Related article in Hip & Pelvis

  • Original ArticleSeptember 1, 2013

    0 141 48

    The Total Hip Replacement Arthroplasty for Femur Neck Fractures in the Elderly

    Jae Hwan Cho, MD, Chang Hyun Ryu, MD, Kye Young Han, MD, PhD

    Hip Pelvis 2013; 25(3): 197-202
    Abstract
    Purpose: To analyze the clinical and radiological outcomes of total hip replacement arthroplasty (THRA) for the treatment of femur neck fractures in the elderly.
    Materials and Methods: Femur neck fracture patients older than70 years of age, who showed good preoperative walking ability without dementia,and underwent THRA between February, 2008 and March, 2010 were reviewed retrospectively. Twelve patients(13 hips) were enrolled and the mean ages of the patients were 79.4(70-91). The mean follow-up period was 31(20-49) months. The modified Koval index was used to determine the clinical outcome. Inclination and anteversion of acetabular cup, loosening, osteolysis, periprosthetic fractures and dislocations were evaluated using the radiographs.
    Results: The modified Koval index decreased from 4.92 to 4.84 at the final follow-up, but the decrease was not significant (P=0.339). Dislocations occurred in 2 cases postoperatively(2/13, 15.4%). No other complications were encountered.
    Conclusion: The THRA for the treatment of femur neck fractures in elderly patients over 70 years of age showed satisfactory clinical and radiological outcomes. Nevertheless, caution should be taken regarding the relatively high incidence of postoperative dislocations.
  • Original ArticleMarch 31, 2016

    14 221 57

    Result of Internal Fixation for Stable Femoral Neck Fractures in Elderly Patients

    Byung-Woo Min, MD, Kyung-Jae Lee, MD, Ki-Cheor Bae, MD, Si-Wuk Lee, MD, Seok-Jung Lee, MD, Jung-Hoon Choi, MD

    Hip Pelvis 2016; 28(1): 43-48
    Abstract
    Purpose: This study was conducted to evaluate the results of internal fixation for stable femoral neck fractures occurring in patients over 65 years old.
    Materials and Methods: Between 2008 and 2014, we evaluated 25 patients over 65 years old with Garden type 1 and 2 femoral neck fractures that were treated with internal fixation after a minimum follow up of 1 year. There were 5 males and 20 females and the average age was 72.3 years (range, 65-84 years) at the time of surgery. Fracture site union, horizontal shortening and complications were evaluated as radiographic parameters and change of walking ability (as measured using Koval walking ability score) was investigated as a clinical parameter.
    Results: Union of fracture site was achieved in 24 out of the 25 cases (96.0%). The average length of horizontal shortening was 6.5 mm (range, 0.2-19.7 mm). At final follow up, 3 cases experienced complications: nonunion (n=1), avascular necrosis (n=1), and subtrochanteric fracture after minor trauma (n=1). Walking ability decreased an average of 1 step at the final follow up.
    Conclusion: Internal fixation for stable femoral neck fractures occurring in patients over 65 years showed satisfactory union rates. However, care should be taken with this technique given the possibility of decreased walking ability resulting from horizontal shortening.
  • Case ReportSeptember 30, 2016

    4 368 63

    Bilateral Femoral Neck Stress Fracture in Child: A Case Report

    Gun-Woo Lee, MD, Kyung-Soon Park, MD, PhD, Taek-Rim Yoon, MD, PhD, Eshnazarov Kamolhuja Eshnazarovich, MD*

    Hip Pelvis 2016; 28(3): 169-172
    A femoral neck stress fracture in child is rare, particularly in bilateral case. It is easy to miss initially or may be misdiagnosed. The authors experienced a case of bilateral femoral neck stress fracture in a 10-year-old boy with bilateral hip. The patient was successfully healed by conservative treatment. We report this rare case with a review of the literature. A femoral neck stress fracture should be included in the differential diagnosis in children who present with sustained hip or groin pain.
  • Case ReportMarch 31, 2017

    8 235 48

    Bilateral Femoral Neck Stress Fracture Presented with Unilateral Symptoms in a Shipman Laborer: A Case Report

    Asep Santoso, MD*, Sang-Don Joo, MD, Dong-Hyun Lee, MD, Young-Jun Seol, MD, Kyung-Soon Park, MD, PhD, Taek-Rim Yoon, MD, PhD

    Hip Pelvis 2017; 29(1): 77-80
    Femoral neck stress fracture occured commonly in athlete and military recruit populations, some of them are bilateral. Bilateral femoral neck stress fracture that associated with other occupation is very uncommon. We report a bilateral femoral neck stress fracture case that presented with unilateral symptoms in a male shipman laborer. The patient was successfully treated conservatively. Stress fracture sometimes occur associated with an unexpected specific occupation. Consideration of bilateral involvement is highly important in managing stress fracture.
  • Original ArticleDecember 1, 2008

    1 136 45

    Comparison of the Results of Internal Fixation of Femoral Neck Fracture According to the Fixation Methods

    Sung Kwan Hwang, M.D. Ph.D., Ho Young Ryu, M.D.

    J Korean Hip Soc 2008; 20(4): 265-272
    Abstract
    Purpose: We wanted to compare the stability, the complications and the patients’functional recovery after undergoing internal fixation with dynamic hip screws or cannulated hip screws for treating fracture of the femoral neck.
    Materials and Methods: Out of one hundred twenty six patients who had fracture of the femoral neck, seventy six patients were treated with cannulated screws and fifty patients were treated with dynamic hip screws from October 2000 to January 2007. The clinical information included the age and gender distribution, the operation time, the total blood loss, the interval from injury to operation, the etiology of the fractures and the functional outcome. The preoperative X-ray information included the fracture type by the Garden stage, the Singh index and the posterior cortex comminution. The postoperative information included the quality of reduction and the pin and screw position. The Garden alignment index, evidence of union, the FIM™ score, the complications and the failure rate.
    Results: No statistical difference was noted between the two fixation methods regarding the gender, the initial fracture displacement, the postoperative reduction or the position of the fixation device, the functional outcome using FIMTM score and the complication. Yet the cannulated screw fixation group showed a significantly shorter operation time and less total blood loss (P<0.05).
    Conclusion: To decrease the operation time and blood loss, cannulated screw fixation is considered to be the more useful fixation method for treating fracture of the femoral neck.
  • Original ArticleSeptember 30, 2023

    1 507 140

    Treatment of Femoral Neck Fractures in the Elderly: A Survey of the Korean Hip Society Surgeons

    Hong Seok Kim, MD, PhD , Je-Hyun Yoo, MD, PhD* , Young-Kyun Lee, MD, PhD , Jong-Seok Park, MD, PhD , Ye-Yeon Won, MD, PhD§

    Hip Pelvis 2023; 35(3): 157-163
    Abstract
    Purpose: This study examined the methods for treatment of femoral neck fracture (FNF) preferred by members of the Korean Hip Society (KHS) and identified factors that influence decisions regarding the surgical intervention of choice.
    Materials and Methods: A total of 97 members of the KHS responded to the 16-question survey which included questions about the mean number of surgeries performed each month for treatment of femoral neck fractures, the cut-off age for deciding between internal fixation and arthroplasty, the implant used most often, usage of cement, and factors influencing each decision.
    Results: The mean cut-off age used when deciding between internal fixation and arthroplasty was 64 years old. Hemiarthroplasty (HA) (70%) was the most preferred option for treatment of displaced FNFs in cases where arthroplasty was indicated (total hip arthroplasty [THA] 19% and dual mobility THA 11%). The main reasons for selection of arthroplasty over reduction with internal fixation were age and pre-fracture ambulatory status. Pre-trauma ambulatory status and/or sports activity were the main factors in selection of HA over THA. Cement was used by 33% of responders. Poor bone quality and a broad femoral canal were factors that influenced the usage of cement.
    Conclusion: Management of FNFs in the elderly is a major health problem worldwide; thus, remaining alert to current trends in treatment is essential for surgeons. The mean cut-off age used in deciding between internal fixation and arthroplasty was 64 years old. HA is the preferred method for treatment of displaced FNFs for members of the KHS.
  • Original ArticleSeptember 1, 2024

    0 822 306

    Direct Anterior Approach in Total Hip Arthroplasty: A Single Center Experience

    Rajesh Malhotra, MS , Sahil Batra, MS , Vikrant Manhas, MS, DNB , Jaiben George, MS , Anitta Biju, GNM , Deepak Gautam, MS*

    Hip Pelvis 2024; 36(3): 196-203
    Abstract
    Purpose: The direct anterior approach (DAA) for conducting total hip arthroplasty (THA) is gaining popularity worldwide. However, careful selection of patients and surgeon experience are important. Although promising outcomes have been reported in international studies, research on DAA in Southern and Southeast Asia has been limited.
    Materials and Methods: This prospective study included 157 patients who underwent THA using the DAA between January 2019 and June 2022. The patients were divided into three groups for the comparison. Data on preoperative, intraoperative, and postoperative variables were acquired. Improvement of the surgeon’s performance to use of a DAA approach was examined using the CUSUM (cumulative summation method).
    Results: The mean age of the patients was 43.9 years. Differences in intraoperative variables and complications were observed among the three groups, and improved outcomes were reported in later cases. Functional outcomes showed significant improvement, and no differences were observed between groups. The results of learning curve analysis indicated a shift towards consistent success after the 82nd case, reaching an acceptable rate of failure by the 118th case.
    Conclusion: The findings of this study suggest that DAA can offer benefits but there is a learning curve. Complications were initially high but began decreasing after approximately 80 cases. Careful selection of patients is critical, particularly in the effort to minimize being presented with a challenging case. This study provides insights that may be helpful to surgeons when considering DAA; however, further study is warranted.
  • Original ArticleSeptember 1, 2024

    0 612 256

    Complications and Healthcare Cost of Total Hip Arthroplasty in Patients with Depressive Disorder

    Antoinette R. Portnoy, BS*,† , Shirley Chen, BS, MS , Ameer Tabbaa, MD , Matthew L. Magruder, MD , Kevin Kang, MD , Afshin E. Razi, MD

    Hip Pelvis 2024; 36(3): 204-210
    Abstract
    Purpose: The purpose of this study was to determine whether the rates of (1) in-hospital lengths of stay (LOS), (2) readmissions, (3) medical complications, and (4) costs of care are higher for patients with depressive disorder (DD) undergoing primary total hip arthroplasty (THA) for treatment of femoral neck fractures (FNFs).
    Materials and Methods: A retrospective query of a national administrative claims database for patients undergoing primary THA from 2006 to 2014 was conducted. Patients with DD undergoing THA for treatment of FNF were 1:5 ratio propensity score matched to a cohort (DD=6,758, controls=33,708). Primary endpoints included LOS, 90-day medical complications, 90-day readmissions, and healthcare reimbursements. A P-value less than 0.05 was considered statistically significant.
    Results: Longer LOS were observed for patients with DD compared to those without DD (5.6 days vs. 5.4 days, P<0.001). Similar readmission rates (29.9% vs. 25.0%, odds ratio [OR] 1.03, P=0.281) were observed between groups. The odds of 90-day medical complications were higher for patients with DD compared to control subjects (60.6% vs. 21.4%, OR 1.57, P<0.0001). Within the 90-day episode of care interval, patients with a history of DD incurred significantly higher healthcare expenditures ($21,382 vs. $19,781, P<0.001).
    Conclusion: Our findings showed longer LOS, higher odds of 90-day medical complications, and higher healthcare expenditures within the 90-day episode of care following a primary THA for treatment of FNF for patients with DD compared to the matched cohort. Thus, accordingly, patients with DD should receive counseling prior to undergoing surgery.
H&P
Vol.36 No.4 Dec 01, 2024, pp. 231~325
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