CURRENTCONCEPTSINJOINTREPLACEMENTTMSPRING2004Thecourseobjectivesare:◆Tofacilitatefaculty/participantdiscussiononcontemporaryhip,kneeandshoulderarthroplastyuseinclusiveofdesignconcepts,materialadvancesandclinicalresults.◆Topresentsolutionstodifficulthip,kneeandshouldermanagementproblemsaswellassurgicaltechniqueswhichassisttheirsolution.◆Toevaluatetheuseofcurrentfixationmethodsinprimaryandrevisionproceduresincludingcement,hydroxyapatite,porouscoated,pressfitandimpactiongraftingapplications.◆Toaddresscurrentconcernsregardingimplantmateriallimitationsandbiologicresponseaswellasidentifyclinicalinterventionstrategies.◆使会议参加者对当前髋关节、膝关节及肩关节的成形进行讨论，包括设计概念、材料发展和临床效果。◆提出对疑难的髋关节，膝关节肩关节如何解决的问题，以及相关的外科技术。◆评价当前的固定方法在原发和翻修操作步骤的应用，包括骨水泥压迫嵌入、压迫移植应用。发表当前一些新概念，如材料的研制、生物反应、以及确认临床发展的方向。HipArthroplasty:I.IntroductionA.Demographics◆Morethan220,000fracturesofthehipoccureachyearinNorthAmerica.◆Cost-greaterthan9billiondollarhealthcarecostsperyear.◆eterogeneouspatientpopulation-somepatientsareactivecommunityambulatorsbutmanyarenursinghomeresidents.B.Issues◆Optimaltreatmentofdisplacedfemoralneckfracturesremainscontroversial.◆Generalagreementthatpatientsregardlessofagewithnon-displacedorvalgusimpactedfractures(stable)willbetreatedwithinternalfixation.◆Generalagreementthathealthypatients60yearsoryoungeraregoodcandidatesforinternalfixation.◆However,treatmentofpatientsolderthan60yearsofageiscontroversial.C.TreatmentOptions◆Internalfixation◆ArthroplastyII.Questions1.Whichpatientswithdisplacedfemoralneckfracturesshouldbetreatedwithinternalfixation?◆Factorsthatshouldbeconsideredincludeage,fracturetype,activitylevelandoverallhealth2.Shouldpatientsbeingtreatedwithanarthroplastyprocedurereceiveaunipolar,bipolarortotalhiparthroplasty?3.Isthereevidencebasedinformationtosupportthesedecisions?III.InternalFixationversusProstheticReplacementA.ClinicalData1.ObservationalStudies◆Valuelimitedbyretrospectivedesign,potentialselectionbias2.Randomizedtrials◆Biasdecreasedbyrandomization◆However,randomizedtrialsassessedavarietyofdifferentarthroplastyoptionswhichmaynotbeclinicallyrelevanttoday◆Smallsamplesize:limittheabilityofthesetrialstoprovidedefinitiveguidancefortheorthopaedicsurgeonB.MetaAnalyses(Cochranedatabase,Bhandarietal)1.SummaryResultsofMeta-Analyses◆Arthroplastyreducestheriskofrevisionsurgery.◆Internalfixation-decreasedbloodloss,operativetime,bloodtransfusionandriskofdeepwoundinfection.◆Unfortunately,nodefinitivedifferenceswerenotedwithrespecttomortality,degreeofresidualpain,orfunctionallevelsbetweenthetwotreatments2.PrimaryArthroplastyVersusEarlySalvageAfterFailedInternalFixation◆Conclusions:Patientsundergoinginternalfixationforadisplacedfemoralneckfractureneedtobeinformedthatifthistreatmentfailsandthatifacementedhipissubsequentlyperformed,theresultsmaynotbeasgoodasaprimaryhiparthroplasty.(McKinleyandRobinson,JBJS,2002)IV.TreatmentRecommendationsA.InternalFixationVersusArthroplasty1.Youngandhealthypatients(lessthan60yearsofage)internalfixation2.Olderpatients-70yearsofageorolder-arthroplastydependingonactivitylevel,overallhealth,bonestock3.61-70yearsofage-grayarea,decisionshouldbemadebaseduponabilitytoobtainreduction,bonequality,general...
