractures and 67 patients with unhealed fractures. Patients in the healed group predominantly chose standard stems and experienced better functional outcomes (p < 0.001, p = 0.002). In contrast, the unhealed group preferred long stems, resulting in longer surgical durations and increased blood loss (p = 0.008, p < 0.001). Binary logistic regression analysis revealed that nonunion of the proximal femoral medial buttress was an independent risk factor for long stems (p < 0.0001, OR = 10.402). CONCLUSION The selection of femoral prostheses following FIF-ITF is influenced by the fracture healing status, particularly the presence of proximal femoral medial buttress. The decision tree model suggested that long-stem prostheses are more appropriate when there is inadequate fracture healing and the proximal femoral medial buttress is absent.
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Affiliation(s)
- Jiexin Huang
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopedic SurgeryNanping First Hospital Affiliated to Fujian Medical UniversityNanpingChina
| | - Jiagu Huang
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopedic SurgeryNingde Municipal Hospital of Ningde Normal UniversityNingdeChina
| | - Haiqi Ding
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Jianhua Lyu
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopedic SurgeryAffiliated Hospital of Putian UniversityPutianChina
| | - Changyu Huang
- Department of Orthopaedic SurgeryQuanzhou Orthopedic‐TraumatologicalQuanzhouChina
| | - Yang Chen
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Qijin Wang
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of OrthopedicsAffiliated Mindong Hospital of Fujian Medical UniversityFuzhouChina
| | - Hongyan Li
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Baijian Wu
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ying Huang
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Minghui Yang
- Department of Orthopaedics and TraumatologyBeijing Jishuitan HospitalBeijingChina
| | - Xinyu Fang
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Wenming Zhang
- Department of Orthopaedic Surgery, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Provincial Institute of Orthopedics, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
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Ratanpal A, Kamath KR, Salian PRV, Baliga SS, Annappa R, Banerjee S. Mortality and functional outcomes in elderly adults treated surgically by hemiarthroplasty for femoral neck fractures. SAGE Open Med 2025; 13:20503121241307264. [PMID: 39790293 PMCID: PMC11713951 DOI: 10.1177/20503121241307264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 11/28/2024] [Indexed: 01/12/2025] Open
Abstract
Background Despite multiple studies, less recent literature and data regarding the mortality associated with hip fractures in the elderly population are available. Objectives To assess the mortality data and functional outcomes of patients who underwent cemented and uncemented hemiarthroplasty in femoral neck fractures. To evaluate if preoperative (minimum 2 months) calcium and vitamin D supplement intake in patients affects postoperative mobilization with or without walker support. Methods All patients aged 65 and above who underwent hemiarthroplasty for femoral neck fractures in our tertiary care center were included. Postoperative functional outcomes were determined using the Modified Harris Hip score and Oxford Hip score at 3, 6, and 12 months. The mortality of the procedures was assessed at 3, 6, and 12 months. Individuals who took both calcium and vitamin D supplements for at least 2 months before surgery were divided into two groups: those who did not take supplements and those who did. Results We studied 110 patients above the age of 65 years. The postoperative mortality rate at 3, 6 months and 1 year postoperatively was found to be 3.6%, 4.7%, and 15.5% respectively. Functional outcomes were assessed at 3, 6, and 12 months postoperatively using modified Harris Hip score and Oxford Hip score and were found to be identical in both cemented and uncemented hemiarthroplasty groups. Patients who took calcium and vitamin D supplements preoperatively (minimum 2 months) could walk without support at the end of 1-year post-surgery. Conclusion Early surgery and early mobilization should be the main aim of treatment for femoral neck fractures.
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Affiliation(s)
- Ankush Ratanpal
- North DMC Medical College and Hindu Rao Hospital, Guru Gobind Singh Indraprastha University, Delhi, India
| | - Katapadi Ramachandra Kamath
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Preetham Raj V Salian
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Saiprasad Sarvothama Baliga
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Rajendra Annappa
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal, India
| | - Sayak Banerjee
- ESIC Medical College and Hospital and Occupational Disease Center [East Zone], Joka, Kolkata, India
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Yuan D, Zhang Z, Wang X, Chang W, Xie W, Zhang Y. Efficacy of four internal fixation devices on femoral neck fractures in young adults: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e40265. [PMID: 39533559 PMCID: PMC11557037 DOI: 10.1097/md.0000000000040265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND The primary treatment of femoral neck fracture in young adults is internal fixation. The high complication rate after femoral neck fracture greatly affects the life of patients. There are many internal fixation devices for femoral neck fracture, but each has its advantages and disadvantages. Our aim was to determine the best internal fixation for young people with femoral neck fractures. METHODS We searched 5 databases from January, 2016 to December, 2023. Randomized controlled trials and cohort studies that met the inclusion criteria were assessed for quality using the RoB.2 and ROBINS-I scales, respectively. The network meta-analysis was conducted within a Bayesian framework utilizing a random effect model. Data analysis was performed using the "multinma" package within the R 4.2.0 software. RESULTS A network meta-analysis of 34 studies involving 2291 patients was conducted. Results indicated that the inverted triangular cannulated screws demonstrated the lowest intraoperative bleeding volume (surface under the cumulative ranking curve [SUCRA] = 0.8732) based on the SUCRA. The medial buttress plate (MBP) exhibited superior efficacy in improving the Harris hip score (SUCRA = 0.8465), reducing complications (SUCRA = 0.9251), and accelerating fracture healing time (SUCRA = 0.8111). Additionally, the femoral neck system was ranked highest in terms of operation time (SUCRA = 0.7749) and femoral neck shortening (SUCRA = 0.7933). CONCLUSION This network meta-analysis findings indicated that MBP resulted in superior postoperative hip function, reduced complication rate, faster fracture healing time. Considering the good physical condition of young adults, surgeon may consider utilizing MBP to achieve improved postoperative outcomes.
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Affiliation(s)
- Daotong Yuan
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Zhimeng Zhang
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Xu Wang
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Wenjie Chang
- Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
| | - Wenpeng Xie
- Department of Orthopedic Surgery, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan City, Shandong Province, China
| | - Yongkui Zhang
- Department of Orthopedic Surgery, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan City, Shandong Province, China
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Thompson AL, Kuttner NP, Greenberg M, Hidden KA, Yuan BJ. Cannulated Screws or Hemiarthroplasty for Femoral Neck Fractures: Is There a Mortality Difference? J Orthop Trauma 2024; 38:596-601. [PMID: 39137060 DOI: 10.1097/bot.0000000000002900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES To determine the difference in mortality and reoperation rate between femoral neck fractures (FNFx) treated with cannulated screw (CS) fixation or hemiarthroplasty (HA). METHODS DESIGN Retrospective study. SETTING Institutional registry data from a single Level I trauma center. PATIENT SELECTION CRITERIA Inclusion criteria were patients older than 60 years with FNFx (OTA/AO 31-B) who underwent primary operative treatment with a HA or CS. OUTCOME MEASURES AND COMPARISONS Mortality and reoperation rates following primary operative treatment between patients treated with either HA or CS. Kaplan-Meier survival curves were generated. Comparisons in the primary outcomes were made between the HA and CS cohorts using univariate and multivariate analyses where appropriate. RESULTS A total of 2211 patients were included in the study (1721 HA and 490 CS) and followed for an average of 34.5 months. The average age was 82.3 years (60-106 years), and patients were predominantly female (66.3%). One-year mortality was higher for the HA group compared with the CS group with a hazard ratio of 1.37 ( P = 0.03); however, over the lifetime of a patient or to the final follow-up, survival was not statistically significant (Relative Risk 0.95, 95% confidence interval, 0.83-1.1, P = 0.97). The rate of reoperation at 1 year was lower for HA (5.0%) than for CS (10.1%) (hazard ratio 3.0, 95% confidence interval, 2.1-4.34, P < 0.0001). CONCLUSIONS Patients with FNFx treated with HA had the same risk of mortality as those treated with CS across the lifetime of patients or until the final follow-up. There is no difference in mortality at the 30-day and 90-day time point, but there is a significant difference in mortality at 1 year. HA treatment was associated with a significantly lower reoperation risk when compared with CS across the lifetime of the patient or until the final follow-up. LEVEL OF EVIDENCE Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.
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Liu B, Hou G, Yang Z, Zhang Z, Zhou F, Tian Y. Machine learning models to predict osteonecrosis in patients with femoral neck fractures undergoing internal fixation. Injury 2024; 55:111830. [PMID: 39236603 DOI: 10.1016/j.injury.2024.111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/26/2024] [Accepted: 08/17/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE This study aimed to use machine learning (ML) to establish risk factor and prediction models of osteonecrosis of the femoral head (ONFH) in patients with femoral neck fractures (FNFs) after internal fixation. METHODS We retrospectively collected clinical data of patients with FNFs who were followed up for at least 2 years. Only intracapsular FNFs were included. In total, 437 patients and 24 variables were enrolled. The entire dataset was divided into training (89.5 %) and test (10.5 %) datasets. Six models-logistic regression, naive Bayes, decision tree, random forest, multilayer perceptron, and AdaBoost-were established and validated for predicting postoperative ONFH. We compared the area under the receiver operating characteristic curve (AUC), accuracy, recall, and F1 score of different models. In addition, a confusion matrix, density curve, and learning curve were used to evaluate the model performance. RESULTS The logistic regression model performed best at predicting ONFH in patients with FNFs undergoing internal fixation surgery, with an AUC, accuracy, recall, F1 score, and prediction value of 0.84, 0.89, 1.00, 0.94, and 89.1 %, respectively. The learning and density curves demonstrated a good prediction fitting degree and distinct separation. When establishing the ML models, the reduction quality, internal fixation removal, American Society of Anesthesiologists classification, injury mechanism, and displacement distance of the medial cortex were the top five risk factors positively correlated with the occurrence of ONFH. CONCLUSIONS The logistic regression model had excellent performance in predicting ONFH in patients with FNFs after internal fixation and could provide valuable guidance in clinical decision-making. When choosing treatment options for patients with FNFs, doctors should identify the risk factors and consider using the presented models to help anticipate outcomes and select individualised treatment.
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Affiliation(s)
- Bingchuan Liu
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Guojin Hou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Zhongwei Yang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Zhishan Zhang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Fang Zhou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
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Ono T, Watanabe N, Hayakawa K, Kainuma S, Yamada H, Waseda Y, Kanda Y, Fukuoka M, Tokuda H, Murakami H, Kuroyanagi G. Comparative outcomes of cemented versus cementless stems in bipolar hemiarthroplasty for femoral neck fractures. Medicine (Baltimore) 2024; 103:e39946. [PMID: 39465847 PMCID: PMC11479440 DOI: 10.1097/md.0000000000039946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 09/13/2024] [Indexed: 10/29/2024] Open
Abstract
We aimed to compare the clinical and surgical outcomes of cemented vs uncemented bipolar hemiarthroplasty in the treatment of femoral neck fractures in the elderly. Patients (n = 99) without preoperative cardiopulmonary problems undergoing bipolar hemiarthroplasty for femoral neck fracture between August 2015 and February 2019 were randomly divided into cemented (group C) and uncemented (group U) stem fixation groups. Mean operative time, mean intraoperative blood loss, and percentage of intraoperative use of vasopressors, pre- and postoperative activities of daily living (ADL), incidence of postoperative complications, and radiological evaluation of stem alignment were evaluated. A total of 99 patients were included (group C, n = 42; group U, n = 57). Group C had a significantly longer mean operative time (P < .001) and a significantly higher percentage of intraoperative vasopressor use as compared to group U (P < .05). In contrast, the amount of intraoperative blood loss was similar between the 2 groups (P = .30). Likewise, there was no statistically significant difference in pre- and postoperative ADL performance between the groups (P = .70 and .44, respectively). Postoperative computed tomography revealed that stem anteversion was higher in group C than in group U (P < .05). Cemented and uncemented stems were equivalent in terms of blood loss and postoperative complications in patients with femoral neck fractures. Uncemented stem showed advantages in reducing operative time and intraoperative vasopressor administration. Also, fixation method was not investigated in this study.
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Affiliation(s)
- Tomoya Ono
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Watanabe
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
| | - Kazuo Hayakawa
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
| | - Shingo Kainuma
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
| | - Hiroki Yamada
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
| | - Yuya Waseda
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
| | - Yoshihiro Kanda
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
| | - Muneyoshi Fukuoka
- Department of Orthopedic Surgery, Tosei General Hospital, Seto, Japan
| | - Haruhiko Tokuda
- Department of Metabolic Research, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Clinical Laboratory, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Howard LC, Sheridan GA. What's New in Hip Surgery. J Bone Joint Surg Am 2024; 106:1645-1652. [PMID: 39052695 DOI: 10.2106/jbjs.24.00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Lisa C Howard
- University of British Columbia, Vancouver, British Columbia, Canada
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Ramadanov N, Voss M, Jóźwiak K, Prill R, Hakam HT, Salzmann M, Dimitrov D, Becker R. Indirect comparison in network meta-analysis between SuperPATH, direct anterior and conventional approach hemiarthroplasty in patients with femoral neck fracture. Medicine (Baltimore) 2024; 103:e39068. [PMID: 39058802 PMCID: PMC11272366 DOI: 10.1097/md.0000000000039068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The aim of the study was to compare the short-term outcome of SuperPATH, direct anterior (DAA) and conventional approach (CA) hemiarthroplasty (HA) in patients with femoral neck fractures using a network meta-analysis. METHODS PubMed, China National Knowledge Infrastructure, Epistemonikos, and Embase were searched until May 31, 2024. In a network meta-analysis, mean differences with 95% confidence intervals were calculated using the Hartung-Knapp-Sidik-Jonkman method and a fixed/random effects model for continuous outcomes, and odds ratios with 95% confidence intervals were calculated using the Mantel-Haenszel method and a fixed/random effects model for dichotomous outcomes. RESULTS The literature search identified a total of 9 randomized controlled trials on SuperPATH with 762 patients and 8 randomized controlled trials on DAA with 641 patients. In the overall ranking, SuperPATH was placed first, DAA second and CA third. SuperPATH HA was best in 7, second best in 2 and third best in 1 of the 10 outcome parameters. DAA HA was best in 2 and second best in 8 of the 10 outcome parameters. CA HA was best in 1 and third best in 9 of the 10 outcome parameters. In the indirect comparison between SuperPATH HA and DAA HA, SuperPATH HA had a 1.36 point lower visual analog scale at 2 to 7 days postoperatively and a 0.17 lower overall complication rate compared to DAA. CONCLUSION For the treatment of patients with femoral neck fractures, SuperPATH HA ranked first, DAA HA ranked second and CA HA ranked third. Based on the results, we recommend that trauma surgeons increase their use of minimally invasive hip HA techniques. It should be noted that SuperPATH HA had a significantly lower overall complication rate compared to DAA HA when the minimally invasive technique was chosen.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Maximilian Voss
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Hassan Tarek Hakam
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Mikhail Salzmann
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Dobromir Dimitrov
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
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Ramadanov N, Salzmann M, Voss M, Hable R, Hakam HT, Prill R, Dimitrov D, Becker R. The influence of operation time for hip hemiarthroplasty on complication rates and mortality in patients with femoral neck fracture: a retrospective data analysis. J Orthop Surg Res 2024; 19:311. [PMID: 38802945 PMCID: PMC11129483 DOI: 10.1186/s13018-024-04797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The aim of the present study was to investigate the influence of various factors, in particular operation time, on mortality and complication rates in patients with femoral neck fractures who have undergone hip hemiarthroplasty (HHA) and to determine a cut-off value above which mortality and complication rates increase significantly. METHODS Cases of patients with femoral neck fracture treated with HHA between 1 January 2017 and 31 December 2023 were screened for eligibility. Multiple logistic regressions were calculated to determine which factors (patient age, experience of surgeon, patient sex, ASA score, time to surgery, operation time) influenced the incidence of complications and mortality. The exact cut-off value for complications and mortality was determined using the Youden index of the ROC curve (sensitivity vs. specificity) of logistic regression. RESULTS A total of 552 patients were considered eligible for this study. During the 90-day follow-up period after HHA, 50 deaths and 34 complications were recorded, giving a mortality rate of 9.1%, and a complication rate of 6.2%. Of the 34 complications recorded, 32.3% were infections, 14.7% dislocations, 20.7% trochanteric avulsions, 11.8% periprosthetic fractures, 11.8% nerve injuries, and 8.8% deep vein thrombosis. The odds ratio (OR) of a patient experiencing a complication is 2.2% higher for every minute increase in operation time (Exponential Beta - 1 = 0.022; p = 0.0363). The OR of a patient dying is 8.8% higher for each year increase in age (Exponential Beta - 1 = 0.088; p = 0.0007). When surgery was performed by a certified orthopaedic surgeon the mortality rate lowered by 61.5% in comparison to the surgery performed by a trainee (1 - Exponential Beta = 0.594; p = 0.0120). Male patients have a 168.7% higher OR for mortality than female patients (Exponential Beta - 1 = 1.687; p = 0.0017). Patients with an operation time of ≥ 86 min. have a 111.8% higher OR for mortality than patients with an operation time of < 86 min. (Exponential Beta - 1 = 1.118). CONCLUSION This retrospective data analysis found that the risk of a patient experiencing a complication was 2.2% higher for every minute increase in operation time. Patients with an operation time above the cut-off of 86 min had a 111.8% higher risk of mortality than those with an operation time below the cut-off. Other influencing factors that operators should be aware of include patient age, male sex, and operator experience.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany.
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
| | - Mikhail Salzmann
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Maximilian Voss
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Robert Hable
- Faculty of Applied Computer Science, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Hassan Tarek Hakam
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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11
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Gatz M, Horst K, Hildebrand F. [Treatment of proximal femoral fractures : Principles, tips and tricks]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:335-342. [PMID: 38413428 DOI: 10.1007/s00113-024-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
Proximal femoral fractures occur at an annual incidence of approximately 200/100,000 inhabitants and mortality rates range up to 30% especially in geriatric patients where complications are not necessarily associated to surgery. In nearly all cases surgical treatment is required. Procedures to preserve the femoral head have to be performed as early as possible (as specified by the Federal Joint Committee, GBA, within 24 h). For joint-preserving approaches in medial femoral neck fractures a time to surgery within 6 h is considered to be advantageous. Perioperative patient care is of high importance regarding the prevention of pneumonia, renal failure, delirium and further complications. Postoperatively full weight bearing enables for early mobilization and prevention of surgery-related complications. Nonunions, avascular necrosis of the femoral head, cut-out and prosthetic dislocation must be avoided by the selection of the appropriate procedure. Minimally displaced femoral neck fractures are primarily treated by osteosynthesis and conservative management is only considered in isolated cases. For displaced femoral neck fractures, factors such as a young biological age with high activity levels, the absence of arthritis and good bone quality with a successful reduction favor for a femoral head-preserving osteosynthesis. Otherwise, (hybrid) total hip replacement (THR) is the preferred method for unstable and displaced fractures, whereby hemiarthroplasty should only be considered for very old and patients with pre-existing diseases. Fractures in the trochanteric region are treated with a proximal femoral nail and subtrochanteric fractures are managed using a long proximal femoral nail. To avoid secondary complications, the choice of optimal treatment should be based on a good understanding of the injury pattern, biomechanical and technical aspects of each procedure.
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Affiliation(s)
- Matthias Gatz
- Klinik für Orthopädie, Unfallchirurgie und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - Klemens Horst
- Klinik für Orthopädie, Unfallchirurgie und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Frank Hildebrand
- Klinik für Orthopädie, Unfallchirurgie und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Ramadanov N, Voss M, Hable R, Prill R, Hakam HT, Salzmann M, Dimitrov D, Becker R. Patient-related Predictors for the Functional Outcome of SuperPATH Hemiarthroplasty versus Conventional Approach Hemiarthroplasty: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials. Orthop Surg 2024; 16:791-801. [PMID: 38298174 PMCID: PMC10984811 DOI: 10.1111/os.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Specialist literature lacks evidence that explores associations between patient characteristics and the beneficial treatment effect of SuperPATH hemiarthroplasty (HA) compared with conventional approach (CA) HA. To investigate and identify patient-related predictors of the effect size of the short-term functional outcome of SuperPATH HA and CA HA by performing a systematic review and meta-regression analysis of randomized controlled trials (RCTs). A systematic search of literature was performed in PubMed, CNKI, CENTRAL of The Cochrane Library, Clinical trials, and Google Scholar until August 25, 2023. For the continuous outcome parameter Harris hip score (HHS) ≤1 week and 3 months postoperatively, mean differences (MDs) with 95% confidence intervals (CIs) were calculated. A meta-regression analysis was based on random-effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method for continuous covariates. A total of five RCTs with 404 patients were found. The following predictors of HHS ≤1 week postoperatively were identified: patient age (predictor estimate = 1.29; p < 0.01), patient age groups (predictor estimate = 14.07; p < 0.01), time to mobilization (predictor estimate = 5.51; p < 0.01). The following predictors of HHS 3 months postoperatively were identified: incision length (predictor estimate = -2.12; p < 0.01); intraoperative blood loss (predictor estimate = 0.02; p < 0.01). Patient age, time to mobilization, incision length, and intraoperative blood loss were identified as predictors of the effect size of early postoperative functional outcome as measured by HHS. Elderly patients, particularly those over 70 years of age, appear to benefit from SuperPATH HA. Based on these findings, and taking into account our limitations, we recommend that the use of minimally invasive SuperPATH HA in elderly patients should be more widely considered and not limited to elective THA patients.
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Maximilian Voss
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Robert Hable
- Faculty of Applied Computer ScienceDeggendorf Institute of TechnologyDeggendorfGermany
| | - Robert Prill
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Hassan Tarek Hakam
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Mikhail Salzmann
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics, Faculty of MedicineMedical University of PlevenPlevenBulgaria
| | - Roland Becker
- Center of Orthopedics and TraumatologyUniversity Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
- Faculty of Health Science BrandenburgBrandenburg Medical School Theodor FontaneBrandenburg an der HavelGermany
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