Faculty Bibliography

A successful outcome after hip fracture surgery depends on more than just the technical measures such as union, alignment, and range of motion. The central goal of treatment is to restore the patient to his or her prefracture state of function and independence. Comprehensive evaluation of outcomes after hip fracture has become an important component of treatment. Outcomes after the hip fracture include short- and long-term mortality, short- and long-term complications, length of hospital stay, place of discharge (home vs. nursing home), posttreatment ambulatory ability, and the return to prefracture level of function and independence in activities of daily living. A variety of factors have been found to contribute to these outcomes. These include, but are not limited to, age, gender, number and type of comorbidities, type of fracture, details of treatment, and prefracture functional status. Knowledge of the patient's risk factors for a poor functional result, as well as a thorough evaluation of the outcome after the fracture, are all intimately tied to a good result

Degenerative joint disease is known to occur in patients with a history of polio. However, minimal or absent quadriceps function is generally considered to be a contraindication to total knee arthroplasty. We describe an elderly patient with quadriceps paralysis secondary to poliomyelitis who underwent a successful total knee replacement for severe osteoarthritis. The primary operative indication was disabling pain. At the 1-year follow-up the patient reported excellent pain relief, and there were no clinical or radiographic signs of deformity

Clinical and radiographic follow-up was performed on a consecutive series of 105 patients who underwent 120 total hip arthroplasties at the authors' institution from 1983 to 1988 with a straight, cobalt-chrome femoral stem implanted using a second-generation cementing technique. The mean age at the time of surgery was 68.5 years, and the mean follow-up was 16 years. At 16 years' follow-up, the prevalence of revision for aseptic loosening of the Spectron femoral component was only 4.2%; 5 stems were revised for aseptic loosening at a mean of 10.2 years after implantation. Sixteen-year survivorship of the component was 93.9% +/- 2.7% when revision for aseptic loosening was taken as the endpoint or 90.3% +/- 4.4% when either revision for aseptic loosening or radiographic evidence of loosening was taken as the endpoint

This study compares the stability of 3 cannulated cancellous lag screws with that of 2 cannulated cancellous lag screws for fixation of subcapital femoral neck fractures. Using 10 matched pairs of human cadaveric femurs, subcapital femoral neck osteotomies were created, reduced, and then randomized to 1 of the 2 fixation methods. The constructs were tested with anterior loading to 500 N, incremental axial loading from 100 N to 1000 N, and cyclic loading at 1000 N. The specimens stabilized using 3 screws showed greater resistance to anterior loading, less inferior femoral head displacement, and less superior gapping at the osteotomy site. Although 2 screws may be an acceptable fixation method for this fracture type, the addition of a third screw provides supplemental stability and appears justified