PURPOSE: This study was performed to analyze the potential impact of cement use and favorable pre-injury activity on clinical outcomes of bipolar hemiarthroplasty (BHA) compared with total hip arthroplasty (THA) in elderly patients with femoral neck fractures. MATERIALS AND METHODS: Systematic review and meta-analysis of 12 clinical studies (5 randomized controlled trials and 7 comparative studies). Subgroup analysis was performed based on type of fixation method (cemented vs. cementless) and in the patient with independent ambulation, respectively. RESULTS: A significantly higher dislocation rate was observed in patients treated with THA compared with those treated with BHA in individuals capable of independent ambulation before injury (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.62; P=0.05, Z=1.98). Also, the dislocation rate was significantly higher in patients treated with cemented THA compared with those treated with cemented BHA (OR, 0.18; 95% CI, 0.05–0.62; P=0.006, Z=2.73). EQ-5D was significantly higher in those treated with cemented THA compared with patients treated with cemented BHA. Lastly, HHS was significantly higher in patients treated with cementless THA compared with those treated with cementless BHA. CONCLUSION: An increase in the dislocation rate was observed when THA was performed in elderly patients with femoral neck fracture and who were pre-injury independent walkers. In addition, cemented THA was associated with a higher dislocation rate compared with cemented BHA. However, the dislocation rate in those treated with cementless THA were similar to patients treated with cementless BHA. With regards to functional score, THA was superior to BHA in both cementless and cemented fixation.
Aged ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Butylated Hydroxyanisole ; Dislocations ; Femoral Neck Fractures ; Femur Neck ; Hemiarthroplasty ; Humans ; Methods ; Walkers ; Walking

PURPOSE: The aim of the current study is to report the advantage and disadvantage of total hip arthroplasty performed in direct anterior approach (DAA) by comparing it to the posterolateral approach (PLA). MATERIALS AND METHODS: Twenty-five hip arthroplasty done in DAA (12 total hip arthroplasty [THA] and 13 bipolar hemiarthroplasty [BHA]) were compared with the same number done in PLA (13 THA and 12 BHA). Intraoperative assessments including operation time, anesthetic time, bleeding amount were recorded with intraoperative complications. Immediate postoperatively, position of the prosthesis and leg length discrepancy were measured and were compared between the two approaches. RESULTS: The operation time was 22 minutes and 19 minutes longer in DAA for THA and BHA respectively while the anesthetic time difference was 26 and 10 respectively. However, these parameters showed no statistical difference. No significance was found when bleeding amount was compared. For DAA, cup alignment was within safe zone in 100% both for inclination and for anteversion while this was 83.3% and 75.0% respectively in PLA. Leg length difference was 3 mm in DAA and 5 mm in PLA but had no significant difference. Tensor fascia lata tear was the most common complication occurring in 9 patients. CONCLUSION: Although significant was not reached there was trend toward more operation time and anesthetic time when DAA was used. However, the trend also showed that cup and stem were likely to be in more accurate position and in adequate size which is likely due to the accurate use of fluoroscopy.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Bleeding Time ; Butylated Hydroxyanisole ; Fascia Lata ; Fluoroscopy ; Hemiarthroplasty ; Hemorrhage ; Hip* ; Humans ; Intraoperative Complications ; Leg ; Prostheses and Implants ; Tears

PURPOSE: To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. MATERIALS AND METHODS: From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were > or =70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). RESULTS: Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. CONCLUSION: In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.
Aged* ; Butylated Hydroxyanisole ; Early Ambulation ; Femoral Fractures* ; Femur ; Fracture Fixation, Intramedullary ; Fracture Healing ; Hemiarthroplasty* ; Hip Fractures ; Hospitalization ; Humans ; Medical Records ; Reoperation ; Retrospective Studies

Butylated hydroxyanisole (BHA) is a synthetic phenolic compound consisting of a mixture of two isomeric organic compounds: 2-tert-butyl-4-hydroxyanisole and 3-tert-butyl-4-hydroxyanisole. We examined the effect of BHA against hydrogen peroxide (H2O2)-induced apoptosis in primary cultured mouse hepatocytes. Cell viability was significantly decreased by H2O2 in a dose-dependent manner. Additionally, H2O2 treatment increased Bax, decreased Bcl-2, and promoted PARP-1 cleavage in a dose-dependent manner. Pretreatment with BHA before exposure to H2O2 significantly attenuated the H2O2-induced decrease of cell viability. H2O2 exposure resulted in an increase of intracellular reactive oxygen species (ROS) generation that was significantly inhibited by pretreatment with BHA or N-acetyl-cysteine (NAC, an ROS scavenger). H2O2-induced decrease of cell viability was also attenuated by pretreatment with BHA and NAC. Furthermore, H2O2-induced increase of Bax, decrease of Bcl-2, and PARP-1 cleavage was also inhibited by BHA. Taken together, results of this investigation demonstrated that BHA protects primary cultured mouse hepatocytes against H2O2-induced apoptosis by inhibiting ROS generation.
Animals ; Apoptosis/*drug effects ; Butylated Hydroxyanisole/chemistry/*pharmacology ; Cell Survival/drug effects ; Cells, Cultured ; Hepatocytes/*drug effects ; Hydrogen Peroxide/*toxicity ; Male ; Mice ; Mice, Inbred ICR ; Molecular Structure

PURPOSE: The purposes of the current study were to assess the early results of cementless hip arthroplasty (HA) for femoral neck fractures in elderly patients with severe osteoporosis and to compare the clinical outcomes between those who underwent total HA (THA) or bipolar hemiarthroplasty (BHA). MATERIALS AND METHODS: From April 2011 to May 2012, we performed 87 cementless HAs for displaced femoral neck fractures in elderly patients (> or =65 years) with severe osteoporosis. Among them, we studied 70 hips that were able to be followed-up for >24 months. Of these, 34 underwent THA and 36 underwent BHA. Clinical results were evaluated using the Harris hip score (HHS), Koval classification, and radiographs. RESULTS: Only one instance of femoral stem loosening was observed. Additionally, no dislocations were observed and no revision surgeries were required. The mean changes in the functional items of the HHS scores were 2.8 and 5.2 for those who underwent THA and BHA, respectively (P<0.05). According to the Koval classification used for the ambulatory status analysis, the mean perioperative change in the grade was 0.8 (0-4), with no significant differences noted between the THA and BHA groups. CONCLUSION: The early results of cementless HA for femur neck fractures in elderly patients with osteoporosis were satisfactory, and THA was found to have a functional advantage over BHA.
Aged* ; Arthroplasty* ; Butylated Hydroxyanisole ; Classification ; Dislocations ; Femoral Neck Fractures* ; Hemiarthroplasty ; Hip ; Humans ; Osteoporosis*

Fractures of the femoral neck in elderly patients can be treated by internal fixation, hemiarthroplasty, or total hip arthroplasty (THA), and the treatment modality used should be determined on the basis of considerations of the degree of fracture displacement, age, functional demands, and the risk factors for surgery and anesthesia. We studied 85 active elderly patients who underwent minimally invasive two-incision THA or conventional bipolar hemiarthroplasty (BHA) within 2 weeks of injury for the treatment of acute displaced femoral neck fractures. Patients were followed up for a minimum of 24 months. The average operation times were 70 minutes in the THA group and 46 minutes in the BHA group (p=0.002), and average blood losses during the perioperative period were 921 cc and 892 cc, respectively (p=0.562). In the THA group, the average postoperative Harris hip score was 88.3 and the average Western Ontario and McMaster University score was 28.8, whereas in the BHA group the corresponding scores were 80.4 (p=0.006) and 32.5 (p=0.012), respectively. There were 2 cases of hip dislocation in the THA group, and 2 cases in the BHA group underwent conversion to THA. Our short-term follow-up results were better for minimally invasive two-incision THA than for conventional BHA for the treatment of acute displaced femoral neck fractures in active elderly patients.
Aged ; Anesthesia ; Arthroplasty ; Butylated Hydroxyanisole ; Displacement (Psychology) ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Hemiarthroplasty ; Hip ; Hip Dislocation ; Humans ; Ontario ; Perioperative Period ; Risk Factors ; Tacrine

OBJECTIVES: The aim of this study is to evaluate the short-term results and complications of treating the intertrochanteric fracture with bipolar hemiarthroplasty (BHA) in elderly population. METHODS: We retrospectively reviewed 31 unstable intertrochanteric fracture patients who were treated with BHA between January 2007 and August 2009 in older populations more than 65 years old. The 6 males and 25 females had a mean age of 79.8 years (range: 66-88) and a mean follow-up of 36.3 months (range: 24-55). We analyzed the radiological outcomes, functional recovery grade, using Jensen's social function score and Harris hip score (HHS), and complications. RESULTS: The average operation time and blood loss was 148.9 min (range, 110-215 min) and 455.2 mL (range, 200-1200 mL). Mean preoperative and postoperative hemoglobin (Hb) was 10.9 g/dL (range, 8.6-13.4 g/dL) and 10.5 g/dL (range, 5.1-14.1 g/dL) respectively. Average 1.3 pints of blood transfusion was performed. Ambulation with (or without) crutch was possible at mean 6.8 days postoperatively. The stability and alignment indices were adequate in all cases at final follow-up. On clinical results, the average HHS score, was changed from 79.7 points (range, 44-100) preoperatively to 73.0 points (range, 46-92) postoperatively, and the preoperative and postoperative Jensen's score was 1.8 (range, 1-3) and 2.1 (range, 1-4) respectively. CONCLUSIONS: The BHA is an acceptable alternative for unstable intertrochanteric fractures in older population.
Aged ; Blood Transfusion ; Butylated Hydroxyanisole ; Female ; Femur ; Follow-Up Studies ; Hemiarthroplasty ; Hemoglobins ; Hip ; Hip Fractures ; Humans ; Male ; Retrospective Studies ; Walking

PURPOSE: This study was performed to establish an experimental rabbit model for single-stage maxillary sinus augmentation with simultaneous implant placement. METHODS: Twelve mature New Zealand white rabbits were used for the experiments. The rabbit maxillary sinuses were divided into 3 groups according to sinus augmentation materials: blood clot (BC), autogenous bone (AB), and bovine-derived hydroxyapatite (BHA). Small titanium implants were simultaneously placed in the animals during the sinus augmentation procedure. The rabbits were sacrificed 4 and 8 weeks after surgery and were observed histologically. Histomorphometric analyses using image analysis software were also performed to evaluate the parameters related to bone regeneration and implant-bone integration. RESULTS: The BC group showed an evident collapse of the sinus membrane and limited new bone formation around the original sinus floor at 4 and 8 weeks. In the AB group, the sinus membrane was well retained above the implant apex, and new bone formation was significant at both examination periods. The BHA group also showed retention of the elevated sinus membrane above the screw apex and evident new bone formation at both points in time. The total area of the mineral component (TMA) in the area of interest and the bone-to-implant contact did not show any significant differences among all the groups. In the AB group, the TMA had significantly decreased from 4 to 8 weeks. CONCLUSIONS: Within the limits of this study, the rabbit sinus model showed satisfactory results in the comparison of different grafting conditions in single-stage sinus floor elevation with simultaneous implant placement. We found that the rabbit model was useful for maxillary sinus augmentation with simultaneous implant placement.
Animals ; Bone Regeneration ; Bone Substitutes ; Butylated Hydroxyanisole ; Dental Implants ; Durapatite ; Floors and Floorcoverings ; Guided Tissue Regeneration ; Maxillary Sinus ; Membranes ; Models, Animal ; Osteogenesis ; Rabbits ; Retention (Psychology) ; Sinus Floor Augmentation ; Titanium ; Transplants

PURPOSE: This study evaluated the clinical and radiologic results of total hip arthroplasty and bipolar hemiarthroplasty using collarless polished tapered femoral stem. MATERIALS AND METHODS: We retrospectively reviewed the results of 33 patients who underwent THA and BHA using cemented CPT femoral stem from November 2006 to April 2009. The mean follow-up period was 33 months. The clinical results were evaluated with a Harris Hip Score (HSS), and radiographic results were assessed with cement grade, osteolysis, loosening, stress shielding and subsidence methods. RESULTS: Mean HSS improved with 91 points. Postoperative cement grade was A in 14 cases, B in 14 cases, C1 in 5 cases and D in none. Aseptic loosening was not found, while focal radiolucency in zone 8 was found. 70% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. Subsidence of the femoral stem was less than 1 mm in 32 cases, and was 1.47 mm in another case. Ectopic ossification was observed in 13 cases, class I in 11 cases, and class II in 2 cases, using Brooker's classification. CONCLUSION: This study showed the good clinical and radiographic results of THA and BHA with a cemented CPT femoral stem at the mid-term follow-up. However, a long-term follow-up study will be needed to evaluate the more precise clinical and radiographic outcomes.
Arthroplasty ; Butylated Hydroxyanisole ; Follow-Up Studies ; Hemiarthroplasty ; Hip ; Humans ; Ossification, Heterotopic ; Osteolysis ; Retrospective Studies ; Tacrine

Antioxidative and aldose reductase (AR)-inhibitory effects of a fermentation filtrate of Rubus coreanus (FRC) were investigated using corneal/retinal homogenate and lens cytosol, respectively. Rat corneal/retinal homogenate was treated with 50 microM FeCl3 in the presence of FRC (3.2-100 microg/mL) for 30 min at 37degrees C, and thiobarbituric acid-reactive substances (TBARS) was quantified as a lipid peroxidation parameter. FRC markedly suppressed the TBARS production in a concentration-dependent manner, leading to 50% (IC50) and 100% (IC100) inhibitory concentrations of 20 and 95 microg/mL, respectively, which was similar to the effect of butylated hydroxyanisole. Activity of AR from rat lens was assayed in the presence of FRC (1-31.6 microg/mL) at 25degrees C using glyceraldehyde as a substrate. FRC inhibited lens AR by 50% (IC50) and 90% (IC90) at approximately 2 and 31.6 microg/mL, respectively, comparable to the effect of quercetin. The results indicate that ERC could be a promising candidate for the improvement of eye injury and visual dysfunction of dry eye and diabetic patients.
Aldehyde Reductase ; Animals ; Butylated Hydroxyanisole ; Cytosol ; Eye ; Eye Injuries ; Fermentation ; Glyceraldehyde ; Humans ; Lipid Peroxidation ; Quercetin ; Rats ; Thiobarbituric Acid Reactive Substances