COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Methods- The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail. Results: The age of the patients in present study was in range of 60 - 80 years. There was a preponderance of female in present study in both groups. The mean duratioin of surgery in the Bipolar group (91.24±9.21Minutes) was much More That In PFN (53.12 ±6.02Minutes) Group. All patients of Bipolar group was discharged between 4 to 9 days and in PFN group 4 to 12 days after surgery. The average harris hip score in PFN group is 87.32±4.13 and in Bipolar group is 85.02±7.92. Final functional outcome were better in PFN group (P value 0.01) than by Bipolar group and significant. Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results. Keywords: Hip Arthroplasty, PFN, Complication

Differences in hip fracture care in Europe: a systematic review of recent annual reports of hip fracture registries

Purpose Hip fractures are of growing interest due to their increasing number, subsequent functional decline and high institutionalization rate of patients, mortality, and costs. Several process measurements are essential for hip fracture care. To compare and improve these, hip fracture registries in Europe became popular. This systematic review aims to describe the differences between hip fracture registries in Europe as well as the differences in hip fracture treatment between countries. Methods A systematic search using the keywords “hip fracture” AND “national” AND “database OR audit OR registry OR register” was performed in PubMed, Embase and Cochrane Library according to PRISMA guidelines till 3rd December 2020. Recent annual reports of identified hip fracture registries in Europe were additionally identified in June 2021. Comparisons of most common case-mix, process and outcome measurements were performed. Results 11 registries in Europe were identified. Differences were observed regarding inclusion criteria of the different registries. Comparison of the different registries was difficult due to differences in the way to report measurements. While mortality rates differed substantially between countries, most of the process measurements met recommendations according to recent guidelines. Conclusion Hip fracture registries were a valid tool to compare hospitals within one country. However, a comparison between registries of different countries should have also been easily possible. For this, the registries need to make their data easily accessible and further unify their way of measuring and reporting.

ANALISIS PELAKSANAAN PROGRAM INDONESIA SEHAT DENGAN PENDEKATAN KELUARGA PADA INDIKATOR HIPERTENSI DI WILAYAH KERJA PUSKESMAS KABUPATEN BADUNG

ABSTRAK Program Indonesia Sehat dengan Pendekatan Keluarga (PIS-PK) terdiri dari 12 indikator salah satunya adalah indikator penderita hipertensi berobat secara teratur. Kabupaten Badung sudah terindeks pra sehat namun menduduki peringkat kedua terendah capaian indikator hipertensi berobat secara teratur (24,52 %) se Provinsi Bali. Tujuan penelitian untuk mengetahui pelaksanaan (PIS-PK) pada indikator hipertensi di wilayah kerja Puskesmas Kabupaten Badung khususnya dari segi input, proses dan lingkungan. Desain penelitian yang digunakan adalah penelitian deskriptif kualitatif. Penelitian dilaksanakan di Puskesmas Kuta II dan Mengwi III pada bulan Maret – Juli 2020. Jumlah informan 20 orang dipilih dengan purposive sampling. Pengumpulan data dengan wawancara mendalam dan FGD, kemudian dianalisis tematik. Validasi data dengan triangulasi sumber dan peer debriefing. Hasil penelitian yaitu input : SDM yang bertanggung jawab yaitu pemegang program hipertensi; tidak ada dana khusus untuk mendukung PIS-PK pada indikator hipertensi; Sarana prasarana pendukung berupa tensimeter, pinkesga dan alat tulis; metode berupa kunjungan keluarga; sasaran yaitu keluarga. Proses : Perencanaan berupa pembuatan tim dan jadwal tindak lanjut; Implementasi dilakukan dengan kunjungan, posbindu dan program inovasi; Monev melalui rapat minilok, pelaporan via aplikasi KS dan laporan bulanan. Lingkungan internal dan geografi tidak mempengaruhi program. Faktor ekonomi akan mempengaruhi gaya hidup masyarakat. Faktor sosial budaya mempengaruhi pelaksanaan program. Kata Kunci: PIS-PK, Hipertensi, Puskesmas, Badung ABSTRACT The Healthy Indonesia Program with the Family Approach (HIP-FA) consists of 12 indicators, such as an indicator of hypertension sufferers taking medical treatment regularly. Badung regency has indexed pre-healthy. Nevertheless, Badung Regency occupies the fourth position with the highest number of hypertension sufferers and ranks the second lowest achievement indicator of hypertension for regular treatment (24.52%). This study aims to determine the implementation (HIP-FA) of hypertension indicators in Badung District Health Center, especially in terms of inputs, processes and outputs. The research design uses a qualitative descriptive study. The investigation takes place in Kuta II and Mengwi II Health Center from March - July 2020. The number of informants is 20 people that were selected through purposive sampling. The data was collected through in-depth interviews and FGD and analyze by thematic analysis. The data is validated by the triangulation of sources and peer debriefing. The research results which is the inputs: The HR responsible for the PIS-PK hypertension indicator is the holder of the hypertension program at the Public Health Center: There are no special funds to support PIS-PK on the hypertension indicators: Supporting equipment such as tensimeter, pinkesga and stationary: Method of family visit, the target is the family. Process: Planning in the form of team building and follow up schedule: The implementation is carried out by visiting Posbindu and innovation programs: M&E is conducted once and every 3 months through minilok meetings and reporting via the KS application and monthly reports. The internal environment and geography do not affect the program. Economic factors do not affect the implementation of the program but will affect people's lifestyles. Socio-cultural factors influence the implementation of the program. Keywords: HIP-FA, Hypertension, Primary Health Care, Badung

REHABILITATION PROTOCOL AFTER HIP ARTHROSCOPY

Introduction Pain in the hip joint area related to the femoro-acetabular impingement syndrome, local cartilage damage, or labrum tear is an increasingly common cause of orthopedic consultations. In the case of failure of conservative treatment, the treatment of choice is the arthroscopic treatment of the lesions and arthroplasty. As after any surgical procedure, an important aspect is subsequent rehabilitation, which may increase the positive effect of the treatment. Aim This article aims to present the original rehabilitation procedure after hip arthroscopy. Material and methods The presented rehabilitation program lasts about 5–9 months and consists of four stages. The first stage, lasting two weeks, mainly focuses on protecting the treated structures, reducing pain, and preventing adhesions and blood clots. Stage two, which lasts up to 4–6 weeks, is to restore the correct gait pattern and progress exercises from stage one. In the third stage, which lasts up to 12 weeks, rehabilitation focuses on regaining the full range of motion, muscle strength, and endurance similar to the non-operated leg. After a positive functional assessment, the patient progresses to the fourth stage, which prepares him to return to the entire sports activity. The decision to return to sport is based on the relevant results of the functional assessment and clinical examination. Results This work presents the original protocol of rehabilitation after arthroscopic procedures of the hip joint. Comparing the rehabilitation process, criteria for progression, and the time to return to sport, the protocol proposed by us is in line with the currently accepted rehabilitation trends in the world. Conclusions The rehabilitation protocol proposed by our team was based on the authors’ experience and the available literature. The rehabilitation process has been divided into 4 phases with precise criteria for progression. Biomechanical Functional Assessment plays an important role in the control of the entire course of rehabilitation. Keywords: hip arthroscopy, rehabilitation protocol, functional evaluation

Design and Evaluation of a Hip Joint Implant Wear Simulator

Every year a high number of total hip arthroplasty is reported worldwide and an increase in this number is expected. Several factors may cause hip wear, such as osteoarthritis, obesity, traffic accidents and sport practicing. Wear is a concern when considering hip prostheses, since a prosthesis presents finite life that in many cases is shorter than patient life, and leads to substitution. Also, research is constant and new developments have to be tested, which leads to the necessity of testing devices that reproduce real conditions of hip joint implant functioning. This work describes a low-cost device, according to the ISO 12242. The equipment was built, a set of three commercially available prostheses was tested and the results show wear values coherent with those found in literature. It was found a value of wear rate of (13.30 ± 3,81) mg/106 cycles; wear factor found was (0.41 ± 0,09) x 10-6 mm3 /Nm. After testing, the device was evaluated and no component presented significant wear. Keywords: Hip joint simulator; Prostheses; Wear; Arthroplasty; Test machine.

Morphometrical Analysis of Dry Adult Human Hip Bones by Coxal Index

Background: The hip bone is one of the most useful skeletal elements in adult skeleton for sex determination. Hip bone may be used even when fragmentary for both medico legal and archaeological purposes. The aim of the present study is to measure few morphometric parameters of various hip bones and to assess these values both side wise and gender wise. Method: The present study was conducted in department of Anatomy, Yenepoya Medical College, Mangalore. 100 adult dry human hip bones were included in the study, of which 50 were male and 50 were female hip bones. 50 bones belonged to right side and 50 to left side. The morphometrical parameters measured were length, width and weight of the hip bones. Coxal index was also calculated. Result: Range, mean, median, standard deviation and standard error of mean were determined for each parameter. Conclusions were drawn after comparing the values with series of other workers. Conclusion: The values were slightly higher on the left side compared to the bones of the right side and also the values were more in male bones compared to female bones. The study would help the forensic experts and the anthropologists in specimen identification and sex determination from skeletal remains. It would also be valuable for the anatomists and the orthopedicians in their respective fields. Keywords: Hip bone, morphometry, coxal index, sexual dimorphism, hip bone weight.

Neurogenic Heterotopic Ossification of the Hip after Brain Injury. Function Recovery Preserving Hip Joint: A Case Report

Introduction: Up to 30% of patients with spinal cord injury and to 20% of patients with traumatic brain injury develop neurogenic heterotopic ossification (NHO). Patients develop restriction in joint range of motion (ROM) and impairment in activities of daily life. When neurological recovery occurs, joints dysfunction represents the cause for patients’ autonomy loss. Case Report: We present the case of a 39-year-old Caucasian male involved in a car accident and experienced 14 days of post-traumatic coma. After rehabilitation, no residual motor or sensory neurological deficit was present, but bilateral NHOs surrounding hip joints developed. Seventeen months after trauma, the patient was admitted to our institute. He was confined to bed, absolutely unable to walk, stand or sit. Radiological evaluation consisted in Antero-Posterior X-ray view only, due to the inability to open up his hips for lateral views, and 3D computed tomography scan. “Functional resection” of the ossifications was performed and rehabilitation started from day 1 after surgery. At the final follow-up 24 months from the second operation high grade of clinical satisfaction was reported. The patients were able to walk independently, to put on his socks, and to drive a car and bike. Painless right and left hip ROM was, respectively, 100° and 90° for flexion, 10° for extension, 35° and 30° for abduction, and near normal internal and external rotation. The patient referred that further improvement in mobility and fluency was still present day by day. Conclusion: The rarity of the condition frequently bring to a delay in treatment and the absence of specific guidelines made treatment still dependent on surgeon experiences. A multidisciplinary approach is essential for success. Surgeons should be aware that it is important to refer patients to specialized center, because early resection could provide excellent results, preserving hip, and restoring function and patient independency. Keywords: hip, ossifica

COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity. Methods: The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail. Results: The average harris hip score in PFN group is 88.21±4.36 and in Bipolar group is 85.21±8.12. Final functional outcome were better in PFN group (P value 0.02) than by Bipolar group and significant. Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results. Keywords: Hip arthroplasty, PFN, Complication

Mode I and II Wear in Ceramic on Ceramic Total Hip Arthroplasty: A Case Report

Introduction: Elective total hip arthroplasty (THA) is a common procedure and has been associated with favorable outcomes in both elderly and younger patients. A variety of implant and articular components exist so to allow surgeons to make a patient-specific choice with the intent of maximizing both patient outcomes and implant survival. The utilization of ceramic bearing surfaces during THA has become increasingly prevalent, with their tribological profile conveying favorable wear and osteolysis-resistant properties. Typically, ceramic articulating components are most susceptible to failure through brittle fracture or complications such as squeaking. Case Report: This case describes a 68-year-old Caucasian male who underwent revision of ceramic on ceramic THA due to pain, with intraoperative analysis revealing evidence of gross Mode I acetabular ceramic component wear with a resultant Mode II wear articulation between the ceramic femoral head and acetabular liner. Conclusion: Wear between ceramic implants in THA is infrequently reported, and as such awareness of this uncommon phenomena as well as its potential causative factors is important when considering either primary or revision THA involving ceramic bearing components. Keywords: Hip, arthroplasty, revision, ceramic, wear.

STUDY OF GREATER SCIATIC NOTCH FOR DETERMINATION OF SEX OF HIP BONE BY METRIC METHOD

Background: The distinctive morphology of human skeleton and its clear sexual dimorphism make it of interests from anatomical, forensic, obstetrical, radiological and anthropological point of view. The hip bone is considered as an ideal bone for sex determination as it provides the highest accuracy levels. Many workers have studied various metric parameters for sexing of hip bone. Methods: The present study was done with an aim to find out the sex of hip bone using various parameters of greater sciatic notch. For this purpose, 100 dry hip bones were collected from the Department of Anatomy. Seven different parameters of the greater sciatic notch were used for the study: Maximum width, Maximum depth, Posterior segment, Index I, Index II, Total angle and Posterior angle. Results: All the parameters (especially posterior segment, posterior angle and index II) were found to be highly indicative of sex hip bone by t- test (p<0.005) except the depth. Conclusion: By the present study it was concluded that the width and depth of the greater sciatic notch were a less useful criteria for sexing purposes while the posterior angle was found to be the best parameter, which identified 75 % of left and 88 % of right male hip bones and 92 % of left and 100 % of right female bones. Length of the posterior segment and Index II also assigned sex to a high percentage of hip bones, specially to the female ones (95-97 %), these results suggests that the widening of the greater sciatic notch found in females has occurred mainly in its posterior part. Keywords: Hip, Bone, Index