Introduction

We implemented an exhaustive operative and supervision algorithm for surgical treatment of hip fractures primarily based on own previously published literature. The purpose was to improve supervision and reduce the rate of reoperations.

Introduction: We derived an exhaustive operative and supervision guideline for the treatment of hip fractures from the current international and own published literature, and implemented the guidelines in our department.

Methods: 1274 unselected consecutive patients admitted with a hip fracture were included, 336 of these prospectively after implementation of the new guideline. Demographic parameters, hospital treatment and re-operations were assessed from patient journals. Re-operations were recorded after six months.

Results: 95% (320/336) of operative procedures were found to have followed the new guideline treatment compared to 78% (733/938) prior to its introduction (p< 0.001 X2). Retrospectively we found that only 12% (121/1053) of operative procedures performed as the new guideline prescribes were re-operated compared to 24% (53/221) of operative procedures performed with other methods (p< 0.001 X2). In logistic regression analysis combining sex, age, ASA score, cognitive function, new mobility score, time from admission to operation and level of surgeon’s experience, not following the guideline was the only significant predictor for re-operation (p< 0.001 log. reg.)

After implementing the guideline, the rate of unsupervised junior registrars performing operations declined from 20% (188/938) to 6% (21/336, p< 0.001 X2). The rate of reoperations declined from 15% (139/938) to 10% (35/336, p=0.044 X2, p=0.043 log.reg.), with a 20% (85/436) to 13% (23/174) decline for intracapsulary and an 11% (54/502) to 7% (12/162) decline for extracapsulary fractures.

Conclusion: An exhaustive operative guideline for hip fracture treatment can be implemented. In our case, the guideline both raised the rate of supervision and reduced the rate of reoperations.

Introduction: Analysis of the clinical outcome and survivalrate of the Harris/Galante 1 cup combined with two different stems.

Material and methods: Retrospective study on patients who underwent surgery in the years 1986–1989. There was a total of 544 patients with 593 total hip replacements (THR), 264 patients died prior to investigation (285 THR).

All deceased were checked in the danish patient registration system for revision. 113 patients with 128 THR were operated with the Spotorno CLS stem, and 431 patients with 465 THR with the Mller straight stem.

270 patients with 297 THR were assessed radiographically and according to a modified Harris Hip Score (ROM was not used). Some were due to age or other illnes not able to attend the examination. If possible they were interviewed by telephone.

The median age was 69,4 (range 18,3 – 88,1) for all, for the Spotorno CLS group 55 years (range 18–72) and for the Mller group 72 years (41–88). Male/female ratio: 0,56. Average follow-up was 13 years (range 9,1 -15.1).

The primary diagnosis was osteoarthritis 538 hips, RA 10, fracture sequelae 15, congenital dislocation 14, others contributed with 16 hips.

The survival rates were calculated using the Kaplan-Meier method.

Results: 35 patients have had a revision: 21 because of aseptic loosening, 4 because of femoral fracture, 5 because of dislocation, and 1 because of infection. 4 liners were revised because of polyethylene wear. Only one was in the Mueller group, 3 in the CLS group.

After 13 years the survival rate for the cups was 96.8% including reoperations for polyethylene wear, for the femoral Mueller stem 90.7% and for Spotorno CLS 96.1 %

Conclusion: The Harris/Galante cup and Spotorno show excellent survival after 13 years, and for the Mueller stem the survival rate is comparable to others. The relative high rate of polyethylene wear in the CLS group we believe to be a consequense of the younger patients more active lifestyle.