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Lynn Woolley, 67, cleaner and mother of three from Portsmouth, was one of the first with a new groundbreaking device

Lynn Woolley, 67, cleaner and mother of three from Portsmouth, was one of the first with a new groundbreaking device

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Lynn Woolley, 67, cleaner and mother of three from Portsmouth, was one of the first with a new groundbreaking device

A recent study has shown that a new & # 39; expanding & # 39; implant for repairing crumbling hip joints has the lowest failure rate of such an implant.

Lynn Woolley, 67, cleaner and mother of three children from Portsmouth, was one of the first with the groundbreaking device, she tells Rachel Ellis.

THE PATIENT

I was home eighteen months ago when I fell. I have problems with blood pressure, so sometimes I am a little unstable.

Unfortunately it was a concrete kitchen floor and I fell awkwardly, leaving my left leg and hip in a funny corner.

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In the hospital, an x-ray showed that I had broken my left hip and needed surgery. Without surgery I would probably not be able to walk.

I was shown a diagram of the traditional implant that holds the fractured hip together with a large screw through the neck and the head of the femur.

But I was told that I could be part of a test for a new implant, the X-Bolt, which promises to make the repair more stable because parts of it expand in the fractured bone.

During my consultation I was also told that I had osteoporosis, with bones losing their strength, which explains why my hip joint broke when I fell. I now take medication for that.

After the X-Bolt operation I had strong painkillers and I was in the hospital for five days, but I was on my way immediately.

I lay on crutches for eight to nine weeks and drove again after about six weeks.

I have a 5 inch scar along the side of my left leg and sometimes I still get some problems with my hip. For example, it can be difficult to bend over to put on my socks, but not painful. However, it generally feels good. I'm excited.

Mrs. Woolley said: & # 39; I was told that I could be part of a test for a new implant, the X-Bolt, which promises to make the repair more stable because parts of it expand in the fractured bone & # 39;
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Mrs. Woolley said: & # 39; I was told that I could be part of a test for a new implant, the X-Bolt, which promises to make the repair more stable because parts of it expand in the fractured bone & # 39;

Mrs. Woolley said: & # 39; I was told that I could be part of a test for a new implant, the X-Bolt, which promises to make the repair more stable because parts of it expand in the fractured bone & # 39;

THE SURGEON

Charlotte Lewis is an orthopedic surgeon consultant at Portsmouth Hospitals NHS Trust.

HIP fractures are very common and affect 75,000 people a year in the UK, but can be difficult to treat because they tend to occur in older, vulnerable patients.

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One in 20 operations to repair the fracture fails, either because the device is failing or the patient is getting an infection in the joint.

What are the risks & # 39; s?

  • The implant fails in 0.8 percent of patients.
  • Between 1 and 3 percent of patients develop an infection.
  • One in 50 – 2 percent – develops deep vein thrombosis, a blood clot that normally develops in the leg.
  • It can lead to pulmonary embolism, a potentially fatal condition in which a piece of the clot breaks down in the bloodstream and blocks one of the blood vessels in the lungs.
  • Five percent will get an infection by lying in bed after surgery, hence the need to get up as soon as possible.

We try to operate on patients with a hip fracture within 36 hours because lying in bed can cause pressure ulcers and infections that can be life threatening.

By working fast – in the case of Lynn after only 12 hours – the mortality rates have fallen steadily within 30 days after the operation and have now fallen to around 6 percent (compared to around 8 percent a decade ago). Since the 1950s, hip fractures – cracks or fractures in the top of the thigh close to the hip joint – have been resolved using a device known as a sliding hip screw. Most hip fractures are treated this way, although some have a hip replacement, replacing the entire head of the femur.

The sliding hip screw involves placing a plate along the outer thigh that is screwed into place, and then a larger 4 inch screw is passed through the neck and head of the thigh to hold the fracture together.

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Although this works very well, the hope is that this new device is more stable, with a lower failure rate and better function for patients afterwards.

I was the lead investigator in one of the ten hospitals that participated in the X-Bolt trial of World Hip Trauma Evaluation 4 (WHITE4) last year – the largest ever randomized controlled trial to look at hip fractures.

The X-Bolt device secures the fractured hip with the help of "wings" that expand in the femoral head (the ball section of the ball joint), just like an expandable plug.

The X-Bolt device secures the fractured hip with the help of "wings" that expand in the femoral head (the ball section of the ball joint), just like an expandable plug. Stock image of an arthritic hip

The X-Bolt device secures the fractured hip with the help of "wings" that expand in the femoral head (the ball section of the ball joint), just like an expandable plug. Stock image of an arthritic hip

The X-Bolt device secures the fractured hip with the help of "wings" that expand in the femoral head (the ball section of the ball joint), just like an expandable plug. Stock image of an arthritic hip

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The theory is that this ensures greater anchoring, especially in bones that have become soft and spongy due to osteoporosis. It is like the normal screw but with added wings for stability.

The 20 to 45 minute operation is performed under general or local anesthesia, depending on the condition of the patient. The operation itself is largely performed in the same way as the traditional sliding hip screw procedure.

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First, the injured leg with the patient is placed on his back and put in a special boot and suspended in the air to align the hip. An incision 4 is made on the outside of the injured thigh and the muscle is lifted to reach the femur (femur).

A guidewire is then guided (using X-rays as a guide) from the top of the femur through the fracture to the center of the femur head. A channel is then created using a type of cutting tool, called a reamer, to prepare for the X-bolt device, which comes in various sizes to match the size of the patient's hip. Once the device is in place, the wings in the head of the femur expand.

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A plate is then placed along the outer thigh that is screwed into place and the skin is closed with sutures. By pulling the bones together, the device stimulates the ends of the fracture to compress and this both reduces pain and stimulates the bone to heal.

After surgery, it is important that patients are out of bed the day after surgery to promote their recovery and to prevent breast infections and pressure ulcers.

Patients are out of bed the day after the operation and need painkillers for two to three weeks.

More than 1,100 patients received a standard sliding screw hip or the X-Bolt device as part of the WHITE4 study. They were followed a year after the operation and asked about their quality of life and if they needed revision surgery.

Results, presented at the British Orthopedic Association in September, showed that X-Bolt had a cut-out rate – where the implant was not successfully anchored in the ball of the hip joint, requiring revision surgery – of 0.8 percent after one year.

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This is claimed to be the lowest excision rate of any hip fracture device on the market. This is important because if the procedure fails, it requires a much larger operation with a death rate of 50 percent.

The study also showed that X-Bolt was just as effective as the traditional device to get patients back on their feet.

These results are encouraging and follow an earlier study, published in the Bone and Joint Journal in 2016, called WHITE1, which showed that X-Bolt had a reoperation rate of 0 percent compared to 6 percent for the sliding screw in people with hip fractures.

This device is now available on the NHS outside the trial period.

X-Bolt costs around £ 10,000 for the NHS and private.

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