INTRODUCTION: This prospective randomized study investigated short-term outcomes of cemented vs. HA-coated hip arthroplasty in elderly osteoporotic patients with femoral neck fractures. METHODS: Forty consecutive patients with femoral neck fractures (AO/OTA fracture type B2 and B3) were randomized to receive either an AHS prosthesis (Group A, n = 22, cemented implant) or a Furlong prosthesis (Group B, n = 18, HA-coated implant). Inclusion criteria were: female age ≥75, fracture resulting from minor trauma, ability to communicate and bone mineral density (BMD) T-score at the contralateral hip lower than −2.5 SD. Subjective assessment was evaluated according to a rating system 0-(unsatisfactory) to 10(satisfactory). Average follow-up was 29 months for Group A and 27 months for Group B. RESULTS: Average patient age was 75 ± 5 in both groups. There were no differences in ASA scores between the two groups. Surgical time was 77 ± 12 minutes for Group A, and 72 ± 13 minutes for Group B (ns). Harris hip score was 46 ± 36 in Group A and 62 ± 33 in Group B. (p DISCUSSION: Although femoral neck fractures in elderly osteoporotic patients are usually treated with cemented arthroplasty, our comparative study showed better results with the Furlong prosthesis, even if statistical significance was reached in only two parameters. The outcomes obtained with the Furlong prosthesis are due to the ability of the HA-coating to bind with osteoporotic bone, thus establishing a stable fixation. Fixation failed in only one cemented implant, but our case number was limited and the follow-up short. Post-op mortality at the time of follow-up was high. This was not unexpected, given the age level and health status of the study groups. This study shows that the HA-coated Furlong prosthesis is a viable option for the treatment of elderly osteoporotic femoral neck fracture patients.
The aim of this review is to report on studies of hydroxyapatite-coated external fixation pins as a solution to enhance pin fixation. In a highly loaded animal study, three tapered pin types were compared: Type A uncoated, Type B coated with hydroxyapatite and Type C coated with titanium. There was a 13-fold increase in the extraction torque of Type B pins compared with Type A, and a twofold increase compared with Type C pins. Extraction torque was significantly lower compared with the corresponding insertion torque in both Types A (p < 0.001) and C (p = 0.003). Conversely, with the hydroxyapatite-coated pins there was no difference between extraction and insertion torque. In a clinical study of 76 external fixation pins in 19 patients treated with hemicallotasis for osteoarthritis on the medial side of the knee, pin insertion and extraction torque forces were measured. The patients were randomized to be treated with either standard tapered pins or tapered pins coated with hydroxyapatite. Extraction torque of the hydroxyapatite-coated pins was higher than the extraction torque of the standard pins in both cancellous and cortical bone (p < 0.005). In a prospective, randomized clinical study of osteoporotic wrist fractures, extraction torque of the coated pins was higher than with standard pins (p < 0.0001). These studies demonstrate that with the use of hydroxyapatite-coated pins, no deterioration of pin fixation occurs, and that there is no significant pin loosening and infection, regardless of bone type and loading conditions.
Objective Combined metatarso-phalangeal and inter-phalangeal deformity represents about 1% of hallux valgus deformity, and its treatment remains a debated topic, because a single osteotomy does not entirely correct the deformity and double osteotomies are needed. The aim of this study is to review the results of 50 consecutive combined metatarso-phalangeal and inter-phalangeal hallux valgus treated by Akin proximal phalangeal osteotomy and SERI minimally invasive distal metatarsal osteotomy. Material and Methods Fifty feet in 27 patients, aged between 18 and 75 years (mean 42 years) affected by symptomatic hallux valgus without arthritis were included. Two 1-cm medial incisions were performed at the metatarsal neck and at proximal phalanx. Then SERI osteotomy was performed to correct metatarso-phalangeal deformity and Akin osteotomy was performed to correct interphalangeal deformity. Both osteotomies were fixed with a single K-wire. A gauze bandage of the forefoot was applied and immediate weight-bearing on hindfoot was allowed. K-wire was removed after 4 weeks. All patients were checked at a mean 4 year follow-up. Results All osteotomies healed. Delayed union of metatarsal osteotomy was observed in 1 foot. Slight stiffness was observed in 2 feet. Mean AOFAS score was 47±15 preoperatively and 91±9 at last follow-up. Radiographic findings revealed a significant improvement (p Conclusions The combined SERI-Akin double osteotomy was an useful procedure for correction of complex hallux valgus deformity. Clinical and radiographic findings showed an adequate correction of all parameters of the deformity.