Short-Term Clinical Assessment of Hip Hemi-Arthroplasty in 11 Dogs

Objective The aim of this study was to assess the short-term clinical outcome in dogs following a hip hemi-arthroplasty for the treatment of primary pathological disorders of the hip and as a salvage procedure following failure of the cup component of a total hip replacement. Materials and Methods Medical records of dogs that had a unilateral hip hemi-arthroplasty performed between 2015 and 2020 were reviewed. Data collected included follow-up orthopaedic examinations performed at 0, 2, 8 and 52 weeks postoperatively, pelvic radiography at 0, 8 and 52 weeks postoperatively and an owner questionnaire (Helsinki chronic pain index [HCPI]). Results Eleven unilateral hip hemi-arthroplasty procedures were identified. The median age at time of surgery was 3.6 years (8 months–10 years) and the median follow-up time was 13 months (range: 2 months–3 years). The HCPI for all dogs at follow-up was median 8 ± 7.30 (range: 5–25). Total HCPI was < 12 for 7/10 dogs and ≥ 12 for 3 dogs. Pelvic radiographs at 1 year confirmed osteointergration of the femoral stem implant and no evidence of implant subsidence or progression of osteoarthritis. However, there was some evidence of mild lucency of the acetabular bed around the prosthetic femoral head and mild peri-acetabular sclerosis in four cases. Conclusion Hip hemi-arthroplasty provides a clinically acceptable treatment for disabling disease of the coxofemoral joint with 10/11 patients achieving acceptable short-term clinical function. Long-term assessment of the hip hemi-arthroplasty and comparison with total hip replacement is indicated.

Intra-cardiac cement embolism during hip arthroplasty

A 92-year-old woman presented to the operating room with a right femoral neck fracture. She had a past medical history significant for atrial fibrillation, coronary artery disease with a history of coronary bypass, severely stenotic aortic valve (area 0.9 cm2), diabetes, dyslipidemia, hypertension and dementia. She underwent general anesthesia with continuous Transesophageal Echocardiographic (TEE) monitoring for a right hemi-arthroplasty. While cementing the prosthesis, small cement emboli were initially seen (ME ascending aorta SAX view) migrating in the pulmonary artery (Figure A*). Subsequently, a large (4 cm) cement embolus was visualized in the right atrium, adhered to the Eustachian valve, an embryonic remnant (Figure B*, supplementary video A). The patient experienced no significant hemodynamic compromise or issue with gas exchange. Given embolization risk and severe potential for harm, intervention may be indicated. Treatment options were discussed but given hemodynamic stability, patient age and comorbidities, the patient was monitored without further intervention.

Functional results of shoulders Neer’s prosthesis for four part fracture dislocation of shoulder

<p class="abstract"><strong>Background:</strong> Objective was to study the clinical and functional outcome of shoulder hemi-arthroplasty using Neer’s prosthesis in four part fracture dislocation of shoulder.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on patients who underwent shoulder hemi-arthroplasty using Neer’s prosthesis for four part fracture dislocation of shoulder in Department of Orthopaedics, GMCH Aurangabad from January 2020 to January 2021. The patients were assessed clinically and functionally using Shoulder range of motion, Visual Analog Scale (VAS), American Society of shoulder and elbow (ASES) score and Constant-Murley score and radiological assessment at 3, 6 and 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> At one year follow up of 30 patients, no loosening or dislocation of prosthesis was detected, and mean forward elevation of 129.33^o (90^o - 150^o), mean external rotation of 26.7^o (18^o – 34^o), mean internal rotation of 47.86^o (33^o-58^o), the mean ASES score of 79.46 (range 68-88), the mean VAS score of 1.5 (range 1-3) and mean Constant-Murley score of 82.9 (range 72-94) were achieved. 1 patient developed axillary nerve injury which recovered 6 weeks after surgery and 1 diabetic patient developed superficial infection which healed with antibiotics.</p><p class="abstract"><strong>Conclusions:</strong> Hemiarthroplasty with Neer’s prosthesis can be utilized in four part fracture dislocations of humerus with poor bone stock risking avascular necrosis of head and screw cut out with satisfactory outcome.</p>

Application of a bone conserving revision stem for unstable intertrochanteric fractures in senile osteoporotic population

Purpose Primary hemi-arthroplasty is gaining rising attention to treat unstable intertrochanteric fractures in senile patients with severe osteoporosis. The objective of this study is to evaluate the early clinical and radiographic outcomes using bone conserving revision stem for unstable intertrochanteric fractures in senile osteoporotic population. Methods A retrospective observation of a series of 31 patients with unstable intertrochanteric fractures were conducted. The average age of the patients enrolled was 82.1 years and all patients underwent primary hemi-arthroplasty with the application of bone conserving and fully porous-coated revision stem. Clinical and radiographic evaluations during both the hospital-stay and follow-up were performed. Results The 31 patients were followed up for an average of 23 months postoperatively. The average operation time was 74.2 min while the mean intraoperative blood loss was 200.1 ml, with an average 11.1 g/L decrease of hemoglobulin after the procedure. The mean Harris hip score was 82.1 and visual analog scale was 1.7 at the latest follow-up. No intra-operative or postoperative peri-prosthetic fracture was noted. Postoperative complications included one thrombosis formation in posterior tibial vein and one congestive heart failure, both patients were discharged uneventfully after treatment. Twenty-one (21/31, 67.7%) patients regained their pre-injury walking activities. Radiographically, none of these hips had evident loosening of the stem or osteolysis. With follow-up period of 23 months, the mortality rate was 3.2% (1/31) with no revision required. Conclusion Primary hemi-arthroplasty with application of the bone conserving, cementless revision stem could serve as a reliable alternation in treatment of unstable intertrochanteric fractures in senile population with osteoporosis.

NON CEMENTED BIPOLAR HEMI-ARTHROPLASTY, SURGICALLY INTERVENED FOR GERIATRIC FRACTURES OF NECK OF FEMUR, THAT ARE DISPLACED: A PROSPECTIVE CASE SERIES STUDY.

Fracture neck of femur which are displaced, do not nd a place in the elderly where the head can be preserved even if there is a surgical intervention. Fixation devices like the DHS have time and again failed to satisfactorily treat these fractures. It's here that the Bipolar Hemi Arthroplasty comes to us, as a very handy operative tool. The question is, whether or not the stem of the Bipolar, be cemented or not. The problems of cementation in the elderly carries the risk of BCIs – the bone cementing implantation Syndrome; which can at times be fatal. Cementation makes, future needed Total Hip Replacement, more difcult. In this prospective study of patients conducted at Chettinad Hospital and Research Institute, Kelambakkam, South India ; we have chosen an age group between 61 to 75 years, with an inclusion criterion satisfying type III or IV Garden, but also at the same time, be classiable, as a type A or type B DORR's classication. Our male to female ratio was 1:2 the mean age was 68.5 years and 93.3% (n=84) of patients undergoing un-cemented Hemi-Arthroplasty, when graded by HHS were either Excellent or Good. We had no Poor outcomes in our study. Our minimum follow up was for 12 months, with a mean follow up of 23.5 months. All our cases were done by the Southern Moore's approach, with an average duration of surgery at 82 minutes. The blood loss on an average was 285 ml and the average blood transfusion rate was at 1.8 units. The average post operative stay was for 12 days. From this short-term prospective study, we concluded that Un-Cemented Hemi-replacement Arthroplasty gives Good to Excellent clinico-functional outcomes. It also does not cause any hindrance, if future Total Hip Replacement, is required. Our complication rates were also manageable, with only about 6.7% (n=6) patients, needing revision surgery due to stem loosening.

Physical Manipulation-Induced Femoral Neck Fracture: A Case Report

Manipulative treatments for pain are very widely used nowadays by a variety of physicians. These treatment modalities are generally safe, but various studies have reported serious complications. This report presents the case of a 78-year-old male patient with a history of Parkinson’s disease, who was diagnosed with a right hip fracture that occurred as a result of physical manipulative treatment. He underwent a cemented hemi-arthroplasty as appropriate surgical treatment of his condition. Manipulative treatments can result in minor and major complications ranging from simple sprains and rib fractures to cerebrovascular accidents and death. The frequency of these events seems to be rare; however, no robust studies are present and further investigations are urgently needed. Hip fractures as a result of this treatment have not been previously mentioned. This is the first reported case in the literature of a hip fracture resulting from manipulative treatment. Primary care physicians and orthopedists should be aware of the possibility of this outcome and rule it out whenever necessary.

Cemented hemi-arthroplasty for unstable intertrochanteric fractures in the elderly: a retrospective study

<p class="abstract"><strong>Background:</strong> Unstable intertrochanteric fractures belonging to 31A2 and A3 varieties are difficult challenges for orthopaedic surgeons, particularly in the elderly patients. Osteosynthesis by dynamic hip screw or proximal femoral nail are often plagued by complications like screw cut-out, excessive collapse and fixation failures due to osteoporotic bones. Because of these complications, patients are often kept confined to the bed which may increase the risks of pressure sores, venous thrombosis and pulmonary infections. So, it is desirable to mobilize these elderly patients as quickly as possible following surgery. In recent decades, primary hemi-arthroplasty has emerged as a valuable treatment option for mobilizing these patients early.</p><p class="abstract"><strong>Methods:</strong> We present our retrospective study on 27 patients above 60 years of age, who were managed with cemented bipolar hemi-arthroplasty after sustaining unstable intertrochanteric fractures. All the patients were operated through modified Hardinge approach. The fractured fragments were secured by stainless steel wiring, particularly the greater trochanter, wherever necessary.<strong></strong></p><p class="abstract"><strong>Results:</strong> Twenty-three patients (85%) were able to stand up with walkers by third post-operative day and were able to walk by fifth post-operative day. There was one case of hip dislocation; it was reduced under anaesthesia. No other complications were encountered at an average follow-up of 3.1 years. The Harris hip score was ‘good’ or ‘excellent’ in more than 60% patients.</p><p class="abstract"><strong>Conclusions:</strong> Cemented hemi-arthroplasty appears to be a reliable treatment method for unstable intertrochanteric fractures in the elderly and it allows early weight-bearing and rehabilitation in most patients following surgery.</p><p class="abstract"> </p>