Hip Fractures

To examine survival and community discharge outcomes related to rehabilitation services among patients admitted to nursing homes before the implementation of the Balanced Budget Amendment of 1997. Retrospective cohort. A total of 945 Medicaid-certified nursing homes in Ohio. A total of 11,150 patients admitted for the first time to a nursing home from 1994 to 1996. Not applicable. Community discharge and survival rates among patients who did or did not receive rehabilitation services, using multivariable techniques to adjust for patients' propensity to receive rehabilitation and for other potential confounders. In secondary analyses, we also examined dose-response effects and analyzed the effects of rehabilitation when patients were divided into 5 diagnostic groups (stroke, hip fracture, congestive heart failure, chronic lung disease, other). Rehabilitation was provided to 58% of the patients and was associated with higher community discharge rates (relative risk=1.48; 95% confidence interval [CI], 1.40-1.57) and a lower hazard of death (hazard ratio=.81; 95% CI,.75-.88). Dose-response effects were observed for both outcomes (P<.001) among patients receiving rehabilitation. Rehabilitation was associated with improved community discharge rates in each of the 5 diagnostic groups. New reimbursement policies that discourage the provision of rehabilitation services may have adverse effects on patients, their families, and societal costs of care.

... 2007. http://www.boa.ac.uk/site/showpublications.aspx?ID=59 (accessed 16 May 2011). ↵: Temel JS,; Greer JA,; Muzikansky A,; et al. . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–742. ...

Recently, the number of older adult online users has increased rapidly. In 2004, 22% of Americans aged 65 years or older (about 8 million) used the Internet, and 66% of them performed online searches for health information. The Web, therefore, can serve as a useful medium to educate older adults on selected health topics. In this study, the researchers developed four Web-based learning modules related to hip fracture prevention and tested the usability of these modules employing eight older adult online users. The findings from the usability tests demonstrated that the online learning modules were usable to the older adult participants. Additionally, these individuals could acquire health knowledge using these online modules. The important lessons learned through the research process will assist the researchers in conducting further studies in using health Web learning modules for older adults. A further study will be conducted to test the effects of these modules on preventing hip fractures.

Patterns of clinical symptoms and outcomes of perioperative myocardial infarction (PMI) in elderly patients after hip fracture repair surgery are not well defined. A retrospective 1:2 case-control study in a cohort of 1212 elderly patients undergoing hip fracture surgery from 1988 to 2002 in Olmsted County, Minnesota. The mean age was 85.3 ± 7.4 years; 76% female. PMI occurred in 167 (13.8%) patients within 7 days, of which 153 (92%) occurred in first 48 hours; 75% of patients were asymptomatic. Among patients with PMI, in-hospital mortality was 14.4%, 30-day mortality was 29 (17.4%), and 1-year mortality was 66 (39.5%). PMI was associated with a higher inpatient mortality rate (odds ratio [OR], 15.1; confidence interval [CI], 4.6-48.8), 30-day mortality (hazard ratio [HR], 4.3; CI, 2.1-8.9), and 1-year mortality (HR, 1.9; CI, 1.4-2.7). Elderly patients, after hip fracture surgery, have a higher incidence of PMI and mortality than what guidelines indicate. The majority of elderly patients with PMI did not experience ischemic symptoms and required cardiac biomarkers for diagnosis. The results of our study support the measurement of troponin in postoperative elderly patients for the diagnosis of PMI, in order to implement in-hospital preventive strategies to reduce PMI-associated mortality.

One hundred and twelve patients ranging in age from 40 to 89 with acute intracapsular fractures of the hip were treated between the years 1970 to 1978 by total hip arthroplasty; 63% were subcapital, 27.6% were midcervical, and 8.9% were basilar; 53.5% were classified as Garden's Stage IV, 34.8% as Stage III and 11.6% as Stage II. A significant number of patients had associated medical conditions that made them poor risks for a possible second-stage operation. Moreover, 16 patients were considered for total hip arthroplasty because of associated hip disease. Of 85 patients evaluated after one year, 81.2% had no pain. Most patients maintained their previous levels of activity, but 13 were more active than before injury; 33 were worse. The decrease in activity was generally due to deterioration in associated medical conditions. Our experience indicates that total hip arthroplasty is best reserved for the previously active elderly patient with a displaced subcapital fracture who meets the criteria for prosthetic replacement.

BACKGROUND: The hip joint is a common location for metastatic disease. Actual as well as impending fractures at this site are frequently due to mechanical instability after tumor invasion and are usually treated surgically with hip arthroplasty. The objective of this study was to analyze survival and influences on survival after hip arthroplasty for metastatic hip disease.METHODS: Two hundred and ninety-nine patients who had undergone a total of 306 hemiarthroplasty or total hip arthroplasty procedures for treatment of a pathologic or an impending pathologic hip fracture between 1969 and 1996 at our institution were included in this study. Data that had been acquired prospectively within the total joint registry of our institution were reviewed retrospectively.RESULTS: The median duration of survival after the arthroplasty was 8.6 months. The duration of survival was significantly associated with the site of the fracture, location of the primary tumor, and time from the diagnosis of the primary tumor to the surgery for the fracture (p < or = 0.05). The time from the diagnosis to the arthroplasty was a significant independent predictor of survival.CONCLUSIONS: Patients undergoing hip arthroplasty for metastatic disease have a limited life expectancy, with only 40% (120) of the 299 patients in our series still alive at one year after the surgery. By identifying prognostic factors regarding life expectancy, this study provides surgeons and oncologists with information with which to weigh risks and benefits of hip arthroplasty for individual patients preoperatively.

The purpose of this study was to evaluate the results and complications of hip arthroplasty done for salvage of failed treatment of pathologic proximal femoral fractures secondary to malignancy. Between 1980 and 2000, 42 patients with a mean age of 63 years were treated with hip arthroplasty to salvage failed treatment of a pathologic proximal femoral fracture. Total hip arthroplasty was done in 16 patients (3 uncemented, 2 hybrid, 11 cemented), and bipolar hemiarthroplasty in 26 (2 uncemented, 24 cemented). A modular, proximal femoral replacement construct was used in 15 patients. Patients were followed a mean of 5.8 years (range, 15 days-20 years). Four hips required reoperation, all for deep infection. Harris Hip score improved from an average of 42 points (range, 17-76 points) preoperatively to an average of 83 points (range, 52-100 points) postoperatively. Most recent radiographs showed femoral component loosening in only one patient. Implant survivorship free of revision for any reason at 5 years was 90% (range, 65-96%) and free of revision for aseptic failure or radiographic failure was 97% (range, 64-99%). Hip arthroplasty is an effective treatment for salvage of failed treatment of pathologic proximal femoral fractures. Modular proximal femoral replacements were often required. The most concerning complication was deep prosthetic infection, which occurred in nearly 10% of this patient population, and in 21% of patients with prior irradiation.

The authors retrospectively reviewed 53 hip replacements performed in 50 patients (mean age, 65 years) for plasmacytoma (four lesions) or multiple myeloma (49 lesions) of the hip region. Perioperatively, 49 patients received chemotherapy. Twenty-four hip lesions had radiation therapy. Within a mean followup period of 32.6 months, 15 (28%) complications occurred. Late deep infection, dislocation, and aseptic loosening with medial migration of the acetabular component occurred in one patient each. Three patients died during the first postoperatively month. All of the remaining patients postoperatively regained their previous ambulatory status; hip pain relief was achieved in 98% of patients. At the time of the latest followup evaluation, 84% of the patients had died (median survival time, 18 months) and 16% were still alive (median survival time, 76 months). Patients with plasmacytoma had longer survival than did patients with multiple myeloma (median survival, 6.3 years versus 18 months, respectively). No significant association was found between patient survival and the stage of disease at diagnosis, age, gender, type or location of the myeloma lesion, or the type of implant used. Because of the relatively long survival time, prosthetic replacement is indicated for extensive hip lesions in patients with plasmacytoma or multiple myeloma.

Proximal femur fractures are a common orthopedic injury, and it is estimated that their prevalence will continue to increase over the next twenty years. There has been much debate over the optimal management of basicervical fractures, which can be difficult to identify radiographically. There is also a role for conversion total hip arthroplasty in patients where fracture fixation fails. We present a case report of a proximal femur fracture managed as a basicervical fracture, and subsequently needing a conversion arthroplasty and revision surgery. We also review the literature to identify the complexities of basicervical fractures and conversion arthroplasty.

Hip fractures are serious fall injuries that often result in long-term functional impairment and increased mortality. As the population ages, the number of hip fractures is likely to increase worldwide. The main objective of this pilot study was to evaluate the risk factors of hip fracture among the older adults in the Lebanese population. This pilot epidemiological, prospective, and case-control study was performed in 6 hospitals in Great Beirut and South Lebanon. Subjects who met the inclusion criteria filled out a questionnaire consisting on the socio- demographic characteristics, health status, drugs intake and cigarette smoking. Overall, 195 subjects were recruited, with 65 cases of hip fracture and 130 controls all aged over 50 yr. Females represented around two third of the studied population. The logistic regression, using adjusted odds ratio (ORa), showed a significant relationship between hip fracture and chronic diseases (ORa=3.02; 95% CI: 1.63, 6.66), antihypertensive dr...

To analyze the incidence of the overlap syndrome of depressive symptoms and delirium, risk factors, and independent and dose-response effect of the overlap syndrome on outcomes in elderly adults with hip fracture. Prospective cohort study. University hospital. Individuals with hip fracture without delirium (N = 277; aged 78.0 ± 8.2) consequently enrolled in a prospective cohort study. Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive status using the Short Portable Mental Status Questionnaire upon hospital admission. Incident delirium was assessed daily during the hospital stay using the Confusion Assessment Method. Information on complications acquired in the hospital, severity of complications, re-interventions, length of hospital stay, and 1-month mortality was recorded. Thirty (10.8%) participants had depressive symptoms alone, 88 (31.8%) delirium alone, 60 (21.7%) overlap syndrome, and 99 (35.7%) neither condition. According to multivariate regression analysis, participants with the overlap syndrome had significantly higher incidence of vision impairment (P = .02), longer time-to-surgery (P = .03), and lower cognitive function (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) than participants with no depressive symptoms and no delirium. In the adjusted regression analysis, participants with neither condition were at lower risk of complications than those with the overlap syndrome (P = .03). After adjustment, participants with the overlap syndrome were at higher risk of longer hospital stay independently (P = .003) and in a dose-response manner in the following order: no depression and no delirium, depressive symptoms alone, delirium alone, and the overlap syndrome (P = .002). Depressive symptoms and delirium increase the likelihood of adverse outcomes after hip fracture in a step-wise manner when they coexist. To reduce the risk of adverse outcome in individuals with hip fracture, efforts to identify, prevent, and treat this condition need to be increased.

We aimed to evaluate the factors contributing to delirium after hip fracture and assess the effect of incident delirium on short-term clinical outcomes. A total of 270 non-delirious, consecutive hip fracture patients 60 years and older were included in a prospective cohort study. The patients were assessed with respect to physical status according to the American Society of Anesthesiologists classification, medical comorbidities with the Charlson Comorbidity Index, cognitive function with the Portable Mental Status Questionnaire and depression with the Geriatric Depressive Scale. Incident delirium was evaluated daily. Clinical outcomes and 1-month mortality were recorded. Incident delirium was present in 53.0% of patients. Patients with delirium were older (P = 0.046), had higher American Society of Anesthesiologists and Charlson Comorbidity Index scores (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), lower Portable Mental Status Questionnaire scores and higher Geriatric Depressive Scale scores (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, P = 0.003, respectively). After adjusting for age, multivariate regression analysis in the first model showed that patients with delirium were at higher risk of reintervention plus death (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), complications P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), a higher severity complication score (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and longer length of hospital stay (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In the second model, after adjusting for propensity score, patients with delirium were at higher risk of reintervention plus death (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and longer length of hospital stay (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Patients who are older, with worse physical status, worse cognitive function and depression are more likely to develop delirium after hip fracture. Incident delirium has negative independent effects on short-term outcomes in elderly patients after hip fracture. Geriatr Gerontol Int 2014; ●●: ●●-●●.