Early Total Hip Replacement for Acetabular Fractures: Does Age Affect the Outcome?

Purpose: The aim of this study is to compare the functional outcomes and complication rates of early total hip replacement (THR) for acetabular fractures in the young versus the elderly populations, in a trial to reach a higher level of evidence to know whether to expand or limit the application of early THR to young patients. Methods: This was a multicenter retrospective comparative study that included patients who underwent early THR for an acetabular fracture in the period from February 2012 to December 2018 in one of three level one trauma centers. Patients were divided into an “elderly group” that included patients 65 years or older (seven males and seven females), and a “young group” that included patients younger than 65 years (11 males and three females). The mean period of follow up was 33.57 months (range 12-84). Results: The mean Harris Hip Score (HHS), at the final follow up, in the elderly group was 82.4 (range 75-92) while the mean HHS in the young group was 91.5 (range 72-100). The mean and median HHS in the young group were significantly higher than those in the elderly group. There was no statistically significant difference in the complication rate between the elderly and young patient groups. Conclusion: Significantly superior functional outcomes are expected from young patients managed with early THR for acetabular fractures compared to elderly patients, with comparable complication rates between both age groups. Therefore, there is more confidence to apply this procedure to younger patients when indicated.

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Feasibility and Safety of Left Bundle Branch Pacing for Advance Aged Patients: A Multicenter Comparative Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.661885 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhongyuan Ren ◽

Binni Cai ◽

Songyun Wang ◽

Peng Jia ◽

Yang Chen ◽

...

Keyword(s):

Elderly Patients ◽

Effective Means ◽

The Elderly ◽

Elderly Group ◽

Complication Rates ◽

Related Complication ◽

Aged Patients ◽

Fluoroscopic Time ◽

Symptomatic Bradycardia

Background: Left bundle branch pacing (LBBP) has been shown to be a safe and effective means to achieve physiological pacing. However, elderly patients have increased risks from invasive procedures and the risk of LBBP in elderly patients is not known. We aimed to investigate the safety and efficacy of LBBP in elderly patients >80 years of age.Methods: From December 2017 to June 2019, 346 consecutive patients with symptomatic bradycardia, 184 patients under 80 years of age and 162 over 80 years, were included and underwent LBBP. The safety and prognosis of LBBP were comparatively evaluated by measured pacing parameters, periprocedural complications, and follow-up clinical events.Results: Compared with the younger, the elderly group had worse baseline cardiac and renal function. LBBP was achieved successfully in both groups with comparable fluoroscopic time and paced QRS duration (110.0 [102.0, 118.0] ms for the young vs. 110.0 [100.0, 120.0] ms for the elderly, P = 0.874). Through a follow-up of 20.0 ± 6.1 months, pacing parameters were stable while higher threshold and impedance were observed in the elderly group. In the evaluation of safety, overall procedure-related complication rates were comparable (4.4 vs. 3.8%, young vs. elderly). For prognosis, similar rates of major adverse cardiocerebrovascular events (7.1 vs. 11.9%, young vs. elderly) were observed.Conclusions: Compared to younger patients, LBBP could achieve physiological pacing in patients over 80 with comparable midterm safety and prognosis. Long-term safety and benefits of LBBP, however, necessitate further evaluation.

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Differences in Preoperative Gastric Ultrasound Findings Between Old and Young Surgical Patients: A Retrospective Case-Control Study

10.21203/rs.3.rs-1137760/v1 ◽

2021 ◽

Author(s):

Jin Hee Ahn ◽

Jae-Geum Shim ◽

Sung Hyun Lee ◽

Kyoung-Ho Ryu ◽

Mi Yeon Lee ◽

...

Keyword(s):

Elderly Patients ◽

Case Control Study ◽

Young Patients ◽

The Elderly ◽

Young Group ◽

Pulmonary Aspiration ◽

Elderly Group ◽

Retrospective Case ◽

Cutoff Values ◽

Control Study

Abstract Background: Most gastric ultrasound studies have been conducted in young middle-aged patients. Although age is known to influence gastric ultrasound, comparisons of gastric ultrasound in elderly patients with young patients have not been well elucidated. This study aimed to 1) compare gastric ultrasound assessments between young and elderly patients, 2) determine whether the CSA cutoff values for elderly and young patients should be different, and 3) suggest CSA cutoff values for elderly patients.Methods: This retrospective case-control study evaluated the data of 120 patients who underwent elective surgery under general anesthesia between July 2019 and August 2020. Demographic and gastric ultrasound assessment data were retrieved. Patients were divided into the elderly group (n = 58, age: ≥65 years) and young group (n = 62, age: <65 years). The antral cross-sectional area (CSA) in the supine and right lateral decubitus positions (RLDP), semiquantitative three-point Perlas grade (grades 0, 1, and 2), and gastric volume were determined. CSAs according to different Perlas grades were compared between the two groups. The CSA cutoff values for predicting a high risk of pulmonary aspiration in both the groups were determined. Results: Among patients with Perlas grade 0 (empty stomach), the CSA supine and CSA RLDP were greater in the elderly group than in the young group (CSA supine: 5.12 ± 1.99 cm2 vs. 3.92 ± 0.19 cm2, P = 0.002, and CSA RLDP: 6.24 ± 0.43 cm2 vs. 4.58 ± 0.21 cm2, P = 0.002). The specificity, positive predictive value, and accuracy of the CSA decreased when the CSA cutoff value for the young group (CSA RLDP: 6.92 cm2) was applied to the elderly group. The CSA cutoff values for the elderly group were: CSA supine, 6.92 cm2 and CSA RLDP, 10.65 cm2.Conclusions: The CSA of the empty stomach was greater in elderly patients than in young patients. The CSA cutoff values for predicting pulmonary aspiration risk in elderly and young patients should be differentiated. We suggest that the following CSA cutoff values should be used for predicting pulmonary aspiration risk in elderly patients: CSA supine, 6.92 cm2 and CSA RLDP, 10.65 cm2.

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Distribution of Hounsfield Unit Values in the Pelvic Bones: A Comparison Between Young and Elderly Patients: A Retrospective Cohort Study

10.21203/rs.3.rs-484135/v1 ◽

2021 ◽

Author(s):

Naoya Inagaki ◽

Takaaki Tanaka ◽

Jun Udaka ◽

Shoshi Akiyama ◽

Tatsuki Matsuoka ◽

...

Keyword(s):

Elderly Patients ◽

Young Patients ◽

Hounsfield Unit ◽

The Elderly ◽

Young Group ◽

Ischial Tuberosity ◽

Elderly Group ◽

Ct Scans ◽

Pelvic Bone ◽

Pubic Bone

Abstract Background The fixation strength of bone screws depends on bone mineral density (BMD), so it is important to evaluate bone strength at fracture sites. Few studies have investigated BMD in the pelvis. The aims of this study were to measure the regional Hounsfield unit (HU) values in the cancellous bone of the acetabulum and pelvic ring and to compare these values between young and elderly patients. Methods This study enrolled young patients with high-energy trauma (aged 20–44 years; young group) and elderly patients with low-energy trauma (aged 65–89 years; elderly group). Patients without pelvic computed tomography (CT) scans, those with pelvic bone implants, and those who died were excluded. The HU values on the contralateral (non-fractured) side of the pelvis were measured on CT scans. The CT data were divided into 7 areas: the pubic bone, the anterior and posterior walls and roof of the acetabulum, the ischial tuberosity, the body of the ilium, and the third lumbar vertebra. The HU values in each area were compared between the young and elderly groups. Results Sixty-one young patients and 154 elderly patients were included in the study. The highest HU value was in the roof of the acetabulum regardless of age and sex. HU values were significantly higher in the ischial tuberosity and body of the ilium and lower in the pubic bone and anterior wall. The HU values in all pelvic areas were significantly lower in the elderly group than in the young group, especially in the anterior area. Conclusions HU values in the 6 pelvic areas were not uniform and were strongly related to load distribution. The HU distribution and age-related differences could explain the characteristic causes and patterns of acetabular fractures in the elderly and may help in surgical treatment.

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Presentation and Immediate Outcome of Surgical Treatment of Patients with Carcinoma of the Stomach - A Comparative Study between Young and Elderly patients

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v28i3.6507 ◽

1970 ◽

Vol 28 (3) ◽

pp. 145-150 ◽

Cited By ~ 1

Author(s):

SA Chowdhury ◽

MM Hussain ◽

J Ahmed

Keyword(s):

Surgical Treatment ◽

High Mortality ◽

Young Patients ◽

Partial Gastrectomy ◽

The Elderly ◽

Young Group ◽

Elderly Group ◽

Similar Proportion ◽

Mortality And Morbidity ◽

Carcinoma Of The Stomach

Carcinoma of the stomach is a common malignancy and have a high mortality. Incidence under the age of 45 is comparatively low but appear more aggressive then elderly group. This study was designed to describe the presentation and operative findings in the two groups of patients and to record the outcome of surgical management in these patients.A total of 86 cases were included in this study. 14 were from below 40 years (young group) and 72 were above 40 years (elderly group). Young patients had less definitive symptoms than elderly group. Pain (85.71%) and vomiting (78%) were the most prominent symptoms in both the groups. But in elderly a significant number 54(75%) of cases had anorexia. Lump and visible peristalsis were present in both groups in approximately similar proportion. Histopathologically younger patients had more aggressive disease than the elderly group.The operability in carcinoma of the stomach was more in young group probably due to physical fitness of patient. In both the groups antrum was the commonest site of malignancy. The incidence of malignancy in body was more in young patients. In young group tumor status was T4 in 54.5% and in elderly group 56% was in T4 stage. 80% had lymph node involvement in both the groups. Resection was possible in young group in about 90% and gastrojejunostomy in 9.09% cases. Conversely, in the elderly group resection was possible in 58% and gastrojejunostomy was done in 42% cases. Total gastrectomy was done in 18.18% in young group and 4% in elderly group. Another important finding was partial gastrectomy was done in 72.73% in young but 46% in elderly only. The mortality was more (18.2%) in young group in comparison to (10%) in elderly.Gastric carcinoma was found more aggressive in young with high mortality and morbidity. Efforts should be taken for early diagnosis and prompt surgical treatment. DOI: 10.3329/jbcps.v28i3.6507J Bangladesh Coll Phys Surg 2010; 28: 145-150

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Evaluation of Nonspecific Low Back Pain Using a New Detailed Visual Analogue Scale for Patients in Motion, Standing, and Sitting: Characterizing Nonspecific Low Back Pain in Elderly Patients

Pain Research and Treatment ◽

10.1155/2012/680496 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Yasuchika Aoki ◽

Shiro Sugiura ◽

Koichi Nakagawa ◽

Arata Nakajima ◽

Hiroshi Takahashi ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Elderly Patients ◽

Scoring System ◽

Young Patients ◽

The Elderly ◽

Young Group ◽

Elderly Group ◽

Clinical Impression ◽

Low Back

Because we have a clinical impression that elderly patients have low back pain while in motion and standing, but less pain when sitting, we investigate characteristics of nonspecific low back pain (NSLBP), using a new detailed visual analog scale (VAS) scoring system. One hundred eighty-nine patients with NSLBP were divided into an elderly group (≥65 years old, n=56) and a young group (<65 years old, n=133). Low back pain was evaluated by a traditional VAS scoring system, the Oswestry Disability Index (ODI), and a new detailed VAS scoring system in which pain is independently evaluated in three different postural situations (in motion, standing, and sitting). No significant differences were observed in traditional VAS and ODI scores between the two groups. The results of the detailed VAS showed no significant differences between the two groups while in motion and standing. However, the elderly group showed significantly lower VAS score while sitting compared to the young group. In this study of the first use of a new detailed VAS scoring system, differences in characteristics of NSLBP between elderly and young patients were successfully detected. This minor modification of the traditional VAS may be useful for characterizing and evaluating low back pain.

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NON CEMENTED BIPOLAR HEMI-ARTHROPLASTY, SURGICALLY INTERVENED FOR GERIATRIC FRACTURES OF NECK OF FEMUR, THAT ARE DISPLACED: A PROSPECTIVE CASE SERIES STUDY.

10.36106/3037389 ◽

2021 ◽

pp. 73-76

Author(s):

Arun Kumar.C ◽

Arun Kumar KV ◽

Ashwanth Narayan B ◽

Venkatachalam K ◽

Saran Karthik S ◽

...

Keyword(s):

Prospective Study ◽

Total Hip Replacement ◽

Hip Replacement ◽

The Elderly ◽

Transfusion Rate ◽

Complication Rates ◽

Neck Of Femur ◽

Total Hip ◽

Hemi Arthroplasty

Fracture neck of femur which are displaced, do not nd a place in the elderly where the head can be preserved even if there is a surgical intervention. Fixation devices like the DHS have time and again failed to satisfactorily treat these fractures. It's here that the Bipolar Hemi Arthroplasty comes to us, as a very handy operative tool. The question is, whether or not the stem of the Bipolar, be cemented or not. The problems of cementation in the elderly carries the risk of BCIs – the bone cementing implantation Syndrome; which can at times be fatal. Cementation makes, future needed Total Hip Replacement, more difcult. In this prospective study of patients conducted at Chettinad Hospital and Research Institute, Kelambakkam, South India ; we have chosen an age group between 61 to 75 years, with an inclusion criterion satisfying type III or IV Garden, but also at the same time, be classiable, as a type A or type B DORR's classication. Our male to female ratio was 1:2 the mean age was 68.5 years and 93.3% (n=84) of patients undergoing un-cemented Hemi-Arthroplasty, when graded by HHS were either Excellent or Good. We had no Poor outcomes in our study. Our minimum follow up was for 12 months, with a mean follow up of 23.5 months. All our cases were done by the Southern Moore's approach, with an average duration of surgery at 82 minutes. The blood loss on an average was 285 ml and the average blood transfusion rate was at 1.8 units. The average post operative stay was for 12 days. From this short-term prospective study, we concluded that Un-Cemented Hemi-replacement Arthroplasty gives Good to Excellent clinico-functional outcomes. It also does not cause any hindrance, if future Total Hip Replacement, is required. Our complication rates were also manageable, with only about 6.7% (n=6) patients, needing revision surgery due to stem loosening.

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Characteristics and Clinical Significance of Dome Impaction in Acetabular Fractures

10.21203/rs.3.rs-146669/v1 ◽

2021 ◽

Author(s):

Pengfei Wang ◽

Chen Fei ◽

Zhi Li ◽

Binfei Zhang ◽

Kun Yang ◽

...

Keyword(s):

Clinical Outcomes ◽

Functional Outcomes ◽

Demographic Characteristic ◽

Acetabular Fractures ◽

Sf 36 ◽

Surgical Data ◽

The Mean ◽

High Degree

Abstract ObjectiveThis study aimed to explore the characteristics of acetabular dome impaction fractures(ADIF) and evaluate the clinical outcomes. MethodsTwenty-two ADIF treated by single surgeon were analyzed. The location and size of impaction was measured through Mimics. Patients’ demographic, characteristic data, surgical data and clinical outcomes were collected. The quality of reduction was assessed using criteria described by Matta. Functional outcomes were evaluated using modified Merle d’Aubigné score and SF-36.Results40.91% of the ADIF located at the posterosuperior quadrant,36.36% of the ADIF located at anterosuperior quadrant, 22.73% of the ADIF involved both areas. The average impacted size was 467.24±308.25mm2. The average percent of the impacted was 17.18±8.94%（impaction size/ lunar surfaces）. At the final follow-up, the rate of excellent and good outcome per Matta’s radiographic grading was 77.27%. The modified Merle d’Aubigné score graded as excellent in 5(22.73%), good in 10(45.45%), fair in 5(22.73%), and poor in 2(9.09%). The mean score of SF-36 was 76.76±20.18. Avascular necrosis (AVN) developed in two patients. Heterotopic ossification(HO) developed in one patient. Sciatic nerve injury developed in one patient. Arthritis developed in one patient. ConclusionsThe ADIF can locate at the posterosuperior quadrant, the anterosuperior quadrant or involved both areas. Understanding the characteristics of the dome impaction can aid surgeons during reduction and fixation. Meanwhile, good to excellent outcomes and a high degree of patient satisfaction can be achieved in majority of the patients.

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Open reduction and internal fixation of quadrilateral plate fractures in the elderly: association between initial fracture pattern and outcomes

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04002-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Haiyang Wu ◽

Qipeng Shao ◽

Ranran Shang ◽

Chengjing Song ◽

Ximing Liu ◽

...

Keyword(s):

Internal Fixation ◽

Classification System ◽

Functional Outcomes ◽

Open Reduction ◽

The Elderly ◽

Acetabular Fractures ◽

Quadrilateral Plate ◽

Anatomic Reduction ◽

Functional Scores

Abstract Background Acetabular fractures with medial displacement of the quadrilateral plate (QLP) are common in the elderly. The presence of QLP fractures greatly increase the surgical difficulty of acetabular fractures. This study aims to evaluate the clinical radiological outcomes of open reduction and internal fixation (ORIF) in QLP fractures in elderly patients and to investigate factors potentially affecting the result. Methods We conducted a retrospective study. A series of 37 consecutive patients with acetabular fracture involving the QLP aged 60 years and older who received ORIF between January 2010 and May 2019 were included. QLP fractures were classified according to Walid’s classification system. Radiological outcomes were evaluated using Matta criteria and functional outcomes were assessed using the modified Merle d’Aubigné score. The relationships between Walid’s classification and radiological or functional outcomes were analyzed. Results According to Walid’s classification, 18, 13, 6 were classified as QLP1, QLP2 and QLP3, respectively. The average follow-up was 35.5 ± 10.7 months. We obtained anatomic reduction in 48.6 % (18/37) of cases, imperfect reduction in 40.5 % (15/37) of cases, and poor reduction in 10.8 % (4/37) of cases. Excellent-good functional scores were found in 83.7 % (modified Merle d’Aubigné). There were no cases of screw entering the hip, pull-out and loosening or implant failure during the follow-up. Walid’s classification was positively correlated with radiological outcomes of reduction (r = 0.661; P < 0.001), and functional outcomes (r = 0.478; P = 0.003). Unsatisfactory reduction was demonstrated a correlation with the development of post-traumatic arthritis (r =-0.410; P = 0.012). Conclusions ORIF may be suggested for quadrilateral plate fractures in the elderly. Walid’s classification system is associated with the reduction quality and functional recovery.

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A novel anatomical titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: A propensity-matched cohort study

10.21203/rs.2.21289/v2 ◽

2020 ◽

Author(s):

Haiyang Wu ◽

Ranran Shang ◽

Ximing Liu ◽

Chengjing Song ◽

Yanzhao Chen ◽

...

Keyword(s):

Functional Outcomes ◽

Operation Time ◽

Acetabular Fractures ◽

Matched Cohort ◽

Titanium Plate ◽

Reconstruction Plate ◽

Quadrilateral Plate ◽

The Mean

Abstract Background Surgical treatment of acetabular fractures involving quadrilateral plate is a challenge to orthopaedic surgeons. We have developed a novel fixation technique using a special shaped reconstruction plate combined with several buttress screws of quadrilateral plate which was also called Dynamic Anterior Plate-Screw System for Quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005(RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, anatomical titanium plate (ATP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures. Methods We led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the ATP group during the inclusion period (2016-2018), and were matched to 22 cases in our database of RP group (2008-2016). The primary outcome measures were quality of reduction and functional outcomes. Intraoperative conditions were also compared. Results Of these 22 consecutive patients in ATP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture (12cases, 54.5%) according to Letournel-Judet classification. The mean follow-up period was 23.1 months (range 12-37). There were no significant differences between the two groups with regards the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score( P > 0.05). Compared with the RP group, the ATP group has a shorter operation time(245.1 minutes vs. 286.8 minutes, P = 0.020), less intraoperative blood loss (1136.4 mL vs. 1777.3mL, P = 0.014) and transfusion (780.9 vs. 1256.8mL, P = 0.035). The complication rate was 18.2% in ATP group, and there was no significantly difference compared with the RP group (36.4%)( P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure. Conclusion s The fixation of anatomical titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The anatomical titanium plate of DAPSQ has the advantages of short operation time, less intraoperative bleeding and blood transfusion, and it is worth further promotion and research.

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Total hip arthroplasty in patients with acetabular fractures

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-5-620-627 ◽

2021 ◽

Vol 27 (5) ◽

pp. 620-627

Author(s):

A.A. Pronskikh ◽

◽

K.N. Kharitonov ◽

A.A. Korytkin ◽

S.V Romanova ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Total Hip Replacement ◽

Hip Arthroplasty ◽

Hip Replacement ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Total Hip ◽

Post Traumatic ◽

The Mean

Abstract. Introduction Total hip replacement is the most effective technique for the consequences of acetabular fractures. The study includes the literature review on the outcomes of total hip replacement (THR) in patients with post-traumatic coxarthrosis. Material and methods The search was performed via databases of PUBMED, SCOPUS, Google Scholar, Cochrane library, E-library and publications using the keywords “acetabulum”, “fracture”, “total hip arthroplasty” and “post-traumatic arthritis” published between 1995 and 2020. The exclusion criteria were a series of less than 10 patients, a follow-up period of less than 12 months. Abstracts of the meetings and review articles published either in Russian or in English were included in the study. Patients' demographic data, surgical characteristics and outcomes were reviewed. Results Total 1,843 publications were reviewed and the analysis included data from 20 studies with the total number of 1,184 cases reviewed. Surgical treatments of the patients were performed between 1984 and 2018. The follow–up period averaged to 5.5 ± 1.19 years (range, 2 to 18 years). The mean age of the patients was 56.4 ± 12.7 years. The mean interval from an injury to total hip arthroplasty was 8 ± 2.7 years. The mean Harris Hip Score was 39.4 ± 11 prior to surgery and 86.2 ± 22 postoperatively. The most common postoperative complications were heterotopic ossification (28.9 ± 10 %), aseptic loosening (8.15 ± 1.82 %) and periprosthetic joint infection (7.89+1.86 %). Complications that required revision surgery were noted in 13.47 ± 2.91 % cases. Conclusion THR in patients who sustained acetabular fractures is challenging, and bone grafts or acetabular augments would be needed to address an acetabular defect of any localization.

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