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The Conversion Rate of Bipolar Hemiarthroplasty after a Hip Fracture to a Total Hip Arthroplasty
Sulaiman Alazzawi,Walter B Sprenger De Rover,James Brown,Ben Davis 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.2
Background: Bipolar hip hemiarthroplasty is used in the management of fractures of the proximal femur. The dual articulation iscited as advantageous in comparison to unipolar prostheses as it decreases acetabular erosion, has a lower dislocation rates andis easier to convert to a total hip arthroplasty (THA) should the need arise. However, these claims are debatable. Our study examinesthe rate of conversion of the bipolar hemiarthroplasty to THA and the justifi cation for using it on the basis of future conversionto THA. Methods: All cases of bipolar hemiarthroplasty performed in our unit for hip fractures over a 9-year period (1999-2007) were reviewed. Medical notes and radiographs of all patients were reviewed, and all surviving patients that were contactable received atelephone follow-up. Results: Of all 164 patients reviewed with a minimum of 1 year from date of surgery, 4 patients had undergone a conversion oftheir bipolar prosthesis to THA. Three conversions were performed for infection, dislocation, and fracture. Only one (0.6%) conversionwas performed for groin pain. Conclusions: Our study show that bipolar hemiarthroplasties for hip fractures have a low conversion rate to THAs and this iscomparable to the published conversion rate of unipolar hemiarthroplasties.
Bernard Yan,Hans Tu,Christina Lam,Corey Swift,Ma Sze Ho,Vincent C.T. Mok,Yi Sui,David Sharpe,Darshan Ghia,Jim Jannes,Stephen Davis,Xinfeng Liu,Ben Freedman 대한뇌졸중학회 2020 Journal of stroke Vol.22 No.3
Background and Purpose Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate. Methods We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection. Results One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter). Conclusions Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.