Role of hemiarthroplasty -30th aug 2015
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Hemiarthroplasty is generally recommended over open reduction and internal fixation (ORIF) for displaced femoral neck fractures in elderly patients, as ORIF has higher nonunion and failure rates. Cemented bipolar hemiarthroplasty has better outcomes than uncemented in terms of function, mobility, implant stability, and pain. Total hip replacement provides better function than hemiarthroplasty but is a more complex procedure. For patients aged 65-75 with femoral neck fractures, cemented bipolar hemiarthroplasty is preferable to ORIF, while patients over 75 are best treated with hemiarthroplasty.
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MANAGEMENT OF NONUNIONS AND MALUNIONS OF PROXIMAL HUMERAL FRACTURES.pptx
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1) Intertrochanteric fractures are common hip fractures seen in elderly patients due to falls and osteoporosis, with surgical treatment including plate and screw constructs, nail constructs, and arthroplasty.
2) Blade plates have higher rates of complications like cut-out, non-union, and re-operation compared to sliding hip screw constructs. Intramedullary nails have been shown to reduce failure rates in unstable fractures compared to sliding hip screws.
3) Locking plates, cementless hemiarthroplasties, and total hip arthroplasties are reasonable options in select cases like unstable fractures, pre-existing osteoarthritis, or failure of internal fixation, though internal fixation and intramed
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- Readmission rates following total hip arthroplasty are a concern due to financial penalties for physicians and hospitals. General anesthesia, obesity, and medical complications increase readmission risk.
- Spinal anesthesia reduces readmission rates compared to general anesthesia. Blood conservation strategies like tranexamic acid administration can decrease transfusion needs.
- Larger femoral head sizes are associated with increased revision rates for metal-on-metal bearings due to higher metal ion levels. Modularity in hip implants can cause complications like corrosion, fractures, and dissociation.
- Surgeons must understand risks and utilize techniques like appropriate implant selection and infection prophylaxis to improve outcomes following total hip replacement.
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Distal Humeral Fractures – How to Fix Them, with Correlation with Evidence
This presentation accompanied a talk given by Melbourne based Orthopaedic Surgeon Mr Ash Moaveni, FRACS, on distal humeral fractures.
http://www.melbourneshoulder.com.au
Slides include information on
- Fracture classification
- Epidemiology of Supracondylar Fractures
- Injury Evaluation
- Non-Operative Management
- Elbow Hemiarthroplasty: Indications, case example and literature
- Total Elbow Replacement: Case example and literature
- Open Reduction Internal Fixation: How to fix them, Expectations, Setup, Exposure
- Olecranon Osteotomy literature
- Technical Pearls for Internal Fixation
- Plate Positioning
- Complications
- Summary
Anterior vs Posterolateral Surgical Approach in Primary Total Hip Arthroplasty
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Role of hemiarthroplasty -30th aug 2015
- 1. ROLE OF HEMIARTHROPLASTY--HIP Dr Uday Kumar MS(Orth) DNB(Orth) Sagar Hospitals Sindhi Hospital Chinmaya Hospital Bangalore 6th September 2015 Asram MC Eluru
- 2. 65 year old male ---active— No co morbidities Fall at home Management?
- 3. 75 year old lady Fall at home Displaced Osteoporotic # neck femur Management?
- 4. Hemi Total
- 5. Displaced Fractures ORIF •ORIF is an option in elderly •Complications • Nonunion 10 -33% • AVN 15 – 33% •AVN related to displacement •Early ORIF no benefit • Loss of reduction / fixation failure 16%
- 7. Hemi-arthroplasty of hip Absolute indications •Patients over 65 yrs •Fracture neck not satisfactorily reduced • Loss of fixation after several weeks of operation
- 8. •Pathological fracture •Old undiagnosed fracture •Neck # with complete dislocation of head Absolute indications
- 9. Relative indications •Advanced physiological age with life expectancy more than 10-15 yrs •Parkinsonism, hemiplegia or other neurological disease.
- 10. Contraindications • Active sepsis • Active young person • Preexisting acetabular disease (e.g., rheumatoid arthritis)
- 11. Hemi associated with Lower reoperation rate (6-18% vs. 20-36%) Improved functional scores Slightly increased short term mortality Mathew –JBJS –2010 Matsen---CORR-2014
- 12. --allows faster full weight bearing --It eliminates non-union osteonecrosis failure of fixation risks (>20% to 30% of cases with ORIF require secondary surgery). Hemi-arthroplasty vs ORIF
- 13. Disadvantages •Removal of anatomical head •More extensive procedure --greater blood loss -A risk of acetabular erosion exists in active individuals
- 14. Hemiarthroplasty Unipolar vs. Bipolar •Bipolar theoretical advantages •Lower dislocation rate •Less acetabular wear/ protrusio •Less Pain •More motion
- 15. •Bipolar •Disadvantages •Cost •Dislocation often requires open reduction •Loss of motion interface •Polyethylene wear/ osteolysis
- 18. Hemiarthroplasty Cemented vs. Non-cemented • Conclusion: • Cement gives better results • Function • Mobility • Implant Stability • Pain • Cost-effective • risk of sudden cardiac death • Use cement with cautionn
- 20. THR versus hemiarthroplasty • Studies have reported better functional results compared with hemiarthroplasty • It eliminates the potential for acetabular erosion
- 22. Disadvantages over hemiarthroplasty Include a more extensive surgical procedure Increased implant cost Higher risk of prosthetic dislocation THR versus hemiarthroplasty
- 23. ORIF vs. cemented bipolar hemi vs. THA 37% fixation failure (AVN/nonunion) similar dislocation rate hemi vs. THA (3%) ORIF 8X more likely to require revision surgery than hemi and 5X more likely than THA Keating et al OTA--2012
- 24. CONCLUSION --Bipolar arthroplasty is better than ORIF for fracture neck femur in patients between 65 to 75 years. -- Cemented modular bipolar hemiarthroplasty has more advantages in in osteoporotic fractures. --Above 75 years bipolar arthoplasty is indicated