Arthroplasty in patients with femoral neck fractures

The aim of this thesis was to analyze hip function and the health-related quality of life (HRQoL) in patients with a displaced fracture of the femoral neck treated with a cemented total hip arthroplasty (THA) or a hemiarthroplasty (HA), unipolar or bipolar. Moreover, the purpose was to analyze factors influencing the stability of the THA with special reference to the surgical approach and to evaluate the responsiveness of the Short Musculoskeletal Function Assessment (SMFA), i.e. the instrument’s ability to capture clinically important changes, in patients with femoral neck fractures. A four-year follow-up of a randomized controlled trial (RCT) of 120 elderly patients (mean age 81 years) with a displaced femoral neck fracture randomly allocated to treatment by either THA or bipolar HA (Study I). The results confirmed the better outcome regarding hip function and HRQoL after THA as compared to HA in the longer time perspective. In an RCT, 120 elderly patients (mean age 86 years) with a displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar HA or bipolar HA (Study II). The study showed that unipolar HA and bipolar HA appeared to produce equivalent clinical outcomes regarding hip function and HRQoL after one year, but with a significantly higher incidence of acetabular erosion in the unipolar HA group. In a cohort study, 713 consecutive hips in a series of 698 patients having undergone a primary THA (n = 311) for a displaced femoral neck fracture or a secondary THA (n = 402) due to a fracture healing complication after a femoral neck fracture were included (Study III). The results showed that the anterolateral surgical approach was associated with a significantly lower risk of dislocation than the posterolateral approach with or without posterior repair. In order to evaluate the responsiveness of the SMFA, the 120 patients from Study I were included (Study IV). To evaluate the internal responsiveness of the SMFA, the observed change and the Standardized Response Mean (SRM) in relation to the change in the Dysfunction Index and the Bother Index were calculated. In order to calculate external responsiveness, an External Criterion (EC) was constructed by using the Harris Hip Score. Receiver Operating Characteristic (ROC) curves and logistic regression analysis were used in the evaluation. The results of the study showed that the SMFA indices had good internal responsiveness and acceptable external responsiveness in patients with femoral neck fractures. In conclusion, THA is recommended as the primary treatment for the active, healthy elderly patient with a femoral neck fracture and long life expectancy. In the most elderly patients, bipolar HA and unipolar HA seem to produce equally good clinical results in the shorter time perspective, but the significantly higher incidence of acetabular erosion in the unipolar HA group may imply that bipolar HA should be the preferred treatment. Moreover, in order to minimize the risk of dislocation, we recommend the use of the anterolateral approach for THA in patients with femoral neck fractures. Finally, the SMFA can be recommended for use as one of the measures to evaluate the outcome after a femoral neck fracture

Reference Data on the Normal Abdominal Wall Anatomy and Baseline Characteristics in Seventy-One Nulliparous Women

Aims: The aim of this study was to describe the prepartum anatomy of the abdominal wall in a cohort of nulliparous women, for use as a reference for management of patients with postpartum abdominal wall insufficiency with or without rectus diastasis.Materials and Methods: Seventy-one women were examined with ultrasonography of the abdominal wall. The inter-recti distance (IRD), anatomical variations of the linea semilunaris, and the oblique muscles were assessed. The waistline was measured during activation and relaxation of the abdominal core. Participant characteristics were registered. Questionnaires regarding habitual physical activity (Baecke), low back pain (Oswestry), physical functioning (DRI), urinary incontinence (UDI-6 and IIQ-7), and quality-of-life (SF-36) were answered.Results: Mean age was 30.5 years (range 19–50 years) and mean BMI 23.5 kg/m2 (range 18–37). Ultrasonography showed a mean IRD of 10 mm (range 3–24) at the superior border of the umbilicus, 9 mm (4–20) 3 cm above the umbilicus, and 2 mm (−5–10) 2 cm below the umbilicus. The mean thickness of the linea alba was 3 mm (1.5–5) and mean distances between the lateral edge of the rectus muscle and the external, internal, and transverse oblique muscles were 12 mm (−10–28), 1 mm (−14–13) and 15 mm (−14–32) at umbilicus level. Responses to the DRI, UDI-6, IIQ-7 and Oswestry questionnaires showed generally lower scores than the normal population whereas Baecke and SF-36 scores were similar.Conclusion: This study provides baseline data on normal abdominal wall anatomy in a healthy nulliparous female cohort, as well as levels of activity, physical function, disability, and quality-of-life

Fixation of the fully hydroxyapatite-coated Corail stem implanted due to femoral neck fracture: 38 patients followed for 2 years with RSA and DEXA

Background Today, dislocated femoral neck fractures are commonly treated with a cemented hip arthroplasty. However, cementing of the femoral component may lead to adverse effects and even death. Uncemented stems may lower these risks and hydroxyapatite (HA) coating may enhance integration, but prosthetic stability and clinical outcome in patients with osteoporotic bone have not been fully explored. We therefore studied fixation and clinical outcome in patients who had had a femoral neck fracture and who had received a fully HA-coated stem prosthesis. Patients and methods 50 patients with a dislocated femoral neck fracture were operated with the fully HA-coated Corail total or hemiarthroplasty. 38 patients, mean age 81 (70-96) years, were followed for 24 months with conventional radiographs, RSA, DEXA, and for clinical outcome. Results 31 of the 38 implants moved statistically significantly up to 3 months, mainly distally, mean 2.7 mm (max. 20 mm (SD 4.3)), and rotated into retroversion mean 3.3 (-1.8 to 17) (SD 4.3) and then appeared to stabilize. Distal stem migration was more pronounced if the stem was deemed to be too small. There was no correlation between BMD and stem migration. The migration did not result in any clinically adverse effects. Interpretation The fully hydroxyapatite-coated Corail stem migrates during the first 3 months, but clinical outcome appears to be good, without any adverse events

Dislocation of total hip replacement in patients with fractures of the femoral neck: A prospective cohort study of 713 consecutive hips

Background Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach

Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: A pooled analysis of 30,250 participants data

PURPOSE: To assess the clinical outcomes of unipolar versus bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures in older patients and to report whether bipolar implants yield better long-term functional results. METHODS: We searched PubMed, Scopus, EBSCO, and Cochrane Library for relevant randomized clinical trials (RCTs) and observational studies, comparing unipolar and bipolar hemiarthroplasty. Data were extracted from eligible studies and pooled as relative risk (RR) or mean difference (MD) with corresponding 95% confidence intervals (CI) using RevMan software for Windows. RESULTS: A total of 30 studies were included (13 RCTs and 17 observational studies). Analyses included 30,250 patients with a mean age of 79 years and mean follow-up time of 24.6 months. The overall pooled estimates showed that bipolar was superior to unipolar hemiarthroplasty in terms of hip function, range of motion and reoperation rate, but at the expense of longer operative time. In the longer term the unipolar group had higher rates of acetabular erosion compared to the bipolar group. There was no significant difference in terms of hip pain, implant related complications, intraoperative blood loss, mortality, six-minute walk times, medical outcomes, and hospital stay and subsequently cost. CONCLUSIONS: Bipolar hemiarthroplasty is associated with better range of motion, lower rates of acetabular erosion and lower reoperation rates compared to the unipolar hemiarthroplasty but at the expense of longer operative time. Both were similar in terms of mortality, and surgical or medical outcomes. Future large studies are recommended to compare both methods regarding the quality of life

Surgical preferences of patients at risk of hip fractures: hemiarthroplasty versus total hip arthroplasty

BACKGROUND: The optimal treatment of displaced femoral neck fractures in patients over 60 years is controversial. While much research has focused on the impact of total hip arthroplasty (THA) and hemiarthroplasty (HA) on surgical outcomes, little is known about patient preferences for either alternative. The purpose of this study was to elicit surgical preferences of patients at risk of sustaining hip fracture using a novel decision board. METHODS: We developed a decision board for the surgical management of displaced femoral neck fractures presenting risks and outcomes of HA and THA. The decision board was presented to 81 elderly patients at risk for developing femoral neck fractures identified from an osteoporosis clinic. The participants were faced with the scenario of sustaining a displaced femoral neck fracture and were asked to state their treatment option preference and rationale for operative procedure. RESULTS: Eighty-five percent (85%) of participants were between the age of 60 and 80 years; 89% were female; 88% were Caucasian; and 49% had some post-secondary education. Ninety-three percent (93%; 95% confidence interval [CI], 87-99%) of participants chose THA as their preferred operative choice. Participants identified several factors important to their decision, including the perception of greater walking distance (63%), less residual pain (29%), less reoperative risk (28%) and lower mortality risk (20%) with THA. Participants who preferred HA (7%; 95% CI, 1-13%) did so for perceived less invasiveness (50%), lower dislocation risk (33%), lower infection risk (33%), and shorter operative time (17%). CONCLUSION: The overwhelming majority of patients preferred THA to HA for the treatment of a displaced femoral neck fracture when confronted with risks and outcomes of both procedures on a decision board

Linking Swedish health data registers to establish a research database and a shared decision-making tool in hip replacement.

Sweden offers a unique opportunity to researchers to construct comprehensive databases that encompass a wide variety of healthcare related data. Statistics Sweden and the National Board of Health and Welfare collect individual level data for all Swedish residents that ranges from medical diagnoses to socioeconomic information. In addition to the information collected by governmental agencies the medical profession has initiated nationwide Quality Registers that collect data on specific diagnoses and interventions. The Quality Registers analyze activity within healthcare institutions, with the aims of improving clinical care and fostering clinical research.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

Children at stake : A rhetorical audience analysis of TV commercials for online casinos

This essay in rhetoric examines TV commercials for some of the biggest online casinos in Sweden. The aim is to identify if these gambling companies are targeting young people under 18 years old in their communication. Therefor I analyzed a total of three commercial movies – one from each gambling company – to determine which audience they are directing their communication to. To be able to do this I used Edwin Blacks theory the second persona and Kenneth Burkes theories identification and dramatism. With the use of the pentadic analysis method I found several factors that young people can identify themselves with. According to my results in the analysis I found that the second persona for each TV commercial was young people. Therefor I determined that some of the biggest gambling companies have young people as one of their target groups. I discuss my result in comparison to earlier research about both gambling commercial and children’s ability to understand and trust TV commercials. I also discuss the problematic of these kinds of commercials that targets young people and I’m therefore trying to create awareness about this issue

Arthroplasty in patients with femoral neck fractures [Elektronisk resurs]

The aim of this thesis was to analyze hip function and the health-related quality of life (HRQoL) in patients with a displaced fracture of the femoral neck treated with a cemented total hip arthroplasty (THA) or a hemiarthroplasty (HA), unipolar or bipolar. Moreover, the purpose was to analyze factors influencing the stability of the THA with special reference to the surgical approach and to evaluate the responsiveness of the Short Musculoskeletal Function Assessment (SMFA), i.e. the instrument’s ability to capture clinically important changes, in patients with femoral neck fractures. A four-year follow-up of a randomized controlled trial (RCT) of 120 elderly patients (mean age 81 years) with a displaced femoral neck fracture randomly allocated to treatment by either THA or bipolar HA (Study I). The results confirmed the better outcome regarding hip function and HRQoL after THA as compared to HA in the longer time perspective. In an RCT, 120 elderly patients (mean age 86 years) with a displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar HA or bipolar HA (Study II). The study showed that unipolar HA and bipolar HA appeared to produce equivalent clinical outcomes regarding hip function and HRQoL after one year, but with a significantly higher incidence of acetabular erosion in the unipolar HA group. In a cohort study, 713 consecutive hips in a series of 698 patients having undergone a primary THA (n = 311) for a displaced femoral neck fracture or a secondary THA (n = 402) due to a fracture healing complication after a femoral neck fracture were included (Study III). The results showed that the anterolateral surgical approach was associated with a significantly lower risk of dislocation than the posterolateral approach with or without posterior repair. In order to evaluate the responsiveness of the SMFA, the 120 patients from Study I were included (Study IV). To evaluate the internal responsiveness of the SMFA, the observed change and the Standardized Response Mean (SRM) in relation to the change in the Dysfunction Index and the Bother Index were calculated. In order to calculate external responsiveness, an External Criterion (EC) was constructed by using the Harris Hip Score. Receiver Operating Characteristic (ROC) curves and logistic regression analysis were used in the evaluation. The results of the study showed that the SMFA indices had good internal responsiveness and acceptable external responsiveness in patients with femoral neck fractures. In conclusion, THA is recommended as the primary treatment for the active, healthy elderly patient with a femoral neck fracture and long life expectancy. In the most elderly patients, bipolar HA and unipolar HA seem to produce equally good clinical results in the shorter time perspective, but the significantly higher incidence of acetabular erosion in the unipolar HA group may imply that bipolar HA should be the preferred treatment. Moreover, in order to minimize the risk of dislocation, we recommend the use of the anterolateral approach for THA in patients with femoral neck fractures. Finally, the SMFA can be recommended for use as one of the measures to evaluate the outcome after a femoral neck fracture

Children at stake : A rhetorical audience analysis of TV commercials for online casinos

This essay in rhetoric examines TV commercials for some of the biggest online casinos in Sweden. The aim is to identify if these gambling companies are targeting young people under 18 years old in their communication. Therefor I analyzed a total of three commercial movies – one from each gambling company – to determine which audience they are directing their communication to. To be able to do this I used Edwin Blacks theory the second persona and Kenneth Burkes theories identification and dramatism. With the use of the pentadic analysis method I found several factors that young people can identify themselves with. According to my results in the analysis I found that the second persona for each TV commercial was young people. Therefor I determined that some of the biggest gambling companies have young people as one of their target groups. I discuss my result in comparison to earlier research about both gambling commercial and children’s ability to understand and trust TV commercials. I also discuss the problematic of these kinds of commercials that targets young people and I’m therefore trying to create awareness about this issue