Search

Purpose: To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems., Methods: Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay)., Results: One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization., Conclusion: Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Hector J Aguado reports financial support was provided by AO Foundation. Hector J Aguado reports financial support was provided by Government of Castile and Leon Ministry of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: A frequent complication after total hip arthroplasty is bleeding; to reduce it, intravenous or intra-articular tranexamic acid (TXA) is used. There is no evidence yet on which route of administration is better., Materials and Method: This was a prospective, controlled, randomized study in 2 arms between February 2017 and February 2019. In group A, 15 mg/kg intravenous TXA was administered and in group B 2 g intra-articular TXA. Haemoglobin and haematocrit values were evaluated at 24-72 h, also volume of drained blood, volume of blood lost, transfusions and complications., Results: A total of 195 patients were included: 110 in group A and 85 group B. Haemoglobin dropped 3.10 ± 1.32 g/dl in 24 h and 3.63 ± 1.41 g/dl at 72 h in group A; the haematocrit dropped 8.38 ± 4.67% in 24 h and 15.40 ± 4.39% in 72 h. In group B, haemoglobin dropped 3.09 ± 1.40 g/dl in 24 h and 3.34 ± 1.23 g/dl in 72 h and haematocrit 9.75 ± 3.95% and 10.40 ± 3.72% in 24 and 72 h. No significant differences were found for haemoglobin values at 24 and 72 h and haematocrit at 24 h (p > 0.05); we did not obtain statistically significant differences in drainage, blood loss between groups or in the proportion of transfused. When stratifying the results by age, we obtained significant differences in the decrease in haemoglobin (p = 0.021) and haematocrit (p = 0.025) in patients > 65 years., Conclusions: The different routes of administration of TXA in PTC have a similar effect in reducing post-operative bleeding without evidencing an increase in complications., Level of Evidence: I.

Introduction: One of the most frequent complications after a total hip arthroplasty (THA) is bleeding, intravenous tranexamic acid (TXA) is used to reduce it. We considered it necessary to carry out a study to clarify which administration route is superior., Material and Method: Prospective, controlled and randomized study in 2 arms carried out between February 2017 and February 2018. 15mg/kg of intravenous TXA were administered in group-A and 2gr of intra-articular TXA in group-B. The values of haemoglobin and haematocrit were evaluated at 24h-72h, blood loss volume, drained blood volume, transfusions and complications., Results: 78 patients were included, 31 with intravenous treatment and 47 with intra-articular. The decrease of haemoglobin in the intravenous group was 3.15±1.64g/dl in 24h and 3.75±1.56g/dl in 72h, the haematocrit decreased by 10.4±4.17% in 24h and 11.85±4.15% in 72h. In the intra-articular group there was a haemoglobin fall of 3.03±1.30g/dl in 24h and 3.22±1.2g/dl in 72h and the haematocrit fell by 10.66±3.6% and 12,11±3.29% in 24 and 72h (P>.05). The mean drainage in 24h was 195.80ml in group-A versus 253.93ml in group-B (P>.05) and in 48h it was 225.33ml in group-A and 328.19ml in group-B (P=.009). The intravenous group lost an average of 1,505ml of blood compared to the 11,280ml of the intra-articular group. In 5.1% of the cases, transfusions were necessary. We had no secondary complications., Conclusions: The different routes of administration of TXA in THA have a similar effect in the reduction of postoperative bleeding. There was no evidence of an increase in complications., (Publicado por Elsevier España, S.L.U.)

Purpose: The objective was to assess aseptic complications and functional outcome using a primary total hip arthroplasty with modular neck., Methods: Prospective cohort of 317 consecutive patients. The mean age was 61.1 (range, 41-84) years. The H-Max-M model (Lima, Italy) system was used in all patients. The functional assessment was made by the Harris Hip Score, Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Radiological outcomes were also assessed, and adverse events and complications were noted., Results: The mean follow-up was 6.1 (range, 2-8) years. Functional outcome significantly improved in most patients. There were 3 deep infections (0.9%) and 17 aseptic complications (5.3%) including 1 intraoperative acetabular fracture, 3 later periprosthetic femoral fractures, 1 broken ceramic insert, 1 acetabular loosening, 3 femoral loosening and 1 broken titanium modular neck in a obese patient. No pseudotumors or elevated serum levels of metal ions were found among the patients with radiolucent lines or aseptic loosening., Conclusions: The findings in the present study showed that the H-MAX-M stem provided satisfactory functional outcome in most patients with a low rate of complications attributable to the modular neck design. We consider that using this novel modular neck-stem coupling design can be an alternative to the conventional monoblock stems in patients without overweight.