Total Hip Arthroplasty: Direct Anterior Approach Versus Posterior Approach in the First Year of Practice

BackgroundThe direct anterior approach (DAA) for total hip arthroplasty (THA) has been popularized as a less invasive technique, however outcomes within the first year of practice after fellowship have not been investigated. The primary aim was to determine differences in complications and outcomes between DAA and posterior approach (PA) in the first year of practice. The secondary aim was to determine if there was a learning curve factor in DAA and PA after fellowship training.MethodsTHA cases performed by two surgeons during their first year of practice were reviewed. Overall, 181 THAs (91 DAA, 90 PA) in 168 patients, were performed. Intraoperative differences (blood loss, operative time), hospital stay, complications, reoperations, and revisions were compared.ResultsOverall surgical complications were similar between DAA and PA (11% vs. 9%, p=0.64), but complication profiles were different: dislocation (1% vs. 4%, p=0.17), intraoperative femoral fracture (2% vs. 1%, p=0.32), postoperative periprosthetic fractures (2% vs. 3%, p=0.64). neuropraxia (3% vs. 0%, p=0.08). There was no difference in rate of reoperation (1% vs. 3%, p=0.31). There was a difference in rate of revision at final follow-up (0% vs. 6%, p=0.02). DAA consisted of longer operative time (111 vs. 99 minutes; p<0.001), however was only significant in the first 50 cases (p<0.001), while the subsequent cases were similar (p=0.31). There was no difference in the first 50 cases compared to the subsequent cases for either approach regarding blood loss, complications, reoperations, or revisions.ConclusionDAA and PA for THA performed within the first year of practice exhibit similarly low complication rates, but complication profiles are different. In our series, PA did demonstrate a higher risk of revision at final follow-up. A learning curve is not unique to the DAA. Both DAA and PA THA exhibited a learning curve in the first 50 cases performed at the start of a surgeon’s practice. Level of Evidence: III     

Does the Patient-Reported Outcomes Measurement Information System Correlate to Legacy Scores in Measuring Mental Health in Young Total Hip Arthroplasty Patients?

BackgroundMental health is becoming increasingly important in patient outcomes. The patient reported outcome measurement information system (PROMIS) was developed by the NIH to collect outcome data in rapid dynamic fashion on electronic platforms. The potential role of PROMIS in monitoring young total hip arthroplasty (THA) patients is under-investigated. The purpose of this study is to investigate correlations between PROMIS Depression or Anxiety with SF-12 mental component score.MethodsWe identified 223 hips (200 patients) who underwent primary THA over a 30-month period at a single institution. Patients without preoperative PROMIS or SF-12 mental scores, or >50yo were excluded. All data was collected preoperatively and included age, sex, BMI, ASA, PROMIS Depression, PROMIS Anxiety, and SF-12 Mental component score. We considered floor and ceiling effects as significant if >15% of patients responded with the lowest or highest possible score, respectively. Relationships between SF-12 and PROMIS were investigated using correlation (R), and were considered strong if R>0.7.ResultsMean age was 41-years-old, mean ASA category was 2, mean BMI was 30kg/m2, and 54% were female. None of the PROMs showed any floor/ceiling effects at baseline. PROMIS Depression showed a strong correlation to SF-12 Mental (R=-0.72) while PROMIS Anxiety showed a moderate correlation to SF-12 Mental (R=-0.58). Negative linear relationships were observed because a lower PROMIS Depression/Anxiety values indicates less depressive/anxious feelings (inverse of SF-12).ConclusionPROMIS Anxiety and Depression correlate well with SF-12 mental. These PROMIS domains may be attractive alternatives to legacy mental health instruments in young THA patients. Level of Evidence: III     

Medicaid Payer Status Is Associated With Increased 90-Day Resource Utilization,Reoperation, and Infection Following Aseptic Revision Total Hip Arthroplasty

BackgroundPrior literature has demonstrated increased resource utilization and perioperative complications in patients with a Medicaid payor status undergoing primary total hip and knee arthroplasty. This relationship has yet to be explored in patients undergoing revision total hip arthroplasty (rTHA).MethodsThe National Readmissions Database was queried from 2010 to 2015 for all patients undergoing aseptic rTHA. 90-day complication data were collected, and patients were separated into two cohorts based on insurance payor type: Medicaid and non-Medicaid. Patients were propensity score matched 2:1 on a number of comorbid and operative characteristics. The relationship between Medicaid payor status and postoperative outcomes was then assessed using binomial logistic regression analysis.Results3,110 Medicaid patients were identified and matched to 6,175 non-Medicaid patients. Medicaid patients had increased odds of an early prosthetic joint infection (Odds Ratio [OR] 1.29, p=0.019), superficial surgical site infection (OR: 1.48, p=0.003), and early reoperation (OR: 1.18, p=0.045). Medicaid patients also experienced higher odds of readmissions, extended length of stay, non-home discharge status, and medical complications. Finally, the Medicaid cohort had a $3,332 (95% CI: 2,412-4,253, p<0.001) increased adjusted total cost of care when compared to the non-Medicaid cohort.ConclusionThis study identifies the Medicaid payor status as an independent risk factor for increased resource utilization, reoperation, and infection in the early postoperative period for patients undergoing rTHA. This relationship is likely due to an interplay of multiple variables, including socioeconomic status and access to care. Level of Evidence: IV     

Operative Time and Risk of Surgical Site Infection and Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis

BackgroundThe purpose of this study was to perform a systematic review and meta-analysis on the association between operative time and peri-prosthetic joint infection (PJI) after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).MethodsPubMed, Embase, and Cochrane CENTRAL databases were searched for relevant articles dating 2000-2020. Relationship of operative time and PJI rate in primary total joint arthroplasty (TJA) was evaluated by pooled odds ratios (OR) and 95% confidence intervals.ResultsSix studies were identified for meta-analysis. TJA lasting greater than 120 minutes had greater odds of PJI (OR, 1.63 [1.00-2.66], p=0.048). Similarly, there were greater odds of PJI for TJA procedures lasting greater than 90 minutes (OR, 1.65 [1.27-2.14]; p<0.001). Separate analyses of TKA (OR, 2.01 [0.76-5.30]) and THA (OR, 1.06 [0.80-1.39]) demonstrated no difference in rates of PJI in cases of operative time ≥ 120 minutes versus cases < 120 minutes (p>0.05 for all). Using any surgical site infection (SSI) as an endpoint, both TJA (OR, 1.47 [1.181.83], p<0.001) and TKA (OR, 1.50 [1.08-2.08]; p=0.016) procedures lasting more versus less than 120 minutes demonstrated significantly higher odds of SSI.ConclusionFollowing TJA, rates of SSI and PJI are significantly greater in procedures ≥120 minutes in duration relative to those < 120 minutes. When analyzing TKA separately, higher rates of SSI were observed in procedures ≥ 120 minutes in duration relative to those <120 minutes. Rates of PJI in TKA or THA procedures alone were not significantly impacted by operative time. Level of Evidence: V     

早期下床活动联合髋部周围肌肉抗阻训练对老年全髋关节置换术后患者髋关节功能和生活质量的影响

摘要 目的：观察早期下床活动联合髋部周围肌肉抗阻训练对老年全髋关节置换术（THA）后患者髋关节功能和生活质量的影响。方法：选取我院2018年2月~2020年8月期间收治的老年THA患者83例。使用随机数字表法将患者分为对照组和联合组,例数分别为41例和42例,分别接受早期下床活动、早期下床活动联合髋部周围肌肉抗阻训练干预,对比两组睡眠质量、疼痛情况、生活自理能力、术后多个时点的髋关节功能评分、生活质量,并观察两组并发症发生情况。结果：两组干预后匹兹堡睡眠质量指数（PSQI）、视觉模拟评分法（VAS）评分较干预前下降,Barthel指数（BI）评分较干预前升高,且联合组的变化程度大于对照组（P<0.05）。两组术后1个月、3个月、6个月、12个月Harris人工髋关节功能评分逐渐升高,且联合组高于对照组（P<0.05）。两组干预后心理功能、物质生活状态、社会功能、躯体功能评分较干预前升高,且联合组的变化程度大于对照组（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）。结论：早期下床活动联合髋部周围肌肉抗阻训练可促进老年THA后患者髋关节功能恢复,减轻患者术后疼痛,改善睡眠质量,进而提高患者的生活质量,预防相关并发症的发生,改善预后。     

Deformity Correction in Ankle Osteoarthritis Using a Lateral Trans-Fibular Total Ankle Replacement: A Weight-Bearing CT Assessment

BackgroundAnkle osteoarthritis (AO) is often secondary to prior trauma and frequently presents with joint deformity. Total ankle replacement (TAR) has been shown as a viable surgical option to reduce pain, improve function, and preserve ankle joint range of motion. The standard TAR uses an anterior approach, but recently a lateral trans-fibular approach has been developed. Our aim was to determine if the lateral TAR was able to correct alignment and improve patient reported outcomes (PROs) in patients with end-stage AO.MethodsThis IRB-approved, retrospective comparative study included 14 consecutive patients that underwent lateral trans-fibular approach TAR for end-stage AO. All patients had received pre-and post-operative WBCT imaging on the affected foot and ankle. Using multiplanar reconstruction of WBCT images, measures of coronal and sagittal plane ankle alignment: Foot and Ankle Offset (FAO), Talar Tilt Angle (TTA), Hindfoot Moment Arm (HMA), and Lateral Talar Station (LTS) were performed. PROs were collected pre- and postoperatively at the latest clinical follow-up.ResultsAll patients demonstrated a significant deformity correction in all measurements performed: FAO (7.73%-3.63%, p=0.031), HMA (10.93mm – 5.10mm, p=0.037), TTA (7.9o-1.5o, p=0.003), and LTS (5.25mm-2.83mm, p=0.018). Four of the PROs measured exhibited significant improvement postoperatively, the Tampa Scale for Kinesiophobia (TSK) (42.7-34.5, p=0.012), PRO-MIS Global Physical Health (46.1-54.5, p=0.011), EFAS (5-10.3, p=0.004), and FAAM Daily Living (60.5-79.7, p=0.04). Multivariate analysis assessing the influence of deformity correction in the improvements of PROs found that PROMIS Global Physical Health was significantly associated with improvements in FAO and LTS, TSK associated with HMA, and FAAM Daily Living with FAO and TTA (p<0.05).ConclusionThe results of this retrospective comparative cohort study suggest that the lateral trans-fibular TAR can correct different aspects of AO deformity. The method also impacted PROs, particularly TSK, PROMIS Global Physical Health, EFAS, and FAAM Daily Living. Direct correlation between some of the deformity correction measurements and the significantly improved PROs was found. The obtained data could help surgeons when making treatment decisions and be the base for comparative prospective studies. Level of Evidence: III     

不同入路人工全髋关节置换术对髋关节疾病患者康复进程、髋关节功能和生活质量的影响

目的:探讨不同入路人工全髋关节置换术(THA)对髋关节疾病患者康复进程、髋关节功能和生活质量的影响。方法:回顾性分析2016年4月～2018年11月期间到我院行THA治疗的髋关节疾病105例患者的临床资料。根据入路方式的不同将其分为A组(n=54,后外侧入路)和B组(n=51,SuperPATH入路),术后行1年的随访,比较两组患者康复进程、髋关节功能和生活质量,记录两组术后并发症发生情况。结果:B组术中失血量、术后引流量少于A组,切口长度、术后第一次下地时间短于A组(均P0.05);B组手术时间长于A组(P0.05)。两组术后1个月、3个月、6个月、12个月髋关节屈曲活动度、髋关节功能Harris评分、髋关节外展活动度均较术前呈先升高后趋于平稳趋势(P0.05);B组术后1个月髋关节屈曲活动度及外展活动度、髋关节功能Harris评分高于A组(P0.05);B组术后3个月、6个月、12个月髋关节屈曲活动度及外展活动度、髋关节功能Harris评分与A组比较无差异(P0.05)。两组末次随访时SF-36各维度评分均较术前升高,且B组高于A组(P0.05)。两组术后并发症发生率比较无差异(P0.05)。结论:与后外侧入路方式相比,髋关节疾病患者THA中采用SuperPATH入路,可促进患者早日康复,有利于患者早期髋关节功能的恢复,对生活质量的改善更为显著,且不增加并发症发生率。     

Similar Outcomes Achieved Between Anterior and Posterior Approach Total Hip Arthroplasty Using Dual Mobility Implants

BackgroundDual mobility (DM) bearings for total hip arthroplasty (THA) have been proposed to reduce the risk of instability in high-risk patients; however, their utility in primary THA remains relatively unexplored. No previous reports have described whether surgical approach influences outcomes associated with DM implant systems. This study aims to compare patient reported outcomes and post-operative groin pain between patients undergoing anterior approach versus posterior approach following primary THA with DM implants.MethodsWe retrospectively reviewed all patients who underwent primary THA and received a DM implant between 2011-2021. Patients were stratified into two cohorts based on surgical approach (anterior vs. posterior approach). Primary outcomes included the presence of substantial postoperative groin pain as well as readmission and revision rates. Demographic differences were assessed using chi-square and independent sample t-tests. Outcomes were compared using multilinear and logistic regressions.ResultsOf the 495 patients identified, 55 (11%) underwent THA via the anterior approach and 440 (89%) via the posterior approach. Surgical time (100.24 vs. 109.42 minutes, p=0.070), length of stay (2.19vs.2.67 days,p=0.072), discharge disposition (p=0.151), and significant postoperative groin pain (1.8%vs.0.7%,p=0.966) did not statistically differ between the cohorts. 90-day readmission (9.1%vs.7.7%,p=0.823) and revision rate (0.0%vs.3.0%,p=0.993) did not significantly differ as well. Specifically, readmission (p=0.993) and revision (p=0.998) for instability did not significantly differ between the cohorts. We found no statistical difference in HOOS, JR (p=0.425), VR-12 PCS (p=0.718), and VR-12 MCS (p=0.257) delta score improvement from preoperative to 1-year follow-up between the two groups.ConclusionComparable outcomes following implantation of DM constructs may be achievable irrespective of the surgical approach employed. The incidence of iliopsoas injections for groin pain did not significantly differ between anterior and posterior approaches. Future investigation is needed to determine whether surgical approach influences long-term outcomes in patients receiving DM implants. Level of Evidence: III     

Differences in Infection Rates by Surgical Approach in Total Hip Arthroplasty and Patient Sex: A Systematic Review

BackgroundThere exists conflicting data that patient sex may influence complication and revision rates when undergoing total hip arthroplasty (THA), specifically when comparing different surgical approaches. Differences in body fat or muscular distribution are proposed mechanisms, but these are poorly understood and not well described in current literature.MethodsA systematic review of the literature was conducted from PubMed, Embase, and Web of Science from inception of the database through September 15, 2020. Studies were included if they included patients undergoing primary elective unilateral THA, delineated infections by surgical approach, and delineated infections by patient sex. Basic science, cadaveric, and animal studies were excluded as were case reports. Two authors screened abstracts and then extracted data from the full text article.ResultsThree studies, including 1,694 patients undergoing 1,811 THA were included. 80 infections were included. No study reported a statistically significant difference in infection risk by patient sex or surgical approach, though there was substantial heterogeneity in study design, approach, and analysis.ConclusionLimited data suggests no relationship between sexes across surgical approaches for infection rates. However, poor reporting and small sample sizes preclude definitive conclusions from being drawn. Future studies should emphasize reporting differences in outcomes by patient sex to better elucidate differences, if any, in adverse outcomes between sexes following THA across surgical approaches. Level of Evidence: IV     

直接前方入路与直接外侧入路人工全髋关节置换术的临床效果比较研究

目的:探讨平卧位直接前方入路(DAA)与侧卧位直接外侧入路(DLA)对行初次全髋关节置换术(THA)患者髋关节功能、平衡功能和步态参数的影响。方法:选取2018年2月～2019年10月期间我院收治的初次THA患者97例,根据入路方式的不同随机分为A组(n=47)和B组(n=50),A组行侧卧位DLA,B组行平卧位DAA,比较两组髋关节功能、影像学参数、平衡功能和步态参数,记录两组术后并发症发生率。结果:术后1周、1个月、3个月及6个月两组髋关节Harris评分(HHS)、Berg平衡量表评分(BBS)依次升高,且B组高于A组(P0.05)。B组手术时间长于A组,术中出血量少于A组,切口长度、初次下床行走时间短于A组(P0.05)。术后3个月、6个月两组步频、步速、步长依次升高,且B组高于A组(P0.05)。两组并发症发生率对比,组间比较未见统计学差异(P0.05)。两组术后6个月髋臼假体外展角、前倾角对比,组间比较无显著差异(P0.05)。结论:与侧卧位DLA相比,初次THA患者行平卧位DAA可获得与其相当的手术效果,同时能更好地改善患者髋关节功能、平衡功能和步态,且安全性有保障。     

Low psoas major muscle area as a risk factor for contralateral hip fracture following intertrochanteric fracture

Objective:This study aimed to investigate the relationship between the psoas major muscle area as a risk factor and subsequent contralateral hip fractures in patients with initial intertrochanteric fractures.Methods:Of 136 treated for intertrochanteric fractures, 104 female patients had computed tomography done to assess their fractures at initial stage and had been followed up for more than 2 years. These patients were then divided into 2 groups: i.e. those who had a contralateral hip fracture (CF) (n=16) and those who did not (NF) (n=88) groups. We mainly assessed the relationship between the corrected psoas major muscle area (CPMA) at initial fracture and the occurrence of contralateral hip fracture.Results:The CF group had significantly lower CPMA than the NF group (p=0.001). There was positive correlation between the CPMA and the period from the initial to the contralateral hip fracture in the CF group. The CPMA cutoff value of 480.98 mm²/m², was showed sensitivity of 63.6% and specificity of 87.5% in receiver operating characteristic curve analysis for all patients.Conclusions:The lower CPMA was associated with the contralateral hip fracture within 2 years from initial intertrochanteric fracture. The low CPMA would be a risk factor for contralateral hip fracture.     

Open Versus Arthroscopic Surgical Management for Recalcitrant Trochanteric Bursitis: A Systematic Review

BackgroundWhile excision of the trochanteric bursae to treat lateral hip pain has increased in popularity, no comparison exists between the surgical outcomes and complications of the open and arthroscopic techniques involving trochanteric bursectomy. The purpose of this study was to determine the efficacies and complication rates of arthroscopic and open techniques for procedures involving trochanteric bursectomy.MethodsThe terms “trochanteric,” “bursectomy,” “arthroscopic,” “open,” “outcomes,” and “hip” were searched in five electronic databases. Fifteen studies from 120 initial results were included. Patient-reported outcomes (PRO), pain, satisfaction, and complications were included for analysis.ResultsFive hundred-two hips in 474 total patients (77.7% female) were included in this study. The average age was 54. The fourteen distinct PRO scores that were reported by the included studies improved significantly from baseline to final mean follow-up (12-70.8 months for open; 12-42 months for arthroscopic) for both approaches, demonstrating statistically significant patient benefit in a variety of hip arthroscopy settings (P > 0.05). The complication rates of all procedures ranged from 0%-33% and failure to improve pain ranged from 0%-8%. Patient satisfaction with surgery was high at 95% and 82% reported a willingness to undergo the same surgery again. No significant mean differences were found between the open and arthroscopic techniques.ConclusionThe open and arthroscopic approaches for trochanteric bursectomy are both safe and effective procedures in treating refractory lateral hip pain. No significant differences in PROs, pain, total complications, severity of complications, and total failures were seen between technique outcomes.Level of Evidence: IV     

PROMIS Versus Legacy Patient-Reported Outcome Measures for Sports Medicine Patients Undergoing Arthroscopic Knee,Shoulder, and Hip Interventions: A Systematic Review

BackgroundThe Patient-Reported Outcomes Measurement Information System (PROMIS®)^ǂ was designed to monitor the global wellbeing of patients, with the Physical Function Computer-Adaptive Test (PF-CAT) component focused specifically on functional outcome. PROMIS aims for increased item-bank accuracy, lower administrative burden, and decreased floor and ceiling effects compared to legacy patient-reported outcome measures (PROMs). Our primary research outcomes focused on sports medicine surgical populations, which may skew younger or have wide-ranging functional statuses. Specifically, for this population, we questioned if PROMIS PF-CAT was equal to legacy PROMs in (1) construct validity and (2) convergent/divergent validities; and superior to legacy PROMs with respect to (3) survey burden and (4) floor and ceiling effects.MethodsSearches were performed in April 2019 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing PubMed, Cochrane Central, and Embase databases for Level I-III evidence. This resulted in 541 records, yielding 12 studies for inclusion. PROM data was available for patients undergoing arthroscopic orthopaedic procedures of the knee, shoulder, and hip. Measures of construct validity, convergent/divergent validity, survey burden, and floor/ceiling effects were evaluated for PROMIS PF-CAT versus legacy PROMs.ResultsPROMIS PF-CAT demonstrated excellent or excellent-good correlation with legacy PROMS for physical function and quality of life for patients undergoing arthroscopic interventions of the knee, shoulder, and hip. Compared to legacy PROM instruments, PROMIS PF-CAT demonstrated the lowest overall survey burden and had the lowest overall number of floor or ceiling effects across participants.ConclusionPROMIS PF-CAT is an accurate, efficient evaluation tool for sports medicine surgical patients. PROMIS PF-CAT strongly correlates with legacy physical function PROMs while having a lower test burden and less incidence of floor and ceiling effects. PROMIS PF-CAT may be an optimal alternative for traditional physical function PROMs in sports medicine patients undergoing arthroscopic procedures. Further studies are required to extend the generalizability of these findings to patients during postoperative timepoints after shoulder and hip interventionsLevel of Evidence: III     

Short-Term Outcomes of Hip Fractures in Patients Aged 90 Years Old and Over Receiving Surgical Intervention

BackgroundThe knowledge about short-term outcomes of nonagenarians undergoing surgery for hip fracture in Asian is limited.MethodsThe patients with hip fractures who underwent hip hemiarthroplasty and open reduction with internal fixation (ORIF) for management during the period from 2008 to 2012 were identified and their medical record was retrospectively reviewed.ResultsDuring the study period, a total of 101 patients underwent surgery for management of hip fractures, and the age of patients ranged from 90 to 96 years. The sites of hip fracture were intertrochanteric (n = 57, 56.4%) and the neck of the femur (n = 44, 43.6%). Most of the patients had American Society of Anesthesiologists scores of 3(n = 55) or 4 (in 44 patients). 80.2% (n = 81) underwent the operation within one day after admission; however, there were 13 patients (12.9%) that underwent surgery 48 or more hours later. ORIF and hemiarthroplasty were performed for 63 (62.4%) and 38 (37.6%) patients, respectively. Overall, the 30-day and 1-year mortality rates were 9.9% (10/101) and 17.3% (13/75), respectively. Multivariate analysis showed that the 30-day mortality was significantly associated only with end-stage renal disease (ESRD) (Odds ratio, 11.13, 95% confidence interval, 1.275–97.881, P = .029).ConclusionsThe short-term outcome of surgical management for Asian nonagenarians with hip fractures is favorable in selected patients.     

Serum kinetics of soluble triggering receptor expressed on myeloid cells-1 differs in relation to the type of arthroplasty

Context: Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) participates in the inflammatory process.

Purpose: To describe changes of sTREM-1 in the serum after hemiarthroplasty (HA) and total hip arthroplasty (THA).

Methods: Serial blood samples were drawn from 122 patients with hip fracture. Interleukin-6 (IL-6), sTREM-1, and C-reactive protein (CRP) were measured.

Results: IL-6 and CRP were similarly increased after both HA and THA. sTREM-1 was increased early in HA and late after THA. The only parameter that was higher among patients who developed systemic inflammatory response syndrome was IL-6.

Conclusions: Kinetics of sTREM-1 differs among patients undergoing HA of the hip and those undergoing THA.     

全髋关节置换术与双极人工股骨头置换术治疗老年股骨颈骨折的临床疗效

目的：探讨全髋关节置换术（THA）与双极人工股骨头置换术（BHA）治疗老年股骨颈骨折的临床疗效。方法：选择2013 年7 月-2015 年3 月我院收治的老年股骨颈骨折患者90 例,根据手术方法不同将患者分为全髋关节置换组（THA 组）和双极人工股 骨头置换组（BHA 组）,每组45 例。观察并比较两组患者的手术时间、术中出血量、住院时间、术后并发症的发生率及手术效果。结 果：两组患者的手术时间、术中出血量及住院时间比较,差异无统计学意义（P>0.05）;THA 组并发症的发生率明显低于BHA 组, 差异具有统计学意义（P<0.05）;术后1 年,两组手术优良率比较,差异无统计学意义（P>0.05）;术后两年及三年,THA 组手术优良 率明显高于BHA 组,差异具有统计学意义（P<0.05）。结论：THA和BHA 治疗老年股骨颈骨折均具有良好的临床疗效,但THA具 有更好的远期疗效,而且术后并发症的发生率较低。     

骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后关节疼痛的影响

目的:探讨骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后患者关节疼痛的影响。方法:回顾性分析2012年2月-2013年8月我院收治的股骨颈骨折患者的临床病历资料,按照假体类型将其分为骨水泥型髋关节置换术(A组)和生物型髋关节置换术(B组),通过Harris与分项百分制髋关节疼痛评分比较两组患者术后髋关节的疼痛情况。结果:两组患者的手术时间、术中出血量以及术后引流量比较,差异无统计学意义(P0.05),A组的住院时间短于B组,差异有统计学意义(P0.05)。A组术后3、6个月的髋关节疼痛率均低于B组,术后12、24个月则高于B组,差异有统计学意义(P0.05);经x2趋势分析,A组患者术后髋关节疼痛率随时间增加呈逐渐上升趋势,差异有统计学意义(x2=10.837,P=0.001),B组患者术后髋关节疼痛率随时间增加呈逐渐下降趋势,差异有统计学意义(x2=9.842,P=0.002)。A组患者术后3、6个月的髋关节疼痛评分高于B组,术后12、24个月则低于B组,差异有统计学意义(P0.05);A组术后3、6个月的髋关节疼痛评分高于术后12、24个月,B组3、6个月的髋关节疼痛评分低于术后12、24个月,差异有统计学意义(P0.05)。结论:骨水泥型假体缓解髋关节疼痛近期效果优于生物型假体,而生物型假体远期效果优于骨水泥型假体。     

Factores pronósticos de mortalidad al año de una fractura de cadera por fragilidad ósea. Estudio Maluc Anoia

IntroductionMost of the patients who had a hip fragility fracture are characterized by advanced age, frailty, multimorbidity and high mortality rate into the first year. Our aim is to describe the prognostic factors of mortality one year after a hip fragility fracture.Material and methodsObservational prospective study. During the study period we included patients older than 69 years with hip fragility fracture who were admitted to the Acute Geriatric Unit.ResultsWe have followed 364 patients, 100 of them died (27.5%). The independent prognostic factors of mortality one year after a hip fragility fracture had been: have a less basis score in Lawton and Brody Scale 0.603 (0.505-0.721) (p< 0.001); have a higher score in Charlson Comorbidity Index 2.332 (1.308-4.157) p = 0.04); have a surgical waiting time ≥ 3 days 3.013 (1.330-6.829) p = 0.008); finding hydroelectrolytic disorders and/or deterioration of glomerular filtration 1.212 (1.017-1.444) p = 0.031) during hospital stay; discriminatory capacity of the area under the curve (AUC) (± 95%): 0.888 (0.880-0.891).ConclusionsPrognostic predictors of mortality at one year after a hip fragility fracture are those variables that reflect a worse state of health, complications during hospital stay and a longer surgical waiting time.     

Effect of obesity on inpatient rehabilitation outcomes after total hip arthroplasty

Objective: This study examined whether obesity affected inpatient rehabilitation outcomes after total hip arthroplasty (THA). Research Methods and Procedures: This was a retrospective, comparative study conducted using a computerized medical database derived from THA patients at a university‐affiliated rehabilitation hospital (data from 2002 to 2005). Patients were divided into four brackets based on BMI: non‐obese (<25 kg/m²), overweight (25 to 29.9 kg/m²), moderate obesity (30 to 39.9 kg/m²), and severe obesity (≥40 kg/m²). All patients completed an interdisciplinary inpatient rehabilitation program after THA. Functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores (FIM/LOS), hospital charges, and discharge disposition location were collected. Results: FIM scores improved from admission to discharge similarly in all groups (25 to 29.5 points). However, FIM efficiency, LOS, and total charges were curvilinearly related with BMI (all p < 0.05). Total hospital charges were highest in the severely obese group compared with the overweight group (p < 0.05). Non‐homebound discharge disposition rates were lower in non‐obese (13.1%) and severely obese groups (10.5%). Discussion: Elevated BMI does not prevent FIM gains in THA patients during inpatient rehabilitation. However, BMI is related with FIM efficiency, LOS, and hospital charges in a curvilinear fashion. Severely obese patients can achieve physical improvements but at a lower efficiency and greater cost.