O110] Hemiarthroplasty for intracapsular fractures of the proximal femur using HAC coated endoprosthesis--A study of outcomes and health economics in 515 patientsAim: To report the clinical and radiological outcome of consecutive hip hemiarthroplasties using the JRI-Furlong HAC coated femoral components. We also aim to analyse the cost implications and functional outcome.Methods: We reviewed 515 consecutive cementless hemiarthroplasties of the hip using HAC coated stems in 502 patients performed at one institution between 2001 and 2004. The femoral component is collared with a neck-stem angle of 127 • , made of stainless steel and fully coated with hydroxyapatite. A stainless steel bi-polar head was used in all cases. The minimum follow-up was 2 to a maximum of 5 years. Patient demographic data was collected from the medical records. The co-morbidity was recorded using a co-morbidity score, described by Charlson et al. The pre-operative, immediate post-operative and final follow-up radiographs of all patients were systematically reviewed for migration and subsidence of the stem, stem-bone radiolucency, calcar resorption, endosteal cavitation, and ectopic calcification. Any acetabular erosion was systematically measured. The radiographic stability of the femoral component was determined by Engh's criteria. Anterior thigh pain was quantified on a visual analogue scale (VAS). The quality of life was assessed using EuroQol EQ-5D.Results: The mean age was 86.2 years. Dislocation occurred in 11 patients (4 recurrent). Re-operations were performed in 26 patients. Three stem revisions were performed for aseptic loosening. Other re-operations were for infection (10), peri-prosthetic fractures (9), and recurrent dislocations (4). Intra-operative fracture of the calcar was recognised in 27 patients. Circlage wiring was performed in 20 of these patients. Three patients had the stem revised intra-operatively to a long-stemmed prosthesis. Nineteen hips were converted to total hip replacements (11 cemented cups, 8 HAC coated cups) at a mean 3.2 years. The femoral component was left intact in all these patients. Seventy-one per cent of the patients did achieve the pre injury mobility status at 12 months. Clinical outcome was recorded at last follow-up in 239 patients. The mean Harris and Oxford scores were 73 (49-86) and 28.4 (18-40), respectively. The Charnley score was 4.7 (3-6) for pain, 4.5(3-6) for movement and 4.9 (4-6) for mobility. Stable stem by bony in-growth was identified in 96.3%. Mean stem subsidence was 2.5 mm (0.20-5.4 mm). Radiolucencies were present around 11% of the stems involving not more than 3 zones and not exceeding 1 mm. Ectopic calcification was seen in 16 hips (Brooker's Grade I -12 hips; Grade II -4 hips). Overall survival at 5 years with removal or repeat revision of either component for any reason as the end point was 85.2% (95% CI ±11.2). The overall cost of treatment using this prosthesis was less (6-19%) than the conventional cementless/cemented hemiarthroplasty. The cost benefit analysis was 0.6...
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