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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 12 - 12
1 Sep 2012
Skettrup M Kjersgaard AG Colding C Solgaard S
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Introduction

The postoperative management of patients after total hip replacement traditionally includes restrictions of movements and the use of aids (toiletelevation, sleeping pillow, a.o.) in the first 3 months after operation. Few studies have investigated the benefit of such restrictions. The aim of the present study was to evaluate how patients with total hip replacements (THR) are doing with and without restrictions in the first 3 months after surgery, and if walking ability and patients satisfaction was influenced by the postoperative regime.

Patients and Methods

80 patients undergoing primary uncemented THR were randomized to either the conventional regime with restrictions of movement and obligatory use of aids, or a postoperative regime without restrictions. Surgery was performed through a posterolateral short incision. The femoral component was the uncemented Bimetric prosthesis, non collared with HA coating, and a 36 mm femoral head. The cup was the Trilogy cup with a highly crosslinked polyethylen liner. No postoperative drainage was used and immediate weight bearing was allowed in both groups. We monitored walking speed, TUG score (timed up and go) and VAS pain score. The patients were scored by a trained physiotherapist preoperatively, 2 times each day during admission, and 14 and 90 days after surgery. Radiographic examination was performed after 3 days and after 3 months. At the 3 months evaluation a SF-36 score was registered.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 90 - 90
1 May 2011
Solgaard S Kjersgaard AG
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Introduction: Since 2000 all total hip replacements have been subjected to a continuous quality control. We report an increasing rate of postoperative fractures around uncemented femoral components after minimal or no trauma.

Methods: Four to 6 weeks after the THR all patient files and radiographs are evaluated and demographic data, complications and radiographic position of the implant registered. Surgery was performed according to the manufacturer’s instructions, and full weight bearing was allowed. If a fracture occurred during the first postoperative weeks a further analysis of the case was performed.

Results: During the 9 years 3.295 primary total hip replacements were performed. In the period the use of uncemented THR increased from 41% to 99%. Totally 69 fractures in 2.408 uncemented THR’s (2.9%) were registered, and 28 of these were of the proksimal split fracture type occurring without any previous trauma. The fractures occurred after a few days up to 4 weeks after surgery and were characterised by a vertical femoral fracture from the calcar to the medial femoral region 5 to 7 cm below the lesser trochanter. All cases were seen in women, but were not correlated to age, BMI or previous femoral neck fracture. In most cases treatment was internal fixation with a trochanteric grip and cables and insertion of a new uncemented femoral component.

Conclusion: The increased use of uncemented femoral components implies a substantial risk of subtrochanteric femoral fracture. The cause of these fractures is unknown, but probably multifactorial. It could be due to a mismatch between the instruments and the prosthesis, to undiagnosed weakness of the bone, or to the vigorous mobilisation made possible by the effective modern treatment of postoperative pain.