Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Dec 2004
Comparative StudyTotal hip arthroplasty: optimal treatment for displaced femoral neck fractures in elderly patients.
Although internal fixation is recommended for most nondisplaced fractures of the femoral neck, the optimal treatment for displaced fractures of the femoral neck is controversial. Options for operative treatment of displaced fractures of the femoral neck include: reduction and internal fixation; unipolar hemiarthroplasty; bipolar hemiarthroplasty; and total hip arthroplasty. One hundred eighty-six displaced fractures of the femoral neck in elderly patients were treated surgically with internal fixation (in 120 patients), hemiarthroplasty (in 43 patients), and total hip arthroplasty (in 23 patients). ⋯ There was no difference in rates of reoperation or mortality, but arthroplasty produced a longer interval to reoperation or death. Arthroplasty was associated with more independent living, and arthroplasty was more cost-effective than internal fixation. Total hip arthroplasty was the best treatment for displaced fractures of the femoral neck in elderly patients in this series.
-
Clin. Orthop. Relat. Res. · Dec 2004
The role of total hip replacement in intertrochanteric fractures of the femur.
Total hip replacement is rarely used in the treatment of acute intertrochanteric fractures of the femur. Pathologic fractures with involvement of the femoral head and/or periacetabular pelvis may represent one such indication; rheumatoid arthritis with or without radiographic involvement of the joint space or end-stage osteoarthritis with substantial hip symptoms before fracture may represent other indications. Total hip replacement is mainly reserved for the treatment of complications such as nonunion or avascular necrosis of the femoral head.
-
Clin. Orthop. Relat. Res. · Dec 2004
Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein.
A retrospective evaluation was done of 15 patients (17 hips) with symptomatic osteonecrosis of the hip treated with core decompression combined with an allogeneic, antigen-extracted, autolyzed fibula allograft and 50 mg of partially purified human bone morphogenetic protein and noncollagenous proteins. The average duration of clinical followup of the patients was 53 months (range, 26-94 months). The osteonecrotic involvement of the hip was classified by plain radiographs using a modification of the Ficat staging system and MRI evaluations. ⋯ Only one of seven hips (six patients) with 50% or less involvement of the femoral head and between 1/3 and 2/3 of the weightbearing surface of the femoral head developed radiographic progression of the femoral head. There was no radiographic progression in the 3 hips with less than 1/3 involvement of the weightbearing surface of the femoral head. Further evaluation of the potential efficacy of bone morphogenetic protein is required in randomized trials.
-
Clin. Orthop. Relat. Res. · Dec 2004
Comment Letter Comparative StudyEvaluation and treatment of spinal injuries in the patient with polytrauma.