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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: 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]

Introduction: Dislocation is a serious and common complication and a great concern with the use of total hip arthroplasty (THA) when treating displaced femoral neck fracture (FNF). Dual-mobility (DM) THA might reduce the dislocation risk. We aim to report the dislocation and revision rate of primary DM THA in patients with displaced FNF.Materials and Methods: Between 2005 and 2015, 966 consecutive patients (676 women) at mean age 80.5 years (range 42-104) with displaced FNF were operated with DM articulation THA by posterolateral approach (PLA). Patient files and radiographs were evaluated for dislocations, revisions, and other complications until death of the patient or August 1st, 2017. Data were crosschecked with the National Patient Registry. Patient's mental state was tested upon admissions. Surgeon's educational level was noted and post-operative cup position was measured.Results: At minimum 1.6-year follow-up, there were 45 (4.7%) dislocations and eight (0.8%) cup revisions. The 30-day mortality was 9.2% and 533 patients (55.2%) were dead at the time of last follow-up. We observed eight intraprosthetic dislocations (IPD); six occurred in relation to closed reduction. Cementless stem fixation was associated with higher dislocation risk (p = 0.04) and higher rate of stem complications (p = 0.002). There was no significant association between cognitive impairment and dislocation (OR 2.0, 95% CI 0.96-4.34, p = 0.06).Conclusion: Overall, DM THA inserted via PLA results in an acceptable dislocation risk and low revision rate in fragile, old patients with acute FNF fracture, regardless of mental status. A unique complication in DM THA is IPD, which requires an immediate open reduction surgery. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the validity of Barthel Index (BI) compared with de Morton Mobility Index (DEMMI), EuroQol-visual analog scale (EQ-VAS), 2-min walk test (2MWT), and timed get-up-and-go test (TUG), and to evaluate the responsiveness of all outcome measures for assessing functional recovery in older patients who underwent hemiarthroplasty after femoral neck fracture.Material and Method: Eighty-one femoral neck fracture patients who were enrolled in a study evaluating functional recovery after bisphosphonate therapy during 2013 to 2015, and who had data available at both baseline and 12 months after surgery were included in this study.Results: All scores improved significantly from baseline to the 1-year follow-up. BI had moderate to strong correlation with DEMMI, 2MWT, and TUG (r-value: 0.490-0.843), and mild to moderate correlation with EQ-VAS (r-value: 0.278-0.323). All outcome measurements had high effect estimates. The minimal clinically important difference (MCID) of BI at 12 months was 9.8 points.Conclusion: Since BI was shown to have good validity (moderate to strong correlation with DEMMI and performance-based tests, and mild to moderate correlation with EQ-VAS), BI can be used to accurately assess functional recovery in patients who undergo hemiarthroplasty after femoral neck fracture. [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]

Purpose: The minimally invasive (MI) anterolateral approach is a relatively new approach for the treatment of femoral neck fractures with a hemiarthroplasty (HA). There is limited research available presenting clinical outcomes after an HA using the MI approach. Therefore the aim of the present study was to compare clinical outcomes of the MI and traditional anterolateral approaches in patients after HA.Methods: Data were extracted from a prospective hip fracture database and completed by retrospective review of the electronic medical records. Patients undergoing HA in a level II trauma teaching hospital between 1 January 2011 and 1 May 2016 were enrolled.Results: A total of 463 patients (67% female), 223 in the MI group (mean age, 82 ± 7) and 240 (mean age, 81 ± 8) in the traditional anterolateral group were enrolled. No significant difference was found in baseline characteristics. The surgeons experience measured by the operations performed per year was in favour of the MI anterolateral group (26 vs 18, p < 0.001). The median operating time for an MI approach was shorter (53 vs 69 min, p < 0.001). No significant differences were found in mortality rates (p = 0.131) and post-operative complications: haematomas (p = 0.63), dislocations (p = 0.63), deep surgical site infections (p = 0.66) and re-operations.Conclusions: Our findings show the MI anterolateral approach has a minimally shorter operation time with no difference in post-operative complications and clinical outcomes. We, therefore, conclude that the MI anterolateral approach is a safe alternative for the traditional anterolateral approach with an improved operation time, a smaller incision and less surrounding tissue damage.Level Of Evidence: Prognostic level III retrospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose: One-third of hip fractures occur in men. The causes underlying hip fractures in men differ from those in women and include alcohol abuse. This retrospective register study evaluated the trends and results associated with different surgical treatment methods for nondisplaced and displaced femoral neck fractures in male patients with alcohol dependence syndrome.Methods: Men with hip fractures were identified from a local district hospital database. Alcohol dependence syndrome was identified as a diagnosis in medical records.Results: For displaced fractures, implant survival after total hip arthroplasty was significantly lower compared to hemiarthroplasty. For nondisplaced fractures, implant survival of cannulated screws was significantly lower compared to sliding hip screws. Overall patient survival for males with alcohol dependence syndrome with hip fracture was 62% at 1 year and 49% at 2 years. Patient survival in this population did not differ between displaced and nondisplaced fractures or among different surgical methods.Conclusion: Patients with alcoholism who had documented evidence of alcohol dependence syndrome represented nearly half of patients <70 years old with low-energy hip fracture. In patients with nondisplaced femoral neck fractures, stability of the internal fixation appeared to play a major role in implant survival; sliding hip screws should be considered over multiple cannulated screws. In patients with displaced fracture, total hip arthroplasty was associated with a significantly higher risk of complications leading to revision compared to hemiarthoplasty.Level Of Evidence: Prognostic Level III. [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]