STUDY DESIGN/SETTING:Retrospective review of clinical outcomes after anterior cervical discectomy and fusion (ACDF) surgery with allograft and plating in patients over 55 years of age.OBJECTIVE:To evaluate the results of ACDF surgery in patients aged 55 years and older.SUMMARY OF BACKGROUND DATA:ACDF surgery has been a standard treatment for cervical degenerative and herniated disc disease for many years. Previous assessments of efficacy have used patient perceived outcome measures including the Neck Disability Index (NDI) and the Short Form 36 Question Health Questionnaire (SF-36). Patient perceived outcome after ACDF surgery in an age-specific cohort (55 y and older) has not been documented previously.METHODS:Fifty-two consecutive patients over 55 years of age who underwent 1 to 3 level ACDF with allograft and plating were identified. Patient perceived outcome questionnaires (NDI and SF-36) were available for 44 patients. There were 28 females and 16 males. Mean age at time of surgery was 61.8 years. Average length of follow-up was 25.2 months (12 to 54 mo).RESULTS:All but one patient demonstrated radiographic healing of the fusion site at the time of their last follow-up. The mean improvement of these 10 groups (total NDI score) was statistically significant (difference =-9.47, t=5.6390, P=1.5198E-06). There was a statistically significant decrease in disability in 7 of the 8 SF-36 categories as well. The mean of the 8 SF-36 categories (total SF-36) improved significantly (improvement=11.92, t=-3.6857, P=0.0007).CONCLUSIONS:On the basis of our statistically significant improvement in NDI and SF-36 scores, as a measure of patient perceived outcome after ACDF surgery, outcomes after ACDF surgery in patients over 55 years of age are not significantly different than those of a younger patient population.

Proximal femoral fractures are relatively common during total hip arthroplasty. The purposes of this study were to identify risk factors associated with femoral fractures and determine their effect on femoral stem survivorship. A total of 2551 hips were examined with up to 16 years of follow-up (mean, 6.8 years). Seventy-five percent of the stems were cemented. The incidence of proximal femoral fracture was 2.3% (59 hips). Risk factors associated with fractures include anterolateral approach, uncemented femoral fixation, and female sex (P < .01). Cerclage wiring was the most common treatment. After a fracture, femoral component survivorship was 95.8% for uncemented stems and 91.7% for cemented stems. In the absence of fracture, stem survivorship was 98.6% for cemented stems and 100% for circumferentially coated tapered titanium uncemented stems.

Proximal femoral fracture is a relatively common occurrence during total hip replacement (THR). The purpose of this study was to identify risk factors associated with proximal femoral fracture during THR and report the outcome of the femoral prosthesis in uncemented and cemented THR. Risk factors examined included surgical approach, patient demographics of age, sex, and body mass index type of femoral component fixation, and types of fracture treatment. 3089 hips were examined with up to 14-year follow-up (mean, 4.7 years). 2295 (74%) femoral stems were cemented and 794 (26%) were uncemented. 82 hips had a proximal femoral fracture for an incidence 2.7%. Uncemented stem insertion had a significantly higher fracture rate at 6.9% compared with cemented stems at 0.8% (P < .0001). Risk factors for proximal femoral fractures include anterolateral approach (P < .0001), uncemented femoral component fixation (P < .0001), and female sex (P = .0016). Treatment with cerclage wiring was the most common treatment and long-term femoral component stability was unaffected by the fracture for uncemented hips (P = .9694). For cemented femoral stems, the stem survival rate was significantly decreased in hips with a proximal fracture compared with those without (93.3% vs. 97.1%) at 7-year follow-up (P < .0001). This study identifies an “at risk” population based on surgical approach, sex, and the use of uncemented components for proximal femoral fracture during THA. Treatment with cerclage wiring in combination with tapered titanium proximally circumferentially coated implants yielded excellent clinical and radiographic results at mean of 4.7 years (range, 0.3-14 years) follow-up.