Elbow Uncemented Hemiarthroplasty: Surgical Technique
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SUBMITTER: Beckwitt C
PROVIDER: S-EPMC10837189 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
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| S-EPMC2628514 | biostudies-literature
Project description:Although hemiarthroplasties are an important treatment for femoral neck fractures, the literature does not provide a clear approach for selecting the implant fixation method. Therefore, we performed a systematic search of the medical literature and identified 11 prospective and retrospective studies that compared results between cemented and uncemented femoral implant fixation methods. After independent blind data extraction, we compared variables between cemented and uncemented cohorts using two different meta-analysis models. Pooled data represented 1632 cemented and 981 uncemented hemiarthroplasties (average age of patients, 78.9 and 77.5 years, respectively). The average operating room times and blood loss volumes were 95 minutes and 467 mL, respectively, for the cemented and 80 minutes and 338 mL for the uncemented cohorts. Postoperative mortality rates, overall complications, and pain were similar between the two cohorts. Despite a few potential trends, we found few statistical differences between cemented and uncemented techniques based on reported outcome measurements. In addition, inspection of this literature underscored the lack of and need for consistent and standardized reporting of outcome variables regarding these procedures.
| S-EPMC2584290 | biostudies-literature
Project description: Not available
| S-EPMC11329019 | biostudies-literature
Project description:ObjectiveControversy still exists regarding using cemented or uncemented hemiarthroplasty for femoral neck fractures in elderly patients. The aim of this study is to compare the effectiveness and safety of the two surgical techniques in femoral neck fracture patients over 70 years old.MethodsWe searched PUBMED, EMBASE, Cochrane Library, CNKI and VIP Database from inception to December 2012 for relevant randomized controlled trials (RCTs). Outcomes of interest include postoperative hip function, residue pain, complication rates, mortality, reoperation rate, operation time and intraoperative blood loss. Odds ratios (OR) and weighted mean differences (WMD) from each trial were pooled using random-effects model or fixed-effects model given on the heterogeneity of the included studies.Results7 RCTs involving 1,125 patients (1,125 hips) were eligible for meta-analysis. Our results demonstrate that cemented hemiarthroplasty is associated with better postoperative hip function (OR = 0.48, 95% CI, 0.31-0.76; P = 0.002), lower residual pain (OR = 0.43, 95%CI, 0.29-0.64; P<0.0001), less implant-related complications (OR = 0.15, 95%CI, 0.09-0.26; P<0.00001) and longer operation time (WMD = 7.43 min, 95% CI, 5.37-9.49 min; P<0.00001). No significant difference was observed between the two groups in mortality, cardiovascular and cerebrovascular complications, local complications, general complications, reoperation rate and intraoperative blood loss.ConclusionsCompared with uncemented hemiarthroplasty, the existing evidence indicates that cemented hemiarthroplasty can achieve better hip function, lower residual pain and less implant-related complications with no increased risk of mortality, cardiovascular and cerebrovascular complications, general complications, local complications and reoperation rate in treating elderly patients with femoral neck fractures.
| S-EPMC3720851 | biostudies-literature
Project description:ImportanceConsensus guidelines and systematic reviews have suggested that cemented fixation is more effective than uncemented fixation in hemiarthroplasty for displaced femoral neck fractures. Given that these recommendations are based on research performed outside the United States, it is uncertain whether these findings also reflect the US experience.ObjectiveTo compare the outcomes associated with cemented vs uncemented hemiarthroplasty in a large US integrated health care system.Design, setting, and participantsRetrospective cohort study of 12 491 patients aged 60 years and older who underwent hemiarthroplasty treatment of a hip fracture between 2009 and 2017 at 1 of the 36 hospitals owned by Kaiser Permanente, a large US health maintenance organization. Patients were followed up until membership termination, death, or the study end date of December 31, 2017.ExposuresHemiarthroplasty (prosthetic replacement of the femoral head) fixation via bony growth into a porous-coated implant (uncemented) or with cement.Main outcomes and measuresThe primary outcome measure was aseptic revision, defined as any reoperation performed after the index procedure involving exchange of the existing implant for reasons other than infection. Secondary outcomes were mortality (in-hospital, postdischarge, and overall), 90-day medical complications, 90-day emergency department visits, and 90-day unplanned readmissions.ResultsAmong 12 491 patients in the study cohort who underwent hemiarthroplasty for hip fracture (median age, 83 years; 8660 women [69.3%]), 6042 (48.4%) had undergone uncemented fixation and 6449 (51.6%) had undergone cemented fixation, and the median length of follow-up was 3.8 years. In the multivariable regression analysis controlling for confounders, uncemented fixation was associated with a significantly higher risk of aseptic revision (cumulative incidence at 1 year after operation, 3.0% vs 1.3%; absolute difference, 1.7% [95% CI, 1.1%-2.2%]; hazard ratio [HR], 1.77 [95% CI, 1.43-2.19]; P < .001). Of the 6 prespecified secondary end points, none showed a statistically significant difference between groups, including in-hospital mortality (1.7% for uncemented fixation vs 2.0% for cemented fixation; HR, 0.94 [95% CI, 0.73-1.21]; P = .61) and overall mortality (cumulative incidence at 1 year after operation: 20.0% for uncemented fixation vs 22.8% for cemented fixation; HR, 0.95 [95% CI, 0.90-1.01]; P = .08).Conclusions and relevanceAmong patients with hip fracture treated with hemiarthroplasty in a large US integrated health care system, uncemented fixation, compared with cemented fixation, was associated with a statistically significantly higher risk of aseptic revision. These findings suggest that US surgeons should consider cemented fixation in the hemiarthroplasty treatment of displaced femoral neck fractures in the absence of contraindications.
| S-EPMC7078801 | biostudies-literature
Project description:IntroductionA small proportion of simple elbow dislocations are grossly unstable and joint congruence is not maintained after reduction. In this rare situation operative treatment is indicated. We describe a new intra articular reconstruction that utilises a slip of triceps tendon to provide immediate stability to the elbow.MethodsWe assessed 20 cadaveric elbows, measuring the length of triceps tendon available and required to complete the reconstruction. We then sequentially sectioned the ligamentous stabilisers of an elbow before performing the new technique. We measured the displacement and angulation possible at the elbow before and after the reconstruction.ResultsAll 20 elbows had sufficient triceps tendon length to complete the new technique. Prior to the reconstruction greater than 30 mm of joint distraction and 90 degrees varus or valgus angulation was possible. Following the reconstruction it was not possible to re-dislocate the elbow. Only 2 mm of joint distraction and 10 degrees of varus or valgus angulation were possible with the triceps graft fixed in position.DiscussionThis novel technique elegantly avoids many of the problems associated with current methods. We have demonstrated that it is technically feasible and easy to perform with minimal equipment requirements or costs.
| S-EPMC4849263 | biostudies-literature
Project description:This feasibility trial aims to assess the practicality of, and obtain preliminary data to inform, a definitive randomised controlled trial (RCT) of total elbow arthroplasty (TEA) versus distal humeral hemiarthroplasty (HA) in patients over the age of 65 years with unreconstructible distal humeral fractures (DHF). 17 patients met the inclusion criteria during the 18-month recruitment period from December 2020 until June 2022, and 15 (88%) consented to be randomised (recruitment rate: 0.7/month). Two patients withdrew from the study prior to surgery leaving 13 patients for analysis (retention rate: 87%). Seven patients were randomised to TEA and six patients to HA. 100% of patients were available for 12-month follow-up. A 10-point difference in favour of HA in DASH (44.5 vs. 54.2) and OES (31.6 vs. 21.3) was seen during 6-week follow-up, while no difference in patient-reported outcome measures was seen at 3- or 12-month follow-up. This study demonstrates feasibility of undertaking an RCT of TEA versus HA in patients over the age of 65 with unreconstructible DHF. Preliminary data corroborate with the ongoing clinical equipoise and support the requirement for a larger adequately powered RCT. This trial is registered in the US Clinical Trials Registry (https://clinicaltrials.gov/study/NCT04646798?cond=distal%20humeral%20fracture&rank=6) Clinical Trial ID: NCT04646798.
| S-EPMC11562461 | biostudies-literature
Project description:IntroductionHip fracture is a serious injury in adults, especially those aged over 60 years. The most common type of hip fracture (displaced intracapsular) is treated for the majority of patients with a partial hip replacement (hemiarthroplasty). The hemiarthroplasty implant can be fixed to the bone with or without bone cement. Cement is the current recommended technique but recently some risks have been identified, which could potentially be avoided by using uncemented implants. Controversy, therefore, remains about which type of hemiarthroplasty offers patients the best outcomes.This is the protocol for a multicentre randomised controlled trial comparing cemented hemiarthroplasty versus uncemented hemiarthroplasty for patients 60 years and over with a displaced intracapsular hip fracture.Methods and analysisMulticentre (a minimum of seven UK hospitals), multisurgeon, parallel group, two-arm, superiority, randomised controlled trial. Patients aged 60 years and older with a displaced intracapsular hip fracture treated with hemiarthroplasty surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either a cemented hemiarthroplasty or a modern hydroxyapatite coated uncemented hemiarthroplasty. Otherwise all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: health-related quality of life (EuroQol 5 dimensions 5 levels) at 4 months postinjury. The treatment effect will be estimated using a two-sided t-test adjusted for age, gender and cognitive impairment based on an intention-to-treat analysis. Secondary outcomes include mortality, complications including revision surgery and cause, mobility status, residential status, health-related quality of life at 1 and 12 months and health resource use. A within-trial economic analysis will be conducted.Ethics, dissemination and fundingWales Research Ethics Committee 5 approved the feasibility phase on 2 December 2016 (16/WA/0351) and the definitive trial on 22 November 2017 (17/WA/0383). This study is sponsored by the University of Oxford and funded by the National Institute for Health Research, Research for Patient Benefit (PB-PG-0215-36043 and PB-PG-1216-20021). A manuscript for a peer-reviewed journal will be prepared and the results shared with patients via local mechanisms at participating centres.Trial registration numberISRCTN18393176.
| S-EPMC6924810 | biostudies-literature
Project description:Medial epicondylitis, also known as "golfer's elbow," is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Patients with medial epicondylitis typically present in the fourth to sixth decade of life and have an insidious onset of medial elbow pain. Occasionally, medial epicondylitis may result from an acute traumatic event, such as an acute avulsion of the common flexor tendon. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. T2-weighted magnetic resonance imaging can show increased signal intensity in the common flexor tendon or a complete rupture. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after conservative treatment. This technique article with accompanying video describes open debridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biological healing.
| S-EPMC6926370 | biostudies-literature
Project description:OBJECTIVES:To describe the surgical treatment and patient outcomes of chronic elbow dislocations. DESIGN:Retrospective review. SETTING:Two tertiary referral centers. PATIENTS/PARTICIPANTS:All patients with surgically treated chronic elbow dislocation with no associated articular fracture from January 2009 to January 2015. INTERVENTION:Review of patient demographics, injury chronicity, surgical technique, and patient outcomes. MAIN OUTCOME MEASUREMENT:Clinical outcomes included elbow range of motion and complications. Radiographic outcomes included the presence of heterotopic ossification. Patient-reported outcomes included the Mayo Elbow Performance Index (MEPI) and the Summary Outcome Determination (SOD). RESULTS:Thirty-two patients with mean follow-up of 22 months (range, 13-41 months) were included. The mean dislocation duration was 6 months (range, 1-34 months). The mean preoperative range of motion was 8 degrees (range, 0-30 degrees). There were no infections or recurrent dislocations. One patient developed transient ulnar nerve palsy postoperatively. There were no cases of new or progressive heterotopic ossification. The mean postoperative extension was 31 degrees (range, 0-75 degrees), and the mean postoperative flexion was 132 degrees (range, 95-150 degrees); the mean final arc of motion was 101 degrees (range, 50-140 degrees). The mean postoperative MEPI was 93 (range, 70-100), and the mean SOD score was 9 (range, 6-10). Using the MEPI, 97% (31/32 patients) had good or excellent outcome. There was no difference in flexion/extension arc or MEPI scores between groups of elbows older and younger than 17 years or dislocations less or more than 3 months. CONCLUSION:This is the largest case series of surgically treated patients with chronic elbow dislocation. Using our surgical technique, 97% of patients had good or excellent outcome with a low complication rate. Open reduction of chronic elbow dislocation can be accomplished while permitting early motion with minimal recurrent dislocation risk. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC5844584 | biostudies-literature