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Rich66 · 10-25-2009, 09:15 PM

For what it's worth, my 76 y/o Dad had a broken hip repair a couple months ago. What I got out of it was that a partial or full hip replacement could get you moving almost immediately, albeit with ongoing restrictions in angle of motion. I think they rely more on adhesives and implanted hardware than typical healing process.
The pins and screws approach requires weeks of keeping weight off the leg as the bone fuses together. The benefit seems to be that if it works out, there is less (no?) risk of dislocation from motion angles.
So..off the top of my head, I wonder if the pins and screws approach is more susceptible to interference from chemo and bisphosphonates etc. Might be worth discussing this with your doc. Not sure if this article is helpful to you but...

1: Ortop Traumatol Rehabil. 2009 May-Jun;11(3):233-41.
Arthroplasty versus Internal Fixation of Femoral Neck Fractures: A Clinical Decision Analysis.

Aleem IS, Karanicolas PJ, Bhandari M.
Departments of Surgery, McMaster University, Hamilton, Ontario, Canada and University of Western Ontario, London, Ontario, Canada.
Background: The optimal surgical management of displaced femoral neck fractures in the elderly remains controversial. Treatment alternatives include arthroplasty and internal fixation. Options for arthroplasty include total hip arthroplasty and hemiarthroplasty, whereas options for internal fixation include multiple screws and sliding hip screws. We sought to compare arthroplasty and internal fixation alternatives and determine the key factors influencing final outcomes using a clinical decision analysis. Methods: We constructed a decision analytic model representing potential outcomes after arthroplasty and internal fixation alternatives. Probabilities of events following each procedure were systematically derived from a literature review. Relative outcome preferences were estimated using health utility questionnaires with surgeons and lay persons. Sensitivity analyses determined threshold values that would alter the preferred decision. Results: In the arthroplasty comparison, patients treated with total hip arthroplasty achieved higher expected utility values than patients treated with hemiarthroplasty (0.80 versus 0.74). In the internal fixation analysis, sliding hip screw fixation yielded higher expected utility values than multiple screws (0.76 versus 0.73). Overall, total hip arthroplasty achieved higher expected utility values than either approach to internal fixation. The superiority of arthroplasty over internal fixation was maintained over a wide range of probabilities and utilities. Conclusions: When outcomes and their values are considered in a systematic manner, arthroplasty results in better patient outcomes when compared to internal fixation in the management of displaced hip fractures in the elderly.
PMID: 19620741 [PubMed - in process]

10-25-2009, 09:15 PM	#13
Rich66 Senior Member Join Date: Feb 2008 Location: South East Wisconsin Posts: 3,431	Re: I need hip surgery which STOPS my chemo! For what it's worth, my 76 y/o Dad had a broken hip repair a couple months ago. What I got out of it was that a partial or full hip replacement could get you moving almost immediately, albeit with ongoing restrictions in angle of motion. I think they rely more on adhesives and implanted hardware than typical healing process. The pins and screws approach requires weeks of keeping weight off the leg as the bone fuses together. The benefit seems to be that if it works out, there is less (no?) risk of dislocation from motion angles. So..off the top of my head, I wonder if the pins and screws approach is more susceptible to interference from chemo and bisphosphonates etc. Might be worth discussing this with your doc. Not sure if this article is helpful to you but... 1: Ortop Traumatol Rehabil. 2009 May-Jun;11(3):233-41. Arthroplasty versus Internal Fixation of Femoral Neck Fractures: A Clinical Decision Analysis. Aleem IS, Karanicolas PJ, Bhandari M. Departments of Surgery, McMaster University, Hamilton, Ontario, Canada and University of Western Ontario, London, Ontario, Canada. Background: The optimal surgical management of displaced femoral neck fractures in the elderly remains controversial. Treatment alternatives include arthroplasty and internal fixation. Options for arthroplasty include total hip arthroplasty and hemiarthroplasty, whereas options for internal fixation include multiple screws and sliding hip screws. We sought to compare arthroplasty and internal fixation alternatives and determine the key factors influencing final outcomes using a clinical decision analysis. Methods: We constructed a decision analytic model representing potential outcomes after arthroplasty and internal fixation alternatives. Probabilities of events following each procedure were systematically derived from a literature review. Relative outcome preferences were estimated using health utility questionnaires with surgeons and lay persons. Sensitivity analyses determined threshold values that would alter the preferred decision. Results: In the arthroplasty comparison, patients treated with total hip arthroplasty achieved higher expected utility values than patients treated with hemiarthroplasty (0.80 versus 0.74). In the internal fixation analysis, sliding hip screw fixation yielded higher expected utility values than multiple screws (0.76 versus 0.73). Overall, total hip arthroplasty achieved higher expected utility values than either approach to internal fixation. The superiority of arthroplasty over internal fixation was maintained over a wide range of probabilities and utilities. Conclusions: When outcomes and their values are considered in a systematic manner, arthroplasty results in better patient outcomes when compared to internal fixation in the management of displaced hip fractures in the elderly. PMID: 19620741 [PubMed - in process] __________________ Mom's treatment history (link)