Purpose Total hip arthroplasty (THA) as primary treatment for displaced femoral neck fractures is controversial as THA is associated with higher rates of dislocation but lower rates of re-operation compared to hemiarthroplasty (HA). A dual mobility cup (DMC) design is associated with lower dislocation and re-operation rates in elective surgery. Is this also the case when used to treat displaced femoral neck fractures? The aim of this study is to compare rates of dislocation and re-operation of any kind following treatment for displaced femoral neck fractures with either bipolar HA or THA with DMC. Methods Two consecutive groups of patients treated for displaced femoral neck fractures at the Regional Hospital in Viborg in Denmark were included. In 2007-2008 171 patients (mean age 84.1 years) were treated with bipolar HA. In 2009-2010 175 patients (mean age 75.2 years) were treated with THA with DMC. Data regarding rates of dislocation and re-operation were obtained by retrospective review of medical records. Results We found a statistically significant difference regarding rates of dislocation and re-operation of any kind in favour of THA with DMC. Dislocation occurred in 25/171 patients [95 % confidence interval (CI) 9.3-19.9 %] treated with bipolar HA and 8/175 patients (95 % CI 1.5-7.7 %) treated with THA with DMC (p=0.002). Re-operations were required in 32/171 patients (95 % CI 12.9-24.6 %) treated with bipolar HA and 16/175 patients (95 % CI 4.8-13.4 %) treated with THA with DMC (p=0.01). Conclusions Our findings indicate that THA with DMC is superior to bipolar HA following treatment for displaced femoral neck fractures in regard to rates of dislocation and re-operation.
Introduction: Acute displaced femoral neck fractures are often treated with cemented hemiarthroplasty (HA). There is increasing evidence that total hip arthroplasty (THA) may be a better alternative, but the degree to which the fixation of the femoral stem used affects the outcome is not fully known. The aim of this study is to compare rates of operative complications and implant survival following THA treatment of displaced femoral neck fractures with either a cemented or an uncemented femoral stem. Methods: The study consists of two groups of patients (N = 334), who were treated for a displaced femoral neck fracture with THA at the Regional Hospital of Viborg during 2007–2012. The first group (50.9%) had uncemented (Corail®) stem while the second group (49.1%) had cemented (Exeter®) stem implanted. Nearly all patients had uncemented dual mobility cup (Saturne®) as acetabular component and were followed up to three months postoperatively. Data regarding rates of implant survival and operative complications were obtained by retrospective review of medical records. Results: We found a statistically significant difference regarding rates of postoperative reoperation with 1.2% (95% CI 0.005–0.03) for cemented and 5.9% (95% CI 0.02–0.09) for uncemented stem (p = 0.02). The main causes for reoperation were peri-prosthetic fractures and deep infections. There was no difference regarding dislocation or peroperative complications. Rates of dislocation were 4.3% (95% CI 0.012–0.07) for cemented and 3.5% (95% CI 0.008–0.06) for uncemented stem (p = 0.72). Rates of peroperative complications were 6.1% (95% CI 0.024–0.1) for cemented and 8.2% (95% CI 0.04–0.12) for uncemented stem (p = 0.1). Discussion: Our results indicate that cemented femoral stem is superior to cementless when rates of reoperation are compared.
Assessment of acetabular retroversion is currently based on conventional anteroposterior (AP) Xray of the pelvis using the cross-over sign (COS) 1 , the posterior-wall-sign (PWS) 2 and the ischialspine-sign (ISS) 3 as the gold standard for evaluation and comparison. Retroversion of the acetabulum has been proposed to contribute to femoro-acetabular pincer impingement (FAI) and development of osteoarthritis 4-7 and thus, radiographic imaging is important in the clinical assessment. FAI is a clinical diagnose where retroversion of the acetabulum may be a cause. Retroversion is a complex 3-dimensional expression where the opening of the superior part of acetabulum is oriented posteriorly instead of anteriorly. Thus, COS describes the expression and PWS and ISS are signs of rotation of the whole acetabular complex. Since symptoms of FAI often start at young age with groin pain during activity young individuals risk exposure to repeated radiation, as they are referred for repeated X-rays for diagnosis, monitoring, surgical planning and postoperative follow-up. The pelvic region is relatively sensitive to radiation, particularly in children and adolescents and thus, radiation exposure should be as low as reasonably achievable. Previous experimental and clinical research in other anatomical areas has proven the dose reduction potential of the low-dose radiographic system (EOS) as compared to conventional digital radiography systems 8-13. The main difference between conventional radiography and EOS is the nature of image acquisition; EOS being a full-body slot-scanner with the option to acquire orthogonal views simultaneously using very low radiation dose associated with the proportional multi-wire chamber detector 14. Few studies have compared EOS-images of the pelvis with
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