Procs III 2011.indb - Journal of Bone & Joint Surgery, British Volume ...

354 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY
090 BILATERAL SIMULTANEOUS TOTAL HIP
ARTHROPLASTY: SAFETY AND EFFICACY
– A META-ANALYSIS
E. Tsiridis, I. Pagkalos, I. Polyzois, G. Pavlou, J.
Charity, E. T i h , G. Gie, R. West
Academic Department of Trauma and
Orthopaedics, Leeds General Infirmary; Leeds
School of Medicine, Leeds University, LS1 3EX
Leeds, UK; Princess Elizabeth Orthopaedic
Centre, Hip Unit, Royal Devon and Exeter
Hospital, EX2 5DS Exeter, UK; Institute of
Health Sciences, Centre for Epidemiology and
Biostatistics, Leeds University, LS1 3EX Leeds,
UK; Cardio-Thoracic Anaesthetic Unit, “Blue
Cross” Hospital, Thessaloniki, Greece.
Comparison of the safety and effi cacy of Bilateral Simultaneous
Total Hip Arthroplasty (BSTHA) with that of
staged (SgTHA) and unilateral (UTHA) was conducted
using DerSimonian–Laird heterogeneity meta-analysis.
A review of the English-language literature identifi ed
23 citations eligible for inclusion. A total of 2063 bilateral
simultaneous THR patients were identifi ed. Metaanalysis
of homogenous data revealed that there were
no statistically signifi cant differences between rates of
thromboembolic events (p=0.268 and p=0.365) and
dislocation (p=0.877) when comparing staged or unilateral
with bilateral simultaneous THR procedures. A
systematic analysis of heterogenous data demonstrated
that mean length of hospital stay was shorter after bilateral
simultaneous THR. Blood loss was reduced after
bilateral simultaneous THR in all studies except for one,
and surgical time was not different between groups.
This procedure was also found to be economically and
functionally effi cacious when performed by experienced
surgeons in specialist centres.
091 CEMENT-IN-CEMENT STEM REVISION
FOR VANCOUVER TYPE B PERIPROSTHETIC
FEMORAL FRACTURES AFTER TOTAL HIP
ARTHROPLASTY: 3 YEAR FOLLOW UP OF 24
CASES
T.W. Briant-Evans, D. Veeramootoo, E. Tsiridis,
MJ. Hubble
Princess Elizabeth Orthopaedic Centre, Royal
Devon and Exeter Hospital, Barrack Road, Exeter
EX2 5DW, Academic Department of Trauma and
Orthopaedics, Leeds General Infirmary, Great
George Street, Leeds, LS1 3EX, UK
Periprosthetic fractures around a cemented femoral
stem present a challenge to the treating surgeon. We
propose a technique whereby a well fi xed cement mantle
can be retained in cases with simple fractures that can be
reduced anatomically. This technique is well established
in femoral stem revision, but not in association with a
fracture.
24 Vancouver type B periprosthetic femoral fractures
were treated by reducing the fracture and cementing a
revision stem into the pre-existing cement mantle, with
or without supplementary fi xation.
3 patients died in the fi rst 6 months for reasons
not related to surgery and one was too frail to attend
follow up. The remaining 20 cases were followed up for
a mean of 3.0 years. The median time to radiological
and clinical union was 3.0 months (2-11). The median
Modifi ed Harris Hip Score was 76.9 (35-97) and there
was no sign of loosening or subsidence of the revision
stems within the old cement mantle in any case at most
recent follow up. One patient had further surgery for
a delayed union and there were 2 subsequent fractures
distal to the original fracture site in patients with poor
bone stock.
Our results support the use of the cement-in-cement
stem revision technique in anatomically reducible periprosthetic
fractures with a well preserved pre-existing
cement mantle. It is particularly suitable for older
patients.
092 TREATMENT OF FEMORAL
PERIPROSTHETIC FRACTURES AFTER TKR
AND THA AT A PROVINCIAL HOSPITAL – 8
YEARS EXPERIENCE
K. Papageorgiou, I. Papageorgiou, P. Tilaveridid,
D. Voutsas, A. Chatzioannidis, S. Gerakas
Orthopaedic Department of G.H Dramas
Periprosthetic fractures represent a challenging problem
in joint arthroplasty the incidence of which seems to be
increasing due to the big number of the arthroplasties
and the increasing average life expectancy.
The purpose of this study is to present the methods
of treatment,the problems that we have to solve intraoperatively
and our long term results about the healing
procedure and the fuctional restoration.
Between 2000-2008 we operated 15 femoral periprosthetic
fractures(1 re-fracture). 10 of them were after
hip arthroplasties.
The classifi cation which used was Lewis-Rorabeck
for the fractures after TKR and Vancouver for them
after THA.
Cause of fracture was fall and the time interval from
the primary operation was 1-14years. The majority of the
patients were women(14), and the mean age 65 years.
13 of the 15 fractures were treated with ORIF and the
remaining two need to be revised. During the follow up
2 of them died due to other pathological problems.The
post op follow up ranged from 1-8(3.5)years.
The postoperative evaluation was done according the
Harris Hip Score and the Knee Society Clinical Rating
System.
The fractures healed after a mean time of 6 months.
Two postoperative wound infections were registered to
the revised fractures and their treatment were successful
with surgical debridement.
All the patients are in good health condition,moving
with some kind of support and they are selfreserved.
As a conclusion we believe that this kind of fractures
demand the proper surgical planning, prediction of all
possible complications and the cooperation of other
specialties and physiotherapisties.
093 THE EFFECTS OF SYSTMENIC
ADMINISTRATION OF SIMVASTATIN TO
FRACTURE HEALING
D. Chissas, P.G. Ntagiopoulos, G. Stamatopoulos,
D. Verettas, K. Kazakos, A. Papalois, G. Loupasis,
A. Papaeliou, G. Anastopoulos, A. Asimakopoulos
2nd Department of Orthopaedic and Trauma
Surgery, “G. Genimmatas” General Hospital
of Athens, Athens, Greece, Department of
Orthopaedic and Trauma Surgery, School of
Medicine, Demokritus University of Thrace,
Greece, Experimental-Research Department,
Elpen Pharmaceuticals, Athens, Greece
Several observational and experimental studies have
investigated the potential anabolic effects of statins on
undisturbed bone but only a few recent studies have
examined the effect of statins on skeletal repair. The
goal of the study is to investigate any potential early
anabolic effect of the systemic administration of simvastatin
in low doses (based on earlier safety and effi cacy
studies on undisturbed bone) on fracture healing.
Fifty-four skeletally mature male New Zealand White
rabbits were used for the study. The rabbits were assigned
to one of three experimental groups: a control group, and
two groups that were orally administrated a diet with 10
and 30 mg/kg/day of simvastatin, respectively. A complete
biochemical blood count was performed to exclude
drug-induced complications. Half of the animals of each
group were sacrifi ced at 15 days and the other half at 30
days after surgery at which time intervals healing quality
was assessed. The bones were subjected to biomechanical
testing, histomorphometric analysis and peripheral
Quantitative Computed Tomography.
In animals received simvastatin of 30 mg/kg/day
a signifi cant reduction of BMD, stiffness, and energy
absorbed to failure were observed. At 15 days, the
amount of cartilaginous callus formation was reduced,
and the void space was signifi cantly increased, in the
animals of both groups that received simvastatin when
compared to the control group (p