Hip international : the journal of clinical and experimental research on hip pathology and therapy
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The role of uncemented fully hydroxyapatite coated hemiarthroplasties for the treatment of displaced femoral neck fractures remains unclear. We investigated if complications, reoperations and mortality differed from that of cemented hemiarthroplasties. The study groups consisted of 78 cemented and 97 uncemented, hydroxyapatite coated hemiarthroplasties with minimum 1 year follow-up. ⋯ Mortality rates did not differ statistically significant between groups. Outcomes were comparable. Introduction of an uncemented hydroxyapatite coated hemiarthroplasty for treatment of displaced femoral neck fractures can be recommended.
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Case Reports
Late instability of bilateral metal on metal hip resurfacings due to progressive local tissue effects.
Reports have emerged of local debris consisting of metal particles, with the development of pseudotumours, pelvic masses, lymphocytic perivascular infiltration of tissue around the implant and a neo-capsule tissue reaction in metal on metal (MoM) hip arthroplasty. Steeply-inclined acetabular components a large abduction angle of more than 55 degrees along with a combination of small size component are likely to give rise to higher levels of metal ions. This report describes a case of localised tissue destruction of abductor muscle probably due to the metal debris causing late onset subluxation/dislocation of a hip resurfacing. Late instability of hip resurfacing should raise concerns relating to possible local tissue reaction and muscle damage, and early revision may be recommended.
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The efficacy of the reverse Less Invasive Plating System in the management of unstable proximal femoral extracapsular fractures was retrospectively evaluated. Twenty-seven patients with complex proximal femoral fractures were identified. There were three open fractures. ⋯ The average Harris hip score at the last assessment was 73 points (range 58-85). The outcome was adversely affected by concomitant medical problems, anatomical reduction and fixation of the plate. The use of this plate in the management of proximal femoral fractures of all types may be a safe and alternative method to other treatment options.
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Septic arthritis of the hip is the commonest septic condition during growth, reaching a distinct peak in frequency during infancy. The aetiology is a haematogenous joint infection. Indicative signs are severe pain when moving the joint, septic appearance and a poor general condition of these small and young patients. ⋯ An ultrasound scan shows the hip joint effusion and the capsular distension. X-ray investigation helps to exclude defective situations. Therapeutic options are: in patients with short history without radiologically visible complications we recommend repeated arthroscopic irrigation and in patients with long history and a radiologically visible defect of the femoral head or dislocation we recommend arthrotomy and open revision or reduction of the hip joint.
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Vascular complications following internal fixation of trochanteric femoral fractures are extremely rare. Iatrogenic injury to the profunda femoris artery or one of its branches and resultant pseudoaneurysm formation has been documented, most commonly following sliding hip screw fixation and typically arises on the posteromedial aspect of the femur. We report an unusual variation, following proximal femoral nailing of an intertrochanteric femoral neck fracture, where the pseudoaneurysm presented four weeks following surgery on the posterolateral aspect of the femur. The mechanism of injury, clinical presentation and potential preventative measures are discussed.