scholarly journals Proximal Femur Metastasis Treatment With Fixation or Hip Replacement. Results of 47 Patients

2021 ◽  
Author(s):  
Selahaddin Aydemir ◽  
Cihangir Türemiş ◽  
Hasan Havitcioğlu ◽  
Sermin Özkal ◽  
Ali Balcı ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Hip Replacement ◽  
Length Of Hospital Stay ◽  
Cancer Type ◽  
Patient Demographics ◽  
Replacement Method ◽  
Implant Placement ◽  
Fixation Group ◽  
Treatment Data ◽  
Impending Fracture

Objective: Purpose of the present study was to compare patients with proximal femur metastasis with actual or impending fractures who were treated by fixation or prosthetic hip replacement. Method: Twenty-seven patients underwent fixation treatment (IM nail, DHS), and 20 patients prosthetic (endoprosthesis or total hip arthroplasty) replacement. Data were analyzed regarding patient demographics, cancer type, localization and type of metastasis, actual or impending fracture, number of bone metastasis, presence of spinal or visceral metastasis and treatment data (ASA class, length of hospital stay or surgery or survival, cement usage, adjuvant treatment, postoperative walking status). Results: Fixation group (63 years) was younger than prosthesis group (70 years) (p: 0.03). Fixation was more preferred at subtrochanteric area (p˂0.001). Cementation of the lesion was more preferred and surgery time was longer at fixation group (p: 0.01). Greater number of complications (mostly medical) were more likely to be seen in the fixation group (6 ‘1 loosening’ vs 3 ‘1 dislocation’). Conclusion: It is not still clear whether one implant is clearly superior to other one, however it was revealed again that nailing was mostly preferred for the subtrochanteric area and tended to have more complications although mostly medical and unrelated to implant placement as previously reported

scholarly journals Recognising anaemia and malnutrition in vascular patients with critical limb ischaemia

2010 ◽  
Vol 92 (6) ◽  
pp. 495-498 ◽  
Author(s):  
M Shah ◽  
A Martin ◽  
B Myers ◽  
S MacSweeney ◽  
T Richards
Keyword(s):  
Nutritional Status ◽  
Hospital Stay ◽  
Nutritional Assessment ◽  
Length Of Hospital Stay ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Patient Demographics ◽  
Laboratory Markers ◽  
Bed Days ◽  
Poor Nutrition

INTRODUCTION Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI. PATIENTS AND METHODS Two observational studies were undertaken, initially a retrospective series of 27 patients with CLI. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 32 patients, laboratory markers to identify the cause for anaemia were assessed. Further nutritional status was assessed by records of height, weight, body mass index and a validated scoring system. RESULTS In the retrospective series, 15 patients (56%) were anaemic. Ten (37%) were transfused a median of 2 units (range, 2–13), a total of 35 units. Patients who were transfused had lower Hb on admission (P = 0.0019), most were anaemic on admission (90%). At discharge, most patients were anaemic (n = 23; 83%). In the prospective series of 32 patients, 20 (63%) were anaemic. Nutritional assessment was performed on 18, only seven patients were scored undernourished. This was increased to 23 by an independent assessor. Anaemia was associated with malnutrition (n = 17; P = 0.049) and an increased hospital stay (mean 25 days [SD 16] vs mean 12 days [SD 8], P = 0.0125; total 513 vs 144 bed days). CONCLUSIONS Anaemia and poor nutrition are common and not recognised in vascular patients presenting with critical limb ischaemia. Anaemia is associated with and increased length of hospital stay.

Patient-Reported Outcome following Metal-On-Metal Resurfacing of the Hip and Total Hip Replacement

2009 ◽  
Vol 19 (3) ◽  
pp. 245-250 ◽  
Author(s):  
David P. Hall ◽  
Del Srikantharajah ◽  
Raimond E. Anakwe ◽  
Paul Gaston ◽  
Colin R. Howie
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Short Form ◽  
Length Of Hospital Stay ◽  
Multivariate Regression Analysis ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Additional Patient ◽  
Total Hip ◽  
Patient Reported

Patient-reported outcome and satisfaction scores have become increasingly important in evaluating successful surgery. This case-matched control study compared patient-reported outcome and satisfaction data following hip resurfacing and total hip arthroplasty. Thirty-three consecutive patients selected for hip resurfacing were compared with 99 patients undergoing cemented total hip replacement (THR), matched for age, sex and pathology. Participants completed a Short-Form 12 Health Survey (SF-12) and Oxford Hip Score questionnaire preoperatively and 6 months post operatively with an additional patient satisfaction questionnaire. There was no difference in length of hospital stay. While both groups reported improved outcome scores, multivariate regression analysis did not demonstrate any significant benefit for one group over the other. Both groups reported high levels of satisfaction, which tended to be better in patients undergoing hip resurfacing.

scholarly journals Prediction of Bone Damage Formation in Resurfacing Hip Arthroplasty

2019 ◽  
Vol 9 (1) ◽  
pp. 5879-5885
Keyword(s):  
Hip Arthroplasty ◽  
Hip Replacement ◽  
Femoral Bone ◽  
Cobalt Chromium ◽  
Element Analysis ◽  
Left Femur ◽  
Bone Model ◽  
Replacement Method ◽  
Physiological Loading ◽  
Resurfacing Hip Arthroplasty

Resurfacing Hip Arthroplasty (RHA) is a hip replacement method that is widely known nowadays. However, the complication on femoral bone fracture often happens in this hip replacement method which associated with the implant positioning. The objective of this study is to predict the damage formation on the bone which resulting from the RHA pin malposition. Finite element analysis was conducted in order to predict the damage formation on the bone model based on the computed tomography (CT) image of a patient. A 3D inhomogeneous bone model was developed from a 47 year old patient with an osteoarthritis disease located on the left femur. The material used for the RHA implant model is cobalt chromium and the implant is then being inserted into the femoral bone. Straight implant position with angle 130° was selected as a reference in the analysis while another three position of varus (> 130°) and valgus (<130°) were selected and known as the pin malposition. The simulation was conducted on each of the selected angles in order to predict the damage formation towards the bone model. The damage formation obtained was from the results of elements failure which occurred after applying the load. Physiological loading of a human which focusing on the normal walking condition was selected as the loading and boundary condition in this study. The femoral bone model experienced the highest damage formation when the implant located at the varus position while reduced significantly when the implant placed at the valgus position.

scholarly journals Decreasing the Blood Transfusion Rate in Elective Hip Replacement Surgery Using an Autologous Drainage System

2007 ◽  
Vol 89 (2) ◽  
pp. 136-139 ◽  
Author(s):  
SW Sturdee ◽  
DJ Beard ◽  
G Nandhara ◽  
SV Sonanis
Keyword(s):  
Blood Transfusion ◽  
Hip Replacement ◽  
Drainage System ◽  
Length Of Hospital Stay ◽  
Transfusion Rate ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
Drain Group ◽  
The Mean ◽  
Arthroplasty Surgery

INTRODUCTION This is a prospective study looking at the effectiveness of autologous postoperative drains in primary uncemented total hip replacement (THR) surgery. PATIENTS AND METHODS A total of 86 patients were studied, with 43 using standard suction drains (normal drain group) and 43 using autologous drains (autologous drain group). RESULTS Thirty-seven units of homologous blood were transfused in the normal drain group and 5 units in the autologous drain group. The mean number of units of homologous blood transfused per patient was reduced from 0.86 to 0.12 (P < 0.01) with the use of autologous drains and the transfusion rate was reduced from 23% to 6% (P < 0.02). The mean length of hospital stay was also reduced by two nights (P < 0.05). There were no adverse effects from using the autologous system and it does reduce the need for a homologous blood transfusion. CONCLUSIONS The system is simple and easy to use and we have also found it to be cost effective. Previously, it has not been reported as being effective in hip arthroplasty surgery, unlike knee arthroplasty surgery. We would recommend using autologous postoperative drains in primary THR surgery.

scholarly journals Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hsuan-Hsiao Ma ◽  
Te-Feng Arthur Chou ◽  
Shang-Wen Tsai ◽  
Cheng-Fong Chen ◽  
Po-Kuei Wu ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Internal Fixation ◽  
Femoral Neck Fracture ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Reoperation Rate ◽  
Fixation Group ◽  
Neck Fracture

Abstract Background Although internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures. Methods We performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration. Results Our results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD − 0.800, 95% CI − 1.011 to − 0.589) and operation duration (SMD − 2.497, 95% CI − 2.801 to − 2.193) were shorter in the internal fixation group. Conclusions Compared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.

Combined Hepatic Arterial Embolization and Hepatic Ablation for Unresectable Colorectal Metastases to the Liver

2012 ◽  
Vol 78 (11) ◽  
pp. 1243-1248 ◽  
Author(s):  
Zhi Ven Fong ◽  
Francesco Palazzo ◽  
Laurence Needleman ◽  
Daniel B. Brown ◽  
David J. Eschelman ◽  
...  
Keyword(s):  
Hepatic Metastases ◽  
Length Of Hospital Stay ◽  
Arterial Embolization ◽  
Therapeutic Benefit ◽  
Colorectal Metastases ◽  
Patient Demographics ◽  
Kaplan Meier ◽  
Hepatic Ablation ◽  
Tumor Distribution

Liver-directed therapy for hepatic metastases includes: intra-arterial techniques such as trans-arterial chemoembolization (TACE) and yttrium-90 resin (90Y) microsphere radioembolization and ablative technologies: cryoablation, radiofrequency ablation, and microwave ablation. Combining embolization techniques with liver ablation may enhance the therapeutic benefit of each and result in improved patient survival. We retrospectively reviewed our experience with combined intra-arterial therapies and ablation for unresectable hepatic colorectal metastases from 1996 to 2011. Patient demographics, tumor characteristics, specific liver-directed treatments, procedure-related morbidity and mortality, and overall survival were recorded. There were 17 (53%) males and 15 (47%) females. Average age for the group was 74.1 years (median, 75.5 years). Fifteen patients (46.9%) had a single hepatic metastasis. Eleven (34%) patients had bilobar tumor distribution and seven (22%) patients had vascular invasion of the portal vein or hepatic/caval venous structures. Seven (21%) tumors were greater than 5 cm in diameter. Twenty-seven (84.4%) patients received TACE and five (15.6%) received 90Y. Fourteen (43%) were embolized before any ablation. Fifty-three per cent of patients required multiple hepatic ablation sessions. Median length of hospital stay was 1 day. There were no procedure-related mortalities and complications occurred in six (18.8%) patients. Mean follow-up for the group was 33 months. Kaplan-Meier 1-, 3-, and 5-year estimated survival was 93.8, 50.0, and 10.1 per cent, respectively. Median survival for the group was 46 months. Hepatic ablation and embolization techniques can be combined safely with minimal morbidity. In our series, we observed 5-year survival in 10 per cent of patients.

scholarly journals Patient and primary care delays in the diagnostic pathway of gynaecological cancers: a systematic review of influencing factors

2019 ◽  
Vol 69 (679) ◽  
pp. e106-e111 ◽  
Author(s):  
Pauline Williams ◽  
Peter Murchie ◽  
Christine Bond
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Gynaecological Cancer ◽  
Current Evidence ◽  
Cochrane Library ◽  
Cancer Type ◽  
Patient Demographics ◽  
Diagnostic Pathway

BackgroundGynaecological cancers are the second most common female cancer type, with survival rates in the UK lower than in many comparable countries. A potentially important factor in the UK’s poorer cancer outcomes is diagnostic delay; gynaecological cancers are the cancer type most likely to be affected by less timely diagnosis.AimTo examine current evidence for factors that contribute to patient and primary care delays in the diagnostic pathway of gynaecological cancer.Design and settingA systematic review of the available literature.MethodPRISMA guidelines were followed. MEDLINE and Embase databases and the Cochrane Library were searched using three terms: primary care; gynaecological cancer; and delay. Citation lists of all identified articles were searched. Two authors independently screened the titles, abstracts, and full texts of publications. Data extraction was performed by one author and quality assured by a second reviewer in a 20% sample of selected articles. Synthesis was narrative.ResultsA total of 1253 references was identified, of which 37 met the inclusion criteria. Factors associated with delayed diagnosis were categorised as either patient factors (patient demographics, symptoms or knowledge, and presentation to the GP) or primary care factors (doctor factors: patient demographics, symptoms or knowledge, and referral process); and system factors (such as limited access to investigations).ConclusionDelayed diagnosis in the patient and primary care intervals of the diagnostic journey of gynaecological cancer is complex and multifactorial. This review identifies areas of future research that could lead to interventions to enable prompter diagnosis of gynaecological cancers.

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