Purpose This study aims to investigate the effect of some factors such as the diameter of bipolar prosthetic heads, body mass index (BMI), age, gender, bone mineral density (BMD) and leg length discrepancy (LLD) on the acetabular protrusion in elderly patients who had hip bipolar hemiarthroplasty (BHA) after femoral neck fractures. Methods The study included a total of 209 patients with a mean age of 77.4 ± 6.0 years who underwent BHA. The difference between the femoral head diameter of the patients and the diameter of the bipolar prosthetic head was divided into two groups, ranging from 0 to -2 mm (same and 1,2 mm small size) . Acetabular enlargement and cartilage degeneration were followed by standard AP pelvis radiographs and clinical outcomes were evaluated by the Harris Hip Score (HHS) after surgery and during 5 years of follow-up. Results During the 5-year follow-up, while HHS values decreased, acetabular diameter increased. Acetabular protrusion developed in 21 (10%) patients, acetabular revision surgery was performed for 36 (17%) patients, the difference between native femoral head diameter and prosthetic head diameter was significantly higher in these groups, as was mean LLD (p = 0.0001). Mean T scores obtained with BMD were lower in these groups (p = 0.0001). Conclusion It is safer and more reliable to use a bipolar prosthetic head the same size as the patient’s native femoral head in BHA. When considering the acetabular protrusion and revision surgery rate in this study, small-size bipolar prosthetic head implantation is not recommended and may cause devastating complications.

Aim: The aim of this retrospective study is to assess the effectiveness of surgical intervention for Kienböck's disease using 4-5 Extensor Compartmental Artery (4-5 ECA) pedicled osseous flap Method: Patients who underwent 4-5 ECA pedicled bone grafts for Kienböck's disease between January 2012 and January 2022 were included in the study. The patient files were analyzed retrospectively for age, gender, follow-up time, and complications. Disease staging was performed preoperatively using direct X-ray and MRI, and radiological improvement was evaluated postoperatively using radiography. The functional and clinical assessment was made by comparing preoperative and postoperative VAS, Q-Dash, and Mayo scores. Results: This study involved 23 patients (12 female and 11 male) with Kienböck's disease who underwent 4-5 ECA pedicled bone graft surgery. 13 cases were right-handed while 10 were left-handed. The mean age was 37.5 ± 12.5 years, and the mean follow-up time was 68 months. The mean preoperative Q-Dash score was 78.8 (± 9), the VAS score was 6.5 (±1.2, and the Mayo wrist score was 34.34 (±11.8). The mean postoperative Q-Dash score was 33.1( ±10), the VAS score was 2.4 (±1.7), and the Mayo wrist score was 73.9 (±14.5). The differences between preoperative and postoperative Q-DASH scores (p<0.05), VAS scores (p<0.05), and Mayo wrist scores (p<0.05) were statistically significantly improved. Disease progression was observed in only two patients based on the Lichtman Classification in their follow-up radiographs. Conclusion: Our study demonstrates that the surgical treatment of Kienböck's disease using a 4-5 ECA pedicled osseous flap is a reliable and effective surgical treatment option.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.