A Unique Complication of Femoral Broach Fracture and Incarceration During Total Hip Arthroplasty.
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ABSTRACT:
SUBMITTER: Brzezinski A
PROVIDER: S-EPMC8387731 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:There are an increasing number of vascular complications after hip replacement, some of which can be life-threatening. However, there are few reports of lower limb ischemic symptoms after undergoing an otherwise uncomplicated classic total hip replacement. We report a patient with low weight who developed postoperative limb ischemia resulting from blood clots caused by insertion of a Hohmann retractor close to small anterior acetabular osteophytes. Ultrasonography and angiography revealed her symptoms to be the result of femoral artery intimal injury with lower extremity arterial thrombosis, which led to pain, numbness, and decreased skin temperature. The patient underwent timely percutaneous intervention with a femoral artery stent, which relieved her symptoms. The discussion reviews femoral artery injury during total hip arthroplasty.
| S-EPMC6287226 | biostudies-literature
Project description:Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056-1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731-0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067-1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.
| S-EPMC10558430 | biostudies-literature
Project description:A 39-year-old male presented with multiple gunshot wounds and resultant left comminuted femoral head and neck fractures with retained intraarticular bullet fragments. Successful staged reconstruction was performed with initial placement of an antibiotic spacer and subsequent conversion to total hip arthroplasty. Staged reconstruction with an antibiotic spacer and conversion to total hip arthroplasty is a viable treatment approach for a gunshot wound resulting in intraarticular bullet fragments and comminuted femoral head and neck fractures not amenable to open reduction and internal fixation to reduce the risk of periprosthetic joint infection.
| S-EPMC8857266 | biostudies-literature
Project description:The prolonged use of bisphosphonates has been associated with an increased rate of atypical femoral fracture. A 77-year-old woman with prolonged bisphosphonate use presented to our office with groin pain and end-stage arthritis, She was scheduled for a total hip replacement. Before the surgery and with minimal trauma, the patient then suffered a displaced atypical femoral fracture. She underwent a total hip replacement as a treatment for her fracture and her arthritis. Subsequently, the patient presented with pain in the contralateral thigh with an incomplete atypical femoral fracture. That side was also treated with a total hip arthroplasty. An uncemented stem with open reduction internal fixation and a long cemented stem were used on the complete fracture and incomplete fracture sides, respectively. At a follow-up of 2 years, the patient had no pain and had excellent function demonstrating the short-term success of both cemented and uncemented stems in total hip arthroplasty after atypical femoral fractures.
| S-EPMC5247513 | biostudies-literature
Project description:BackgroundA fall after total hip arthroplasty (THA) that results in a periprosthetic femoral fracture (PPF) can have devastating functional and psychological consequences in older adults. There are few studies that have evaluated both functional and psychological outcomes of PPF post-THA in the same cohort.MethodsThis is a retrospective study of 130 people who underwent revision THA between 2005 and 2019 due to PPF. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC), Harris Hip Score (HHS), and Short Form-12 (SF-12) assessed physical function, hip joint function, and psychological well-being, respectively. Descriptive statistics using means and standard deviation or frequencies and percentages were used to define the sample. The association between baseline demographic, clinical, and surgical factors on WOMAC, HHS, and SF-12 scores at 1-year post-PPF surgery was modelled using multivariable linear regression. The mean age (n = 130) was 80.6 ± 9.0 years, and 55.4% (n = 72) were female. The mortality rate was 15.4% (n = 20) at 1-year post-PPF surgery. One-year follow-up data were available for 35.4% (n = 46) of patients.ResultsThe WOMAC (n = 37), HHS (n = 32), and SF-12 mental component summary (n = 46) scores at 1-year post-PPF surgery were 67.9 ± 20.3, 78.3 ± 15.0, and 52.7 ± 9.1, respectively. No significant association was found among age, gender, previous history of lower extremity surgery, Vancouver classification, and femoral bone grafting on WOMAC, HHS, and SF-12 scores.ConclusionsOur study found that patients with PPF have fair hip joint function, poor physical function and psychological well-being, and a high mortality rate at 1-year post-PPF surgery.
| S-EPMC9574344 | biostudies-literature
Project description:ObjectivesFor patients with femoral neck fractures, total hip arthroplasty (THA) demonstrates superior outcomes compared with hemiarthroplasty. However, hemiarthroplasty remains a common treatment for femoral neck fractures and the conversion rates are unknown. We compared the results of the 2 procedures using a Medicare database.MethodsWe assembled a cohort of 70,242 patients 65 to 90 years of age with an ICD9 diagnosis and matching Current Procedure Terminology code for femoral neck fracture between 2008 and 2012. Patients were followed forward for 2 years minimum. Incidences of dislocation and mortality were measured. Reoperation for revision of THA or conversion of hemiarthroplasty to THA was assessed by Current Procedure Terminology code. Groups were compared through proportional hazard models controlling for age, race, sex, and comorbidity index.ResultsHemiarthroplasty represented 95% of the patients treated using arthroplasty for femoral neck fracture. The proportional hazard of reoperation and dislocation were significantly lower for hemiarthroplasty than THA (P < 0.0001 for both). At 2 years, fewer than 2% of hemiarthroplasty patients underwent conversion to total hip replacement. Patients treated with THA were more likely to be alive for 2 years (adjusted hazard ratio = 1.67, 95% confidence interval: 1.59-1.92).ConclusionPatients treated with hemiarthroplasty after femoral neck fractures had significantly lower proportional hazard of reoperation than those treated with THA. THA may be associated with lower mortality.Level of evidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC5407395 | biostudies-literature
Project description:Proximal femoral fracture in an ankylosed hip is a challenging condition. There is no consensus on fixation method for these fractures. In addition, despite union the best outcome possible is the restoration of the pre morbid status. We report two different presentations of proximal femoral fracture in ankylosed hip that were successfully treated with primary total hip arthroplasty. We also discuss the surgical principles, technique and advantages of doing primary total hip arthroplasty in such cases.
| S-EPMC6985166 | biostudies-literature
Project description: Not available
| S-EPMC10907387 | biostudies-literature
Project description:Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.
| S-EPMC5859736 | biostudies-literature
Project description:ObjectiveTo evaluate the outcomes of total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for high hip dislocation.MethodsIn this retrospective study, the results of 24 primary THAs with acetabular reconstruction and subtrochanteric femoral shortening osteotomy in 21 patients with high hip dislocation were evaluated. The acetabula were reconstructed with cemented or uncemented cups and bone grafting. Transverse subtrochanteric femoral shortening osteotomies were applied and the osteotomy sites treated by bone grafting and cable fixation. Assessment was by Hip Harris scores and radiographic evaluation.ResultsThe mean follow-up time was 42 months (18-108 months), three cases being lost to follow-up 18-27 months postoperatively. The HHS improved from 47.5 ± 8.7 to 88.5 ± 3.1. The mean length of femoral segments removed was 2.5 ± 0.8 cm (range, 1.0-4.5 cm) and mean acetabular inclination 43° ± 5° (range, 31°-54°). Caudalization of the femoral head center was 3.2 ± 3.0 mm (range, -3 to 12 mm) and lateralization 4.0 ± 4.0 mm (range, -9 to 11 mm). Mean greater trochanter height relative to theoretical hip center was 5.2 ± 1.0 cm (range, 3.5-7.1 cm) preoperatively and 0.2 ± 0.6 cm (range, -0.9 to 1.2 cm) postoperatively. Intraoperative trochanteric fractures occurred in three cases and sciatic nerve palsy in one.ConclusionTHA with subtrochanteric femoral shortening osteotomy is an effective technique for treating high hip dislocation. Its advantages include improvement in limb imbalance and decreased risk of sciatic nerve injury.
| S-EPMC6583667 | biostudies-literature