Increased mortality after a hip fracture has been associated with age, sex, and comorbidity. In order to estimate the long-term mortality with reference to hip fracture type, we followed 499 patients older than 60 years who had been treated surgically for a unilateral hip fracture for 10 years. At admission, patients with femoral neck fractures (n = 172) were 2 years younger than intertrochanteric patients (77.6 +/- 7.7 [SD] vs. 79.9 +/- 7.4 [SD], P = 0.001) and had a greater prevalence of heart failure (57% vs. 40.3%, P = 0.03). Similar mortality rates were observed at 1 year in both types of fracture (17.9% vs. 11.3%, log rank test P = 0.112). Mortality rates were significantly higher for intertrochanteric fractures at 5 years (48.8% vs. 34.7%, P = 0.01) and 10 years (76% vs. 58%, P = 0.001). Patients 60-69 years old with intertrochanteric fractures had significantly higher 10-year mortality than patients of similar age with femoral neck fractures (P = 0.008), while there was no difference between the groups aged 70-79 (P> 0.3) and 80-89 (P = 0.07). Women were less likely to die in 5 years (relative risk [RR] = 0.57, 95% confidence interval [CI] 0.41-0.79, P = 0.0007) and 10 years (RR = 0.65, 95% CI 0.49-0.85, P = 0.002). Age, sex, the type of fracture, and the presence of heart failure were independent predictors of 10-year mortality (Cox regression model P < 0.0001). The intertrochanteric type was independently associated with 1.37 (95% CI 1.03-1.83) times higher probability of death at 10 years (P = 0.002). In conclusion, the type of fracture is an independent predictor of long-term mortality in patients with hip fractures, and the intertrochanteric type yields worse prognosis.
Among 1685 patients who sustained a hip fracture at the island of Crete (Greece) in a 4-year period we found 106 patients with bilateral noncontemporary hip fractures. Pathologic hip fractures and fractures that emerged from high energy trauma were excluded. To investigate the possible factors predisposing to the later fracture in the sound hip, we studied these 106 patients and compared them with the 1579 patients who sustained a single hip fracture (control group). There was no significant difference between the mean age of the bilateral group at the time of the first hip fracture (78.3 +/- 7.4 years, range 52-94 years) and the mean age of the control group (77.3 +/- 11.9 years, range 50-101 years). We found no significant difference in the bone status between the two groups, using both lumbar spine dual photon absorptiometry (DXA) and calcaneus broadband ultrasound attenuation (BUA). Falls, which were the main cause of all the hip fractures, were much more common in the bilateral group. The second hip fracture was of the same location (trochanteric or cervical) in 92% of the trochanteric and 68% of cervical fractures and a tendency to greater displacement or instability was observed. Of the second hip fractures 75% happened in the first 48 months after the first one. The mean interval time was much longer (160 months) when a neck fracture was followed by a trochanteric one.
Robotic arm-assisted arthroplasty was introduced in 2006 and has expanded its applications into unicompartmental knee, total knee, and total hip replacement. The first case of a revision surgery from conventional unicompartmental to total knee arthroplasty with the utilization of the robotic arm-assisted MAKO system is presented. An 87-year-old female presented with deteriorating left knee pain due to failure of medial unicompartmental knee arthroplasty at the outpatient clinic. The patient was advised to undergo revision surgery. Through medial parapatellar arthrotomy, the joint was exposed. With the use of the MAKO system, the estimated depth of the medial plateau according to CT planning was found to be 10 mm more distal than the lateral. The resection line of the remaining plateau was placed deliberately 2 mm more distal in order to achieve satisfactory replacement of the bony gap of the medial tibial condyle by a 10 mm augment. The patient had an uneventful recovery. A plethora of additional applications in the future, such as total shoulder or reverse total shoulder arthroplasty, megaprosthesis placement in oncological patients, and total hip or knee revision surgeries, may improve patient-related outcomes.
We assessed the bone mineral density (BMD), the body mass index (BMI), and the hip axis length (HAL) in 78 postmenopausal women with 38 cervical and 40 trochanteric hip fractures. The results were compared with those of age-matched, control postmenopausal women. No statistically significant difference was found in the values of BMD, BMI, and HAL between the groups of patients with cervical and those with trochanteric fractures, but lower BMD and BMI were found in fracture patients compared with the corresponding values of the control subjects. Contrary to the existing data, HAL was found to be shorter in the fracture patients compared with the controls. Thus, the type of hip fracture was found to be independent of the value of BMD, BMI, and the length of the patient's hip axis. The fact that a shorter hip axis was found in the group of fracture patients compared with that found in the control subjects raises questions about the significance of this parameter as an independent risk factor for hip fracture.
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