OBJECTIVE: To study the incidence and risk factors of osteonecrosis of the femoral head (ONFH) after internal fixation in adult patients with femoral neck fracture (FNF) after 2000, and identify high-risk population of ONFH. METHODS: PubMed, Medline, The Cochrane Library, CNKI, Wanfang and VIP Database were searched to collect all the literatures on ONFH and related risk factors after internal fixation of FNF from January 1th 2000 to July 1th 2020. Study extraction was performed according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literatures extraction, management and data entry, and R Studio 3.6.5 software was used for Meta-analysis. Subgroup analysis, sensitivity analysis and publication bias detection were used to explore the sources of heterogeneity and the reliability of the evaluation results. RESULTS: A total of 16 studies with 5521 patients were included. Meta-analysis showed that the incidence of ONFH after internal fixation for adult FNF was 14.5% [95% CI(0.126-0.165)]. Fracture displacement[OR=0.27, 95%CI(0.21-0.35)] and reduction quality [OR=0.15, 95%CI(0.09-0.27)] were related risk factors for ONFH. The results of subgroup rate analysis showed that the non-displaced fracture necrosis rate was 6.2%[95%CI(0.051-0.077)] and the displaced fracture necrosis rate was 20.4% [95%CI(0.166-0.249)];the good reduction fracture necrosis rate was 8.3%[95%CI(0.072-0.095)] and the poor reduction fracture necrosis rate was 35.5%[95%CI(0.233-0.500)]. The included literatures have good consistency and no publication bias. CONCLUSION After 2000, the total incidence of ONFH after internal fixation of adult FNF has decreased, while the necrosis rates of patients with displaced fracture and poor reduction are still at a high level. The interval between injury and surgery was not analyzed in this study because of the inconstant division in the original literature.
Adult ; Femoral Neck Fractures/complications* ; Femur Head ; Femur Head Necrosis/surgery* ; Humans ; Reproducibility of Results ; Risk Factors

INTRODUCTIONSlipped capital femoral epiphysis is the most common hip problem in the adolescent age group. It can involve both hips, presenting itself bilaterally at first presentation or sequentially. The overall incidence of bilateral disease is variable, but the risk of occurrence is higher when there is underlying endocrinopathy, renal disease and obesity.

MATERIALS AND METHODSAmongst the 36 cases (44 hips) of slipped capital femoral epiphysis that we had, there were 8 cases of bilateral disease, of which 3 were bilateral sequential slips. A retrospective review of all case records and X-rays was done.

RESULTSAccording to Aadalen's criteria, the results were excellent or good in 37 hips, fair in 3 hips, and poor in 2 hips. Two patients were considered as treatment failure because of avascular necrosis. The incidence of bilateral slipped capital femoral epiphysis was 22.2%. The overall average age was 11.4 years. All cases of sequential involvement presented within 15 months of the initial slip. One patient had hypothyroidism (who also had a positive family history for slipped capital femoral epiphysis), while 91.6% were above the 75th percentile for weight. There was no statistically significant difference in age, sex, race, body mass index (BMI) and weight percentile distribution between patients with unilateral and bilateral disease.

CONCLUSIONSatisfactory outcomes can be expected in most patients treated for slipped capital femoral epiphysis. The risk of avascular necrosis is higher in unstable slips. The role of prophylactic contra-lateral pinning should be restricted to patients with hypothalamic-pituitary-ovarian axis disease, especially hypothyroidism.

Adolescent ; Bone Nails ; Child ; Epiphyses, Slipped ; complications ; prevention & control ; surgery ; Female ; Femur Head ; surgery ; Femur Head Necrosis ; etiology ; Humans ; Male ; Recurrence ; Treatment Outcome

OBJECTIVETo study short-term results of hip resurfacing arthroplasty (HRA) in the treatment of patients with avascular necrosis of femoral head (ANFH), and to explore indication and strategy in this surgery.

METHODSFrom December 2006 to December 2009, 37 patients (43 hips) with avascular necrosis of femoral head were treated with total hip resurfacing arthroplasty. Among the patients, 25 patients were male and 12 patients were female, with an average age of 44.5 years (ranged, 21 to 67 years). According to ARCO classification, 3 hips were 3A stage, 6 hips were 3B stage, 16 hips were 3C stage and 18 hips were 4 stage. X-ray evaluation of the patients were conducted. The clinical results were evaluated by the Harris hip score system including pain,range of motion, correction of deformity and total function.

RESULTSThirty-four patients (40 hips) were followed up with an average period of 32.4 months (ranged, 16 to 53 months), and 3 patients were lost. Thirty-seven hips got complete relief of joint pain and 3 patients feel aching pain after walking. There was 1 heterotopic ossification, no femoral neck fracture no dislocation, no infection and no revision in all patients. From pre-operation to present, the average Harris hip score improved significantly from (51.5 +/- 1.7) to (94.3 +/- 1.4). Thirty-seven hips got an excellent result, 3 hips good and no poor.

CONCLUSIONThe total hip resurfacing arthroplasty is an effective solution for the problems of the younger and active patients with ANFH, and the short-term results are satisfying.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Femur Head Necrosis ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; epidemiology

By discussing different ways on prediction, prevention and treatment of femur head necrosis (FHN), to provide a theory reference for future clinical application. By searching, reading and summarizing related-literatures through CNKI, VIP, CBM and foreign-related literature, to sum up the relevance methods and techniques of currently used. It was found that imaging study (especially X-ray and MRI) was of great importance in prediction. There were several ways (both non-surgical or surgical) for prevention and treatment. FHN collapse was affected by many factors, but most of the researches were all focus on one aspect of the mechanism and based on small samples. It is necessary to have a research with a large sample and to compare the effect on different treatment. Early and effective imaging inspection is needed for high risk group of FHN; possibility of collapse should be predicted for existing FHN; core decompression or vascularized bone grafting are required for collapse of high risk group. Early prediction and treatment are essential for FHN patients.
Bone Transplantation ; Decompression, Surgical ; Femur Head Necrosis ; complications ; diagnostic imaging ; surgery ; Humans ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

OBJECTIVETo assess the curative effect and investigate the indications of total hip arthroplasty for treatment of comminuted intertrochanteric fractures.

METHODSTotal hip arthroplasty was carried out in 9 cases of severe intertrochanteric fracture. The patients included two men and seven women. The average age of the patients was 68 years (48-75 years). The period from fracture to operation was 5 days (2-10 days). The mean follow-up period lasted for 11 months (3 months-2 years). There was one patient with comminuted intertrochanteric fracture accompanied by femoral head necrosis and 2 patients with intertrochanteric fracture and stroke. Other 6 patients had severe osteoporosis. The Harris score before operation was 63 points (45-71 points).

RESULTSAt the last follow-up, the patients gained 86 points (70-100 points) according to the Harris score. The effects of the 8 cases were good. The Harris score of all patients improved after treatment. Only two hemiplegia patients needed sticks to walk. The others could walk without hip pain. No radiographic evidence of acetabular wear and prosthesis dislocation or other major complications happened during the follow-up.

CONCLUSIONSProsthetic replacements can well treat unstable intertrochanteric fracture if operative indication is correctly selected. It is suitable for elderly patients and the operation should be performed by experienced surgeons.

Aged ; Arthroplasty, Replacement, Hip ; methods ; Female ; Femur Head Necrosis ; epidemiology ; Fractures, Comminuted ; surgery ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Treatment Outcome

OBJECTIVETo evaluate middle and long-term results of total hip arthroplasties (THA) for the treatment of secondary hip traumatic osteoarthritis and femoral head necrosis after acetabular fractures.

METHODSFrom January 2000 to December 2005, 33 patients with secondary hip traumatic osteoarthritis and (or) femoral head necrosis after acetabular fractures were treated with THA. There were 21 males and 12 females, ranging in age from 27 to 69 years old, with an average of 52 years old. Twenty-three patients were performed with open reduction and internal fixation: 5 patients were treated with anterior approach; 12 patients, posterior approach; 6 patients, combined approaches; other 10 patients, conservative treatment in the early stage. All THA were performed with posterior-lateral approach. Bone union was achieved in the all acetabular fractures. Removal of all implants was necessary in 5 patients, and partial removal in 3 patients. Cemented cup was implanted in 6 patients and uncommented cup in 27 patients. Intraoperative and postoperative complications were observed, and Harris hip scores before surgery and 10 years after operation were compared. The prosthetic loosening, osteolysis or revision were used to evaluate 10 years survival rate of prosthesis.

RESULTSAll the patients were followed up,and the duration ranged from 10 to 15 years, with a mean of 12 years. One patient died at the 10th year after operation. The Harris score at the 10th year was higher than the preoperative one. One and two patients were performed with revision total hip arthroplasty caused by aseptic loosening alone and aseptic loosening combined with osteolysis respectively. Osteolysis occurred in 1 patient; deep venous thrombosis in 4 patients; dislocation of prosthesis in 2 patients. One patient had infection of incision and one patient had infection around the prosthesis. Ten years survival rate of implant was 84.8% (28/133).

CONCLUSIONTHA is an effective method to treat secondary hip traumatic osteoarthritis and (or) femoral head necrosis after acetabular fractures in improving hip joint functions with high implant survival rate and good middle and long-term results.

Acetabulum ; injuries ; Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Female ; Femur Head Necrosis ; surgery ; Fractures, Bone ; complications ; Hip Injuries ; complications ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip ; surgery ; Postoperative Complications ; surgery

BACKGROUND: The number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience. METHODS: This study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months). RESULTS: The preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients. CONCLUSIONS: There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.
Adult ; *Arthroplasty, Replacement, Hip/adverse effects ; Bone Transplantation ; CD4 Lymphocyte Count ; Femoral Fractures/complications/*surgery ; Femur Head Necrosis/complications/*surgery ; Fractures, Ununited/complications/*surgery ; HIV Infections/*complications/immunology/transmission/virology ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Male ; Middle Aged ; Postoperative Complications ; Viral Load ; Young Adult

BACKGROUND: Early stage osteonecrosis of the femoral head (ONFH) has many treatment options including core decompression with implantation of a tantalum rod. The purpose of this study was to evaluate clinical and radiological outcomes and potential complications during conversion total hip arthroplasty (THA) in such patients. METHODS: Six male patients (8 hips) underwent THA subsequent to removing a tantalum rod (group I) from April 2010 to November 2011. We retrospectively reviewed the medical records of these patients. We enrolled 12 age- and sex-matched patients (16 hips) during the same period, who had undergone primary THA without a previous operation as the control group (group II). All patients were followed for at least 3 years. We checked the Harris hip score (HHS), operative time, and volume of blood loss. Radiological results, including inclination, anteversion of the acetabular cup, presence of periprosthetic osteolysis, and subsidence of femoral stem were checked at the last follow-up. RESULTS: The mean preoperative HHS values were 56.5 (range, 50 to 62) and 59.1 (range, 42 to 70) in groups I and II, respectively. The HHS improved to 96.0 (range, 93 to 100) and 97.6 (range, 93 to 100), respectively, at the 3-year follow-up (p = 0.172). Mean operation time was 98.8 minutes (range, 70 to 120 minutes) in group I and 77.5 minutes (range, 60 to 115 minutes) in group II (p = 0.006). Total blood loss volumes were 1,193.8 mL (range, 960 to 1,360 mL) and 944.1 mL (range, 640 to 1,280 mL) in groups I and II, respectively (p = 0.004). No significant differences in inclination or anteversion of acetabular cup and no evidence of osteolysis or subsidence of the femoral stem were reported in either group in radiological follow-up results. However, one case of squeaking occurred in group I during the follow-up. CONCLUSIONS: The two groups showed no clinical or radiological differences except extended operative time and increased blood loss. However, the incidence of squeaking (1 of 8 hips) was higher, as compared to the control group or previously reported values.
Adult ; *Arthroplasty, Replacement, Hip/adverse effects/methods/statistics & numerical data ; Case-Control Studies ; *Decompression, Surgical/adverse effects/methods/statistics & numerical data ; Femur Head/diagnostic imaging/surgery ; Femur Head Necrosis/diagnostic imaging/*surgery ; Humans ; Male ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Tantalum/*therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome

BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Female ; Femoral Neck Fractures/complications/radiography/*surgery ; Femur Head Necrosis/etiology/radiography ; Follow-Up Studies ; *Fracture Fixation, Internal ; Fractures, Ununited/radiography ; Hip Joint/*pathology/radiography ; Humans ; Male ; Middle Aged ; Odds Ratio ; Treatment Outcome