For intertrochanteric fractures, surgical fixation remains the standard operation, including proximal femoral nail antirotation (PFNA) and dynamic hip screws. Total hip replacement is rarely used for acute intertrochanteric fractures of the femur. Several articles have reported bipolar prosthesis replacement (not total hip arthroplasty) being performed in some elderly patients. It is assumed that joint replacement can allow immediate weight bearing, reduce mortality, and have more advantages compared with open reduction and internal fixation. For the treatment of an intertrochanteric fracture combined with femoral head necrosis in middle-aged patients, it has been controversial whether to perform fracture reduction and fixation followed by total hip replacement or direct total hip replacement. At present, there are few surgical indications for primary hip replacement as the initial treatment for acute intertrochanteric fractures. We report a case of bilateral femoral head necrosis with an unstable intertrochanteric fracture and absolute indications for initial total hip replacement. There are no studies in the literature indicating which kind of prosthesis should be used in middle-aged patients with high requirements for joint movement.The burden of osteoarthritis (OA) has increased steadily due to an aging population, increasing life expectancy, obesity and lifestyle factors. Total hip replacement has become one of the most prevalent and successful operations globally and it is projected that demand will continue to grow as the incidence of OA continues to increase. Patients undergoing the operation expect much-improved function and pain relief but also increasingly need to return to work postoperatively, especially given the growing demand for the procedure and the encouragement of older people to continue working by most governments in the developed world. This review provides an overview of function and employment outcomes after hip arthroplasty.

Despite the generally good success rate, some patients do not attain good functional outcomes and it is important that we develop ways to identify these patients preoperatively. We describe the effect of demographic, clinical and other factors on functional outcomes, as well as trajectories of physical function and pain recovery beyond the first few weeks after total hip replacement. Regarding employment outcomes, many people in work preoperatively are likely to resume to work after recovery; however, patients feel that they lack guidance from clinicians about returning to work postoperatively. Our review encompasses factors associated with return to work, timing of return to work, and potential temporary or permanent limitations that people might experience at work depending on type of employment.

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Mishita
Jornal co-ordinator
Journal of Bone Research and Reports