RESUMEN
AIMS: Our aim in this study was to describe a continuing review of 11 total hip arthroplasties using 22.225 mm Alumina ceramic femoral heads on a Charnley flanged femoral component, articulating against a silane crosslinked polyethylene. PATIENTS AND METHODS: Nine patients (11 THAs) were reviewed at a mean of 27.5 years (26 to 28) post-operatively. Outcome was assessed using the d'Aubigne and Postel, and Charnley scores and penetration was recorded on radiographs. In addition, the oxidation of a 29-year-old shelf-aged acetabular component was analysed. RESULTS: The mean clinical outcome scores remained excellent at final follow-up. The mean total penetration remained 0.41 mm (0.40 to 0.41). There was no radiographic evidence of acetabular or femoral loosening or osteolysis. There was negligible oxidation in the shelf-aged sample despite gamma irradiation and storage in air. CONCLUSION: These results highlight the long-term stability and durability of this type of crosslinked, antioxidant containing polyethylene when used in combination with a small diameter alumina ceramic femoral head. Cite this article: Bone Joint J 2017;99-B:1286-9.
Asunto(s)
Acetábulo/diagnóstico por imagen , Óxido de Aluminio , Predicción , Prótesis de Cadera , Polietileno , Complicaciones Posoperatorias/diagnóstico , Radiografía/métodos , Acetábulo/cirugía , Adulto , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , Falla de PrótesisAsunto(s)
Acetábulo/cirugía , Modelos Estructurales , Mallas Quirúrgicas , Equipos Desechables , Humanos , PlásticosRESUMEN
OBJECTIVES: To assess whether allogeneic blood transfusion in the perioperative period is associated with changes in mortality or complication rates in patients undergoing surgical treatment for hip fracture (proximal femoral fracture). DESIGN: Retrospective case-control series, all patients followed up for 1 year or until death. SETTING: District General Hospital in Peterborough, UK. PATIENTS PARTICIPANTS: Three thousand six hundred twenty-five consecutive patients admitted and operated for hip fracture (proximal femoral fracture) during July 1989 to January 2002 (151 months); 1068 (29.9%) received a perioperative allogeneic blood transfusion. MAIN OUTCOME MEASURES: Thirty- 120-, and 365-day mortality, deep and superficial wound infection rates. RESULTS: Overall mortality for all patients at 1 year post fracture was 28.2% (1007 patients). Transfusion was associated with a statistically significant increase in mortality from 120 days onward after hip fracture. However, when this was adjusted with a statistical regression model for baseline characteristics and confounding variables, this difference became statistically insignificant (P = 0.17). Infection rates in the transfusion group were 2.0% for superficial infection and 0.9% for deep infection compared with 1.9% and 0.6%, respectively, in the nontransfusion group. These figures were not statistically significantly different. Other complications of deep venous thrombosis, chest infection, and congestive cardiac failure showed no statistically significant increase in those patients who received transfusion. CONCLUSIONS: Our data suggest that transfusion is not associated with a change in mortality or infection rates in the hip-fracture patient.
Asunto(s)
Fijación de Fractura/efectos adversos , Fracturas de Cadera/microbiología , Fracturas de Cadera/mortalidad , Atención Perioperativa/efectos adversos , Complicaciones Posoperatorias/etiología , Reacción a la Transfusión , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Fracturas de Cadera/cirugía , Humanos , Estimación de Kaplan-Meier , Masculino , Oportunidad Relativa , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/mortalidad , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
The effect of femoral neck-shaft angle and implant type on the accuracy of lag screw placement in extra-capsular proximal femoral fracture fixation was investigated. Radiographs of all extra-capsular proximal femoral fractures seen in one unit over 18 months were reviewed. Of 399 cases, 307 (237 female, 70 male) were included in the study as they had no contra-lateral proximal femoral metal work. Femoral neck-shaft angle (NSA) of the uninjured hip and magnification adjusted tip-apex distance (TAD) of femoral head lag screw were measured. Type of fixation implant was 135 degrees classic hip screw (CHS) (n=144) or 130 degrees intra-medullary hip screw (IMHS) (n=163). Mean contra-lateral NSA was 130.2 degrees (112.9--148 degrees ) and 64 patients (58 female, 6 male) had a NSA <125 degrees . Mean adjusted TAD was 18.7 mm (5.8--43.8mm) and 88.9% of cases had a TAD of less than 25 mm. TAD values were significantly greater using an IMHS if NSA was <125 degrees than if NSA was >125 degrees (p=0.028). This was not the case with the CHS. The use of the 130 degrees -IMHS in patients with a NSA <125 degrees leads to poorer lag screw placement than if NSA >125 degrees and caution is advocated when using this device in such cases.
Asunto(s)
Fracturas del Fémur/cirugía , Cuello Femoral/patología , Fijación de Fractura/métodos , Adulto , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Femenino , Cuello Femoral/cirugía , Fijación Intramedular de Fracturas/métodos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
External fixation facilitates nursing care and early rehabilitation of head-injured children with femoral shaft fractures. We report an unusual complication of early fatigue failure of the external fixator pins without the patient ever bearing weight.