What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study.
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SUBMITTER: Li L
PROVIDER: S-EPMC5085945 | biostudies-literature | 2016 Dec
REPOSITORIES: biostudies-literature
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What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study.
Li Lianhua L Ren Jixin J Liu Jia J Wang Hao H Sang Qinghua Q Liu Zhi Z Sun Tiansheng T
Clinical orthopaedics and related research 20160830 12
<h4>Background</h4>Hip dislocation after treatment of a femoral neck fracture with a hemiarthroplasty remains an important problem in the treatment of hip fractures, but the associations between patient factors and surgical factors, and how these factors contribute to dislocation in patients who have undergone bipolar hemiarthroplasty through an anterolateral approach for femoral neck fracture currently are only poorly characterized.<h4>Questions/purposes</h4>We evaluated patients with bipolar h ...[more]
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Project description:BACKGROUND:The relationship between preoperative hip measurements and dislocation after bipolar hemiarthroplasty is presently unclear. In the current study, we investigated the morphological risk factors associated with dislocation after bipolar hemiarthroplasty of the hip in patients with femoral neck fractures. METHODS:Between January 2011 and June 2017, a nested case-control design study was used to analyze the risk factors for dislocation in 348 patients who had undergone bipolar hemiarthroplasty because of femoral neck fractures. Twelve patients underwent at least one dislocation postoperatively. Sixty patients without dislocation were selected as controls matched in terms of time of surgery, age, and sex, at a ratio of 1:5. Patient acetabular measurements were compared between the dislocation group and the control group, including the center-edge angle, abduction angle, acetabular width and depth, depth-to-width ratio, femoral neck offset, leg length discrepancy, and femoral head coverage ratio. A multivariate logistic regression model was used to evaluate the morphological risk factors of dislocation. RESULTS:Postoperatively, the incidence of dislocation was 3.4%. A smaller center-edge angle was found to be a risk factor associated with dislocation after bipolar hemiarthroplasty of the hip. Patients with small acetabular depth and a small acetabular depth-width ratio were prone to dislocation. Patients with a center-edge angle of ??45.4° or an acetabular depth of ??19.12?mm were more likely to suffer dislocation. CONCLUSIONS:Careful preoperative measurements before bipolar hemiarthroplasty of the hip are important. Surgical intervention for femoral neck fracture patients with a shallow acetabulum should be carefully planned and total hip arthroplasty should be considered when necessary.
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Project description:BackgroundHip hemiarthroplasty (HA) is a standard surgical procedure for elderly patients with displaced fracture of the femoral neck, where dislocation is a possible complication. This study is a systematic review on the risk factors of implant dislocation in patients with femoral neck fracture following hip hemiarthroplasty (HA), and evaluates the methodological quality of the included studies.MethodsStudies on risk factor assessment of dislocation following hip HA were sourced from EMBASE, Ovid, PubMed and ScienceDirect databases. The quality of included studies was evaluated using an improved quality evaluation method combined with a best-evidence synthesis method.ResultsA total of 130,127 patients were involved in 17 observational studies included in this systematic review, with a dislocation rate that ranged between 0.76 and 12.2% (overall incidence was 4-5% by meta-analysis). According to the applied quality evaluation criteria, eight studies were considered to be of high quality, six to be of medium quality, and three to be of low quality. The posterolateral surgical approach was identified as the only risk factor supported by strong evidence, while patients with small acetabular coverage and low postoperative offset were identified as risk factors supported by moderate evidence, and 11 other risk factors were supported by limited evidence.ConclusionThis systematic review provides some evidence in helping surgeons develop optimal prevention strategies for dislocation following hip HA during the perioperative period based on common risk factors identified in the literature. However, conclusive evidence supporting most of these risk factors is lacking and more methodologically rigorous studies are required to increase the confidence of recommendations.
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Project description:Component dissociation after a bipolar hemiarthroplasty is an uncommon complication that usually necessitates reoperation due to difficulties in closed reduction. To our knowledge, only a few cases have been published in the recent literature. We present a case of disassembly location of in a 68-year-old woman who underwent bipolar hemiarthroplasty 10 years ago due to a left hip femoral neck fracture. She began complaining about pain and difficulty to bear weight after an unintentional internal rotation movement of her left hip. The initial radiographs showed the disassembly of the bipolar hip prosthesis, and the patient underwent conversion to total hip arthroplasty. We conducted a literature review to explain the potential causes and mechanisms.
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Project description:BackgroundFew data are available regarding post-operative atrial fibrillation (POAF) in non-cardiothoracic surgery, particularly orthopedic surgery. Hence, given the frequent incidence of POAF after surgery and its marked impact, we need to identify modifiable factors associated with POAF after hip fracture surgery in older patients.MethodsWe conducted a nested case-control study in the unit for perioperative geriatric care of an academic hospital in Paris from July 1, 2009 to December 31, 2019, enrolling all consecutive patients aged ≥ 70 years with hip fracture surgery and no history of permanent AF before admission (retrospective analysis of prospectively collected data). Patients with and without POAF were matched 1:5 on 5 baseline characteristics (age, hypertension, diabetes, coronary artery disease, cardiac failure).ResultsOf the 757 patients included, 384 were matched, and 64 had POAF. The incidence of POAF was 8.5%. The mean age was 86 ± 6 years, 298 (78%) patients were female, and the median Charlson Comorbidity Index was 6 (interquartile range 4-8). The median time from surgery to the occurrence of POAF was 2 days (1-4). On multivariable conditional logistic regression analysis (matched cohort), the modifiable factors present at admission associated with POAF were time to surgery > 48 h (odds ratio [OR] = 1.66, 95% confidence interval [1.01-2.81]) and > 2 units of packed red blood cells (OR = 3.94, [1.50-10.03]).ConclusionsThis study provides new information about POAF in older patients with hip fracture surgery, a surgical emergency whose complexity requires multidisciplinary care.
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Project description:BackgroundSarcoidosis incidence peaks in females around the fifth decade of life, which coincides with menopause, suggesting hormonal factors play a role in disease development. We investigated whether longer exposure to reproductive and hormonal factors is associated with reduced sarcoidosis risk.MethodsWe conducted a matched case-control study nested within the Mammography Screening Project. Incident sarcoidosis cases were identified via medical records and matched to controls on birth and questionnaire date (1:4). Information on hormonal factors was obtained through questionnaires prior to sarcoidosis diagnosis. Multilevel modelling was used to estimate adjusted odds ratios with 95% credible intervals (OR; 95% CI).ResultsIn total, 32 sarcoidosis cases and 124 controls were included. Higher sarcoidosis odds were associated with older age at menarche (OR 1.19: 95% CI 0.92-1.55), natural menopause versus non-natural (OR 1.53: 95% CI 0.80-2.93), later age at first pregnancy (OR 1.11: 95% CI 0.76-1.63) and ever hormone replacement therapy (HRT) use (OR 1.40: 95% CI 0.76-2.59). Lower odds were associated with older age at menopause (OR 0.90: 95% CI 0.52-1.55), longer duration of oral contraceptive use (OR 0.70: 95% CI 0.45-1.07), longer duration of HRT use (OR 0.61: 95% CI 0.22-1.70), ever local estrogen therapy (LET) use (OR 0.83: 95% CI 0.34-2.04) and longer duration of LET use (OR 0.78: 95% CI 0.21-2.81). However, the CIs could not rule out null associations.ConclusionGiven the inconsistency and modest magnitude in our estimates, and that the 95% credible intervals included one, it still remains unclear whether longer estrogen exposure is associated with reduced sarcoidosis risk.
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Project description: Not available
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Project description:To evaluate the association between the long-term use of bisphosphonates and the risk of hip fracture compared to never use among women aged 65 years or older.Case-control study nested in a cohort.General practice research database operated by the Spanish Medicines Agency.Cases of hip fracture were defined as women aged 65 years or older with a validated first diagnosis of hip fracture between 2005 and 2008. Five controls free of hip fracture were matched on age and calendar-year with each case.Information on bisphosphonate use, hip fractures, comedication and comorbidities was collected.Hip fracture risk comparing bisphosphonate users versus never users.Hip fracture risk comparing bisphosphonate users versus never users by individual drugs.The study included 2009 incident hip fractures and 10 045 matched controls. Hip-fracture risk did not differ between bisphosphonate users and never users, adjusted OR=1.09 (95% CI 0.94 to 1.27). No association was observed between hip fracture risk and cumulative duration of bisphosphonate treatment. However, when treatment duration is analysed as time since first prescription, hip fracture risks of the different subgroups compared to never users obtained were as follows: <1 year, OR 0.85 (95% CI 0.60 to 1.21); 1 to <3 years, OR 1.02 (95% CI 0.82 to 1.26); ?3 years, OR 1.32 (95% CI 1.05 to 1.65) (p for trend=0.03).Ever use of oral bisphosphonates was not associated with a decreased risk of hip fracture in women aged 65 or older as compared to never use. No association was observed between hip fracture risk and cumulative duration of bisphosphonate treatment. However, when treatment duration is analysed as time since first prescription, a statistically significant increased risk for hip fracture was observed in patients exposed to bisphosphonates over 3 years.Spanish Ministry of Health. TRA-071.
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Project description:Poor functional outcomes after hemiarthroplasty for proximal humerus fractures are common, yet revision surgery is relatively rare. Arthroscopic treatment for postoperative stiffness can be considered in the setting of functional limits to glenohumeral range of motion impacting activities of daily living after adequate conservative treatment with physical therapy and in the setting of healed, well-positioned tuberosities and humeral components. This Technical Note illustrates a stepwise approach to an arthroscopic lysis of adhesions and capsular release for the treatment of arthrofibrosis of the shoulder. The advantages of this technique include an alternative approach to entering the glenohumeral joint under direct subacromial visualization and a 2-posterior portal approach to the inferior and anteroinferior capsule, which can be challenging to achieve in the setting of severe postsurgical arthrofibrosis.
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