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Purpose: Venous thromboembolism (VTE) is a known complication of hip arthroplasty for femoral neck fractures (FNF) with various prophylactic anticoagulants utilized to decrease risk. The purpose of this study was to assess the efficacy and perioperative outcomes associated with aspirin for VTE prophylaxis following arthroplasty for FNF. Methods: Medical records of 1,220 patients who underwent hip hemiarthroplasty (HHA) or total hip arthroplasty (THA) at an urban academic center from 2011 to 2022 were retrospectively reviewed. Patient characteristics and perioperative outcomes, including length of stay (LOS), VTE, 90-day hospital encounters, and discharge disposition, were collected. Outcomes for patients prescribed aspirin (n = 214) were compared to those prescribed non-aspirin VTE prophylaxis (n = 1006) using propensity score matching. Results: Patients who received aspirin had higher rates of THA (36.0 vs 26.7%; p = 0.008). There were no significant risk-adjusted differences in the incidence of VTE (0.5 vs 0.5%, p = 1.000) and 90-day readmissions (10.4 vs 12.3%, p = 0.646) between patients prescribed aspirin and non-aspirin VTE prophylaxis, respectively. Patients prescribed non-aspirin agents had higher rates of non-home discharge (73.9 vs 58.5%; p < 0.001) and longer LOS (143.5 vs 124.9 h; p = 0.005). Sub-analysis of patients prescribed aspirin and non-aspirin prophylaxis based on comorbidity scores demonstrated no difference in VTE incidence for low (0.0 vs 1.6%, p = 1.000) and high scores (0.0 vs 0.0%, p = 1.000), respectively. Conclusion: Aspirin is not associated with increased incidence of VTE after HHA or THA for FNF. Aspirin prophylaxis should be considered in hip fracture patients to mitigate bleeding risk, particularly those with low to intermediate VTE risk. Level of evidence: Level III, Retrospective study. [ABSTRACT FROM AUTHOR]

Purpose: Minimizing complications is an important focus in hip hemiarthroplasty (HHA) for femoral neck fracture (FNF) patients given the associated high morbidity and mortality rates. This systematic review and meta-analysis aimed to compare the clinical and functional outcomes associated with the direct anterior approach (DAA) compared to other surgical approaches used for HHA. Methods: Studies evaluating HHA-treated FNFs using the DAA were compared through meta-analysis to all other surgical approaches combined and as distinct subgroups. Outcomes included overall complication rate, mortality rate, dislocation rate, reoperation rate, periprosthetic fracture rate, infection rate, length of stay (LOS), mobility, perioperative blood loss, operative time, and postoperative pain. Results: Nineteen studies met the inclusion criteria, totaling 2,018 HHAs. DAA significantly reduced the overall complication rate (odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.57 to 0.94, p = 0.01), dislocation rate (OR = 0.34, 95% CI 0.15 to 0.77, p = 0.01), and LOS (mean difference (MD) = −1.31 days, 95% CI − 2.12 to − 0.50, p = 0.002). Findings from studies that were not appropriate for meta-analysis were qualitatively summarized and suggested improved mobility and reduced postoperative pain with the DAA. Significant differences were not detected in any of the remaining outcomes. Conclusion: The DAA HHA appears to be safer, reduces hospital stay, and may improve early functional recovery. This article supports the DAA HHA as a safe option for the management of displaced intracapsular FNFs. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the differences between direct anterior approach (DAA) and direct lateral approach (DLA) in hip hemiarthroplasty (HHA) after displaced femoral neck fracture (FNF) in early functional outcome, hospital length of stay, morbidity and mortality rates. Methods: This non-interventional retrospective study, carried out at a tertiary trauma centre within the Spanish National Health System, included all patients who underwent a bipolar HHA between 1st January 2018 and 31st December 2019 performed by 2 of our hip unit surgeons. Results: A total of 94 patients were included (40 in DAA group and 54 in DLA group). Median follow-up was 19.2 months (range 8–30.8 months). Postoperative degree of mobilisation showed statistically significant differences in favour of DAA group, where 35% of patients were able to walk with no assistance after surgery. DAA group had 1 day less of hospitalisation in contrast with DLA group overall (8 days vs 9 days, respectively, p < 0.05). Statistically significant differences were not detected in comparing postoperative complications, re-operations rates or 6-months mortality rate. Conclusion: Our study highlights the benefits of DAA for HHA after displaced FNF in terms of postoperative mobilisation degree and hospitalisation length of stay when compared to DLA. [ABSTRACT FROM AUTHOR]

Background: Cemented hemiarthroplasty is a well-documented treatment for patients with femoral neck fractures (FNFs). However, there are not many cohort studies comparing different types of hemiarthroplasty (HA). Objective: To compare CPT and Lubinus SP2 HA for FNF patients concerning complications and radiological measurements. Methods: From January 1, 2013, CPT was introduced instead of Lubinus SP2 as the new cemented HA due to a regional procurement. Data were retrieved 3 years prior and after the introduction. All patient health records were retrospectively reviewed for types of implant, American Society of Anesthesiologists (ASA) score and duration of admission. All X-ray images were analyzed for radiological measurements concerning offset, stem angulation and cement filling. Mortality and major complications within 1 year were retrieved from patient health records as well as the Danish National Patient Registry. Major complications were defined as dislocations, periprosthetic fractures and revisions. Results: 584 cemented HA were included, 300 CPT and 284 with Lubinus SP2. The mean age (SD) was 82 (8.2) years, and there was no baseline difference between the groups concerning age, sex, ASA score and mortality. There were 8.7% major complications for CPT and 9.2% for Lubinus SP2 (p = 0.836). There were, however, seven periprosthetic fractures in the CPT group and one in the Lubinus SP2 group (p = 0.04). In contrast, there were 20 dislocations in the Lubinus SP2 group and 10 in the CPT group (p = 0.042). There was no statistical difference between the stem angulation and periprosthetic fractures (p = 0.824) or major complications (p = 0.602). The Lubinus SP2 had a mean plus 2.7 mm offset postoperatively (p = 0.001), while the CPT had plus 10.6 mm (p < 0.000). The mean (SD) angle of the stems was 1.39 (1.75) degrees for Lubinus SP2 and 2.46 (1.99) for CPT. There was no difference in cementation (p = 0.308). Conclusion: There was no overall statistical difference between the CPT and Lubinus SP2 stem regarding major complications. However, the CPT had a higher prevalence of periprosthetic fractures, while the Lubinus SP2 had a higher dislocation prevalence. The CPT stem had overcorrection of offset and a higher degree of varus positioning. [ABSTRACT FROM AUTHOR]

Purpose: Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods: We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results: We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p < 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p < 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion: Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty [ABSTRACT FROM AUTHOR]

Purpose: We wished to compare the outcome of two types of cemented and uncemented modern stem design implants after hemiarthroplasty, with both an Orthopaedic Data Evaluation Panel rating of 10A.Methods: This retrospective study compares data obtained from two centres, with a total study population of 655 (n = 393 cemented, n = 262 uncemented). Patients were matched at baseline for gender, age, surgery side, American Society of Anesthesiologists score, body mass index and pre-operative haemoglobin level. Outcome measurements were prosthesis-related complications, pre- and post-operative, with reoperation rate and mortality and other complications after 1 year, surgery time, blood loss and immobility at discharge.Results: There were no significant differences in mortality after 1 year, total other complications, immobility at the time of discharge and total prosthesis-related complications between both groups. Significantly more periprosthetic fractures and post-operative infections were seen in the uncemented group with significantly more reoperations compared to the cemented group. Significant differences were seen in cardiovascular complications, blood loss and surgery time in favour of the uncemented group.Conclusions: In consequence of the significant higher prosthesis-related complications (e.g. infections, periprosthetic fractures and reoperations) in the uncemented group in this study, we recommend cemented hemiarthroplasty in patients with a femoral neck fracture.Level of evidence: Level III, Case Controlled Study. [ABSTRACT FROM AUTHOR]

Background: We performed a systematic review and meta-analysis to assess whether the direct anterior approach (DAA) is associated with improved functional and clinical outcomes compared to other surgical approaches for hemiarthroplasty for displaced femoral neck fractures. Materials and methods: Randomized trials and cohort studies of hemiarthroplasty performed via DAA versus another surgical approach (anterolateral, lateral, posterolateral, posterior) were included. Our primary outcome was postoperative functional mobility. Secondary outcomes included overall complication rate, dislocation rate, perioperative fracture, infection rate, re-operation rate, overall mortality, operative time, pain, intra-operative blood loss, and length of stay. Results: Nine studies met inclusion criteria, comprising a total of 698 hips (330 direct anterior, 57 anterolateral, 89 lateral, 114 posterolateral, 108 posterior approach). With regard to functional mobility, DAA was favored in 4 studies, and no study favored another approach over DAA. DAA had a significantly lower dislocation rate compared to posterior capsular approaches. Analysis of other secondary outcomes did not identify statistically significant differences. Conclusion: This is the first systematic review and meta-analysis of the DAA for hemiarthroplasty. Available evidence suggests superior early functional mobility with the DAA. The DAA is associated with a significantly lower dislocation rate compared to posterior capsular approaches for hemiarthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: Femoral neck fracture (FNF) is a devastating injury with serious medical and social consequences. One-third of these patients have some degree of impaired cognitive status. Despite this, a high proportion of hip fracture trials exclude patients with cognitive impairment (CI). We aimed to evaluate whether moderate to severe CI could predict walking ability, quality of life, functional outcome, reoperations and mortality in elderly patients with displaced FNF treated with hemiarthroplasty (HA). Methods: This cohort study included a consecutive series of 188 patients treated with HA for a displaced FNF. Patients were assessed for estimated preoperative and 1 year postoperatively with regard to walking ability, cognitive status, quality of life with EQ-5D and hip function with Harris hip score. Results: There were 188 patients who met the inclusion criteria. A total of 130 patients were in the control group, and 58 were in the CI group. At 1-year follow-up, 31 patients (24%) had died in the control group and 22 patients (38%) had died in the cognitive impaired group. This difference in reoperation and mortality rate was statistically significant (log-rank test, p = 0.016). The CI had a significantly higher incidence of being non-walker (28 vs. 4%, OR 9.2, p = 0.001). The EQ-5D was higher in the control group, while the Harris hip score was comparable in the two groups. Conclusions: Moderate to severe CI was associated with a high incidence of non-walking ability, worse quality of life, high mortality and re-operation rate after femoral neck fractures treated with HA. [ABSTRACT FROM AUTHOR]

Introduction: Current recommendations urge us to operate quickly on femoral neck fractures to reduce the risk of comorbidity decompensation. In some cases, this leads us to operate when an underlying infection is present. In this study, we evaluated the infection rate of bipolar hemiarthroplasty after femoral neck fracture and attempted to relate it to preoperative C-reactive protein (CRP) levels. Materials and methods: The infection rate of bipolar hemiarthroplasty was evaluated in a dual-center, retrospective study of 260 patients over a 2-year period. During the first year, the preoperative CRP levels were not taken into account when scheduling the procedure. During the second year, if preoperative CRP levels were above 50 mg/L, the procedure was delayed to look for and treat any ongoing infections. Results: The overall periprosthetic infection rate in this study was 4.85 % (range 4.8-4.9), with 33 % of patients passing within 1 year due to the infection. In the group where CRP was not taken into consideration, 59 of the 143 operated away patients (41 %) had their preoperative CRP levels measured. Twenty-nine of these patients had CRP > 50 mg/L when they were operated. Of the seven infections in the group, one patient had CRP > 50 mg/L, two had CRP < 50 mg/L, and four patients did not have preoperative CRP levels measured. In the group where CRP was taken into consideration, 104 of the 117 patients (89 %) had their preoperative CRP assessment. Thirty of these patients had CRP > 50 mg/L upon admission; their procedure was delayed to determine the etiology of this CRP elevation. No cause was found in 16 of these 30 patients, and they were operated despite having CRP > 50 mg/L. There were five infections in this group: four patients had CRP > 50 mg/L and were treated accordingly; one patient had preoperative CRP < 50 mg/L. In patients where the preoperative CRP levels were taken into account, the delay before surgery was twice as long as those where CRP levels were not considered. Discussion: C-reactive protein (CRP) level alone is not a good preoperative predictive factor for periprosthetic joint infection, although 80 % of the patient with an infected bipolar hemiarthroplasty had CRP > 50 mg/L upon admission. The increased delay due to the CRP analysis is not without consequence for this cohort. Two previous studies have looked into the predictive ability of CRP levels, but these involved scheduled surgical procedures. Conclusion: This study could not validate the use of CRP levels, nor a 50 mg/L threshold, as predictive factors for a preexisting infection during bipolar hemiarthroplasty for femoral neck fracture. As a consequence, new infection screening tools must be developed and validated. Level of evidence: Retrospective, no control group. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to analyze the radiological outcomes of bipolar hemiarthroplasty after displaced femoral neck fractures of non-arthritic hip joints in rheumatoid arthritis patients. Methods: We retrospectively investigated 25 hip joints in 23 rheumatoid arthritis patients who underwent bipolar hemiarthroplasty for displaced femoral neck fracture of non-arthritic hip joints. All patients were female with an average age of 69.8 years (range 51-83 years). Mean follow-up duration was 8.4 years (range 5-12 years). Radiographs taken immediately, 1 year after surgery and most recently, were collected for each case. Radiographic measurement of the migration distance of the outer-head prosthesis in the direction of vertical, horizontal and medial to Köhler's line was undertaken at 1 year after surgery and most recently. Results: No patients had hip-related pain after surgery. No case indicated apparent central migration and >3-mm migration of the hemisphere in each direction. There was no significant change in migration distance between evaluation at 1 year after surgery and most recently. Conclusions: We conclude that risk of acetabular protrusion appears to be low in patients of rheumatoid arthritis treated with bipolar hemiarthroplasty for displaced femoral neck fractures of non-arthritic hip joints in the medium term. [ABSTRACT FROM AUTHOR]

Minimally invasive osteosynthesis is a well-recognized treatment; however, those of arthroplasty or hemiarthroplasty may rarely be performed. We reviewed the comparison of a mini-incision approach in hemiarthroplasty versus that of an ordinary approach in patients with femoral neck fractures. Two different operative procedures were compared. Thirty-two patients (group 1) had a mini-incision in hemiarthroplasty. Thirty-two patients (group 2) were treated with the conventional approach. The postoperative treatment course was the same for both groups. The mean length of follow-up was 25 months. The results were excellent or good in 86% of the patients (50 of 64) and were equally good for both procedures. However, the full weight bearing term was significantly shortened for patients treated by the mini-incision procedure. Good and excellent results can be expected from either the mini-incision or the ordinary approach in hemiarthroplasty. Only full weight bearing term was significantly short following the mini-incision. This approach results in less dissection and facilitates rapid patient recovery and possibility earlier discharge from the hospital. [ABSTRACT FROM AUTHOR]

Gunshot wounds involving major joints can be lethal as a result of the disruption to major neurovascular tracts. We report on a high-energy ballistic injury resulting in a comminuted femoral neck fracture in an elderly patient with a surgical delay exceeding 20 h. The patient underwent bipolar hemiarthroplasty and led a functional, satisfactory life after surgery. Lead intoxication was also identified, and the blood lead concentration was almost two times the positive diagnostic value (25 μg/dL). The rebound in lead concentration suggested delayed lead toxicity. The patient did not have symptoms of plumbism at the last follow-up 4 years after the injury. [ABSTRACT FROM AUTHOR]