Effect of proximal femoral osteoporosis on cementless hip arthroplasty: A short-term clinical analysis

Objective： The aim of this retrospective investigation was to explore the influence of femoral osteoporosis on short-term curative effects ofcementless hip arthroplasty and to evaluate the femoral metaphyseal bone mineral density （BMD） for femoral osteoporosis in order to guide prosthesis choice and rehabilitation. Methods： We performed 127 total arthroplasty operations between June 1999 to February 2003 and investigated 49 cementless hip replacements with the Metalcancellous cementless Lubeck Ⅱ system being used in all hips. There were twenty men and twenty-nine women whose mean age at the time of the operation was 60 years （range, 52-81 years）. The patients were divided into osteoporosis or normal groups according to the femoral metaphyseal BMD measured preoperatively. The average duration of follow-up was 30 months （range, 8-52 months）. We evaluated all of the patients from a clinical standpoint with use of a standard-terminology questionnaire with respect to the short-term curative effects and patients＇ satisfaction. Hip pain status and functional ability were important indicators of treatment efficacy. Results： Harris hip score and patients＇ satisfaction in femoral osteoporosis patients who underwent noncemented hip arthroplasty were lower （P=0.004, P=0.03） while the incidence of thigh pain was higher （P=0.03） than the patients with non-osteoporosis. Conclusion： The higher incidence of pain, as well as the decrease in function experienced by the patients in osteoporosis group, supports the case that cementless arthroplasty is not a better choice for those patients and that we had better select prosthesis based on the femoral metaphyseal BMD.

CEMENTLESS TOTAL HIP ARTHROPLASTY IN PATIENTS OLDER THAN 70 YEARS

Objective To present 3-15 years follow-up of patients older than 70 years who underwent cementless total hip arthroplasty. Methods One hundred and two consecutive primary total hip arthroplasties utilizing a circumferential proximal porous coated femoral component and smooth surfaced threaded acetabular were performed in 92 patients. The patients were followed up clinically and radiographically every two years from their third year after surgery. Ten patients (10 hips) died and 14 patients (15 hips) were lost to follow up in three years after surgery. Sixty-seven patients (77 hips) were included in this study. Results The pre-operative Harris hip scores and pain scores were 45 and 15 points. They increased to 89 and 42 points by the third year. These scores decreased to 81 and 42 points in the ninth year and 77 and 37 points in the fifteenth year, respectively. More than 75% of the hips demonstrated good or excellent clinical results in the fifth year and 60% of the hips were rated good to excellent in the seventh to eleventh year. In the fifteenth year, only 50% of the hips had good or excellent results. All femoral components showed stable fixation by bone in-growth. Eight acetabular components were revised, with 5 due to mechanical loosening and 3 for recurrent instability. Thigh pain was documented in 4 hips. ConclusionThe smooth-surfaced threaded acetabular component has a high rate of failure. Circumferential proximal porous coated femoral components provided excellent radiographic results and acceptable clinical outcome with definite bone ingrowth. Patients older than 70 may be suitable candidates for cementless total hip arthroplasty.

Cemented bipolar hemiarthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures in senile patients

Objective： To observe the clinical result and assess clinical value of cemented bipolar hemiarthroplasty with a novel cerclage cable technique for treatment of unstable intertrochanteric hip fractures in senile patients. Methods： Forty-eight consecutive patients with unstable intertrochanteric fractures were treated in our hospital from March 2001 to March 2006 （ Evans type Ⅲ in 11 cases, Evans type Ⅳ in 25 cases and Evans type Ⅴ in 22 cases）. All the cases were evaluated by Zuckerman functional recovery score （ FRS ） and operative risk assessment software 1 （ORAS1）, which were based on the patients ＇ physical and laboratory examinations preoperatively. Seventeen cases （19 hips） were treated with cemented bipolar hemiarthroplasty. There were 5 male cases （5 hips） and 12 female cases （14 hips, including 2 patients who suffered from additional slight injuries and resulted in contralateral hip fracture and were treated with the same procedure 3 months after the first operation ）. The average age was 85 years （78-95 years ）. All the operations were carried out under general anesthesia, through Southern incision and lateral approach by the same orthopaedic surgeon. All prostheses consisted of Link SPH femoral stem and bipolar femoral head. All patients were followed up for more than 30 days. Results ： The operative risks of all the 17 cases （ 19 hips） were calculated by ORAS1 preoperatively. The average preoperative FRS was 81.7 （ 80. 7- 82.7 ）. The average predictive value of operative morbidity was 10% （7 %-15 % ）. The average predictive value of mortality was 2.97 % （ 2. 1%-3.2 % ）. The average operation time was 1.5 hours. The average blood transfusion was 400 nd. There were no operative or anesthetic complications and no deaths within 30 days after operation. Sitting up was permitted 3 to 4 days after operation, and partial weight bearing was permitted 5 to 7 days after operation. Patients were allowed to walk with a walker 10 days after operation. The average FRS was 78.7 at 30 days postoperatively. No patient died during at least one year follow-up. Conclusions Although the value of the technique of cemented bipolar hemiarthroplasty in the treatment of unstable intertrochanteric hip fracture is not widely recognized, we have consistently achieved satisfactory results with strict preoperative risk assessment, strict indication selection and systematic postoperative rehabilitation.

Clinical Trial on the Role of Tuina in Rehabilitation Therapy Following Total Hip Replacement

Objective： To observe the clinical effect of tuina in rehabilitation following total hip replacement. Methods： 60 cases were randomly allocated into a treatment group and control group, 30 cases in each group. Cases in the treatment were treated with combined tuina and rehabilitation, while cases in the control group were treated with rehabilitation alone. All treatment retained for two weeks. The results were observed 7 d, 2 weeks and 6 weeks following the total hip replacement using Harris scale and Hamilton Anxiety Rating Scale （HAMA）. Results： For Harris scale, there were significant intra-group differences in different time frames （P〈0.05）; there were no statistical differences between the two groups 1 d, 7 d and 6 weeks following the total hip replacement （P〉0.05）; and there were statistical differences between the two groups 2 weeks following the total hip replacement. For HAMA scale, there were significant intra-group differences in different time frames （P〈0.05）; there were no significant differences between the two groups 1 d following the total hip replacement; and there were substantial differences between the two groups 7 d, 2 weeks and 6 weeks following the total hip replacement. Conclusion： In a given unit time, combined tuina and rehabilitation is superior to rehabilitation alone in improving the patients＇ post-operative pain, articular range of motion and anxiety.

Treatment of comminuted trochanteric fractures and non-union of trochanteric osteotomy in revision total hip arthroplasty

Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.