Femoral Neck Osteotomy: A Salvage Procedure for Unstable and Locked Acetabulum Fractures in Selected Frail Patients

Introduction Purpose of the study is to present and discuss the femoral neck osteotomy as a salvage procedure for unstable, locked geriatric acetabular fractures in selected frail patients. When disadvantages and possible risks of other treatments exceed the benefits, this method may relieve pain and allow for early wheelchair mobilization in frail patients with limited mobility. Materials and Methods We report nine patients from 2008 to 2020, which were treated with an osteotomy of the femoral neck for an unstable acetabular fracture. Indications, ASA-Score, Frailty Index, operative procedure, length of hospital stay, complications and outcomes will be discussed. Results Patient’s age averaged 86 years (range 81–92). Acetabular fractures were classified as six both column fractures, two anterior column posterior hemitransversal fractures and one destruction of the acetabulum by multiple metastases. Fracture dislocation with medialization plus locking of the femoral head and a superomedial dome impaction were present in all patients. All patients were classified as ASA III/ IV and the average value on the CSHA Frailty index was 7 (range 6–7). The operation time averaged 52 min (range 34–62). Immediate wheelchair mobilization in seven out of nine patients was started postoperatively. Conclusion The osteotomy of the femoral neck may be discussed as a salvage procedure in low functional demanding, multimorbid, frail geriatric patients with unstable acetabular fractures and impairment of mobilisation due to a locked femoral head. The procedure has the advantages of a short operation time and immediate mobilization of the patients. However, this procedure only applies as a salvage solution in selected individual cases.

Application of a Novel Osteotomy Instrumentation as a Substitute Tool in Total Hip Arthroplasty

Background: Mechanical failure, power shortage, and unexpected contamination of oscillating saw occasionally happened in actualizing femoral neck osteotomy during total hip arthroplasty, while no appropriate alternative solution be available presently. This study aimed to introduce a novel osteotomy instrumentation (fretsaw, jig, cable passer hook) as a substitute tool while oscillating saw was unavailable in THA.Methods: This study included 40 patients (40 hips) who underwent femoral neck osteotomy during primary THA using the new osteotomy instrumentation (n=20) and oscillating saw (n=20). Clinical data and intraoperative findings of all patients were evaluated.Results: The mean osteotomy time was 22.3 ± 3.1 s (range, 17–30 s) and 29.4 ± 3.7 s (range, 25–39 s) in the oscillating saw group and the new osteotomy instrumentation group, respectively (P<0.001). The Harris Hip Score (HHS) improved in both groups; the mean HSS was 82.3 ± 2.5 and 83.3 ± 3.5 in the oscillating saw group and new osteotomy instrumentation group at 6 months after surgery, respectively (P=0.297).Conclusion: The original osteotomy instrumentation can be an ideal substitute tool for femoral neck osteotomy in THA, especially when the oscillating saw is unavailable or malfunctional.

The use of Fretsaw as a Substitute Osteotomy Tool while Oscillating Saw Malfunction in Hip Arthroplasty

Background: The occurrence of oscillating saw malfunction, power shortage, or contamination occurs frequently when implementing femoral neck osteotomy during total hip arthroplasty (THA). This study aimed to introduce the fretsaw as a novel substitute osteotomy tool with various advantages.Methods: Twenty patients (20 hips) who underwent primary THA were included. Ten patients underwent femoral neck osteotomy using a fretsaw, while the other 10 patients underwent the procedure using an oscillating saw. Intraoperative evaluation and radiographic data were obtained for all patients during and after surgery.Results: The mean osteotomy time was 20.60 ± 1.08s (range 16–27) and 22.10 ± 1.49s (range 16–31) in the oscillating saw and fretsaw groups, respectively. The mean osteotomy height was 1.21 ± 0.16 (range 1.01–1.43) cm and 1.14 ± 0.08 (range 1.02–1.28) cm in the oscillating saw and fretsaw groups, respectively. The use of fretsaw did not result in bone notch or blood splashes.Conclusion: The fretsaw can be a substitute femoral neck osteotomy tool with various advantages in THA while oscillating saw malfunction.

Severe Leg Length Discrepancy after Total Hip Arthroplasty: Where is the Problem- Cup or Stem? A Retrospective Controlled Study

Background: The factors that contribute to the severe leg length discrepancy (LLD) after total hip arthroplasty (THA) are presently unclear. In the current study, we investigated whether the acetabular cup position and femoral stem are related to the patients with severe LLD by comparing with patients who had the leg length equality.Materials and Methods: Between June 2013 and July 2019, patients undergoing unilateral primary THA in the Department of Orthopaedics at our institution were screened. According to the postoperative leg length difference, a total of 178 patients were included in the study. A group of 107 patients had leg length equality (LLD≤3 mm) and the other group of 71 patients had severe LLD (LLD≥15 mm). A standardized protocol for evaluation of anteroposterior hip radiographs was used to measure the postoperative LLD. The difference of acetabular cup position (vertical centre of rotation (VCR), horizontal centre of rotation (HCR)) and the femoral stem(stem height; stem size; femoral neck osteotomy level) between the two groups. We also assessed whether there was a difference in proximal femur morphology between the two groups.Results: On the femoral side, the mean stem height of (70.82±5.49) mm in the severe LLD group was significantly different from the (67.35±6.88) mm mean discrepancy in the leg length equality group (P < .001). Stem size and femoral neck osteotomy level showed no statistically differences between the two groups (P>0.05). On the acetabular side, there was no significant difference between the two groups in the VCR and HCR (P>0.05) . There was also no statistical difference in proximal femur morphology between the two groups (P>0.05).Conclusion: The main reason for the occurrence of severe LLD may be due to improper treatment of the femur side. Although preoperative template could choose a better stem size and femoral neck osteotomy level, surgeons need to pay more attention to the whole operation process of the femur stem.