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Hip hemi-arthroplasty for neck of femur fracture:What is the current evidence?

World Journal of Orthopedics 2018年第11期9卷 235-244页

作者： Greg AJ Robertson Alexander M Wood Edinburgh Orthopaedic Trauma Unit Royal Infirmary of Edinburgh Orthopaedic Department Leeds General Infirmary

This editorial reviews and summarises the current evidence(meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach,two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component,three recent meta-analyses and one Cochrane review have found that while unipolar hemiarthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up(up to 1 year),there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome,complication profile,functional outcome and acetabular erosion rates at longer-term follow-up(2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis,unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique,three recent metaanalyses and one Cochrane Review have found that,while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip hemi-arthroplasties,cemented prostheses have lower rates of implant-related complications(particularly peri-prosthetic femoral fracture) and improved postoperative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality,cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure,one recent meta-analysis has found that,while staples can result in a quicker closure time,there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples

关键词： hemi-arthroplasty Prosthesis Stem Head Hip Femoral Neck Fracture Cement

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Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus

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World Journal of Orthopedics 2022年第2期13卷 178-192页

作者： Jari Dahmen J Nienke Altink Gwendolyn Vuurberg Coen A Wijdicks Sjoerd AS Stufkens Gino MMJ Kerkhoffs Department of Orthopedic Surgery Amsterdam UMCLocation AMCAmsterdam 1105AZNetherlands Department of Orthopedic Research ArthrexNaplesFL 34108United States

BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive endstage ***,there are no clinical studies on the Ankle *** To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple,cystic osteochondral lesions of the talus in patients with failed prior operative *** This is a prospective study during which patients were assessed preoperatively,at 2-and 6 wk,and at 3,6,12 and 24 mo *** with multiple,cystic or large(≥15 mm)osteochondral lesions of the talus after failed prior surgery were *** primary outcome measure was the numeric rating scale(NRS)for pain during walking at 2 years *** outcome measures included the NRS in rest and during stair climbing,the American Orthopaedic Foot and Ankle Society Hindfoot Score,the Foot and Ankle Outcome Score,the Short-Form 36 physical and mental component scale,and the Range of Motion(ROM).Radiographic evaluations were conducted to evaluate prosthetic loosening and *** rates and complications were also *** Two patients underwent an Ankle Spacer implantation on the *** NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years,in patient 1 and 2,*** other patient-reported outcome measures also improved *** were no re-operations nor *** imaging showed no loosening of the implant and no change of implant *** The Ankle Spacer showed clinically relevant pain reduction during walking,improvement in clinical outcomes as assessed with PROMs,and no complications or *** treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.

关键词： hemi-arthroplasty Ankle Spacer Talar surface implant Osteochondral lesions of the talus Endstage

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