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Mühlenfeld M, Strahl A, Bechler U, Jandl NM, Hubert J, Rolvien T. Bone mineral density assessment by DXA in rheumatic patients with end-stage osteoarthritis undergoing total joint arthroplasty. BMC Musculoskelet Disord 2021; 22:173. [PMID: 33573628 PMCID: PMC7879515 DOI: 10.1186/s12891-021-04039-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis). While several factors may lead to low BMD in these patients, the value of BMD measurements in rheumatic patients with end-stage OA scheduled for total joint arthroplasty is unknown. METHODS In this retrospective cross-sectional study of 50 adults with secondary OA due to rheumatic diseases, we evaluated dual energy X-ray absorptiometry (DXA) measurements of both hips and the spine performed within 3 months prior to arthroplasty (n = 25 total hip arthroplasty, THA; n = 25 total knee arthroplasty, TKA). We analyzed various demographic and disease-specific characteristics and their effect on DXA results by using group comparisons and multivariate linear regression models. RESULTS Although patients undergoing TKA were younger (63.2 ± 14.2 vs. 71.0 ± 10.8 yr., p = 0.035), osteoporosis was observed more frequently in patients scheduled for TKA than THA (32% vs. 12%). Osteopenia was detected in 13/25 patients (52%) in both the THA and TKA cohort. In the THA cohort, female sex, lower BMI and prednisolone use were associated with lower T-score in the hip. In TKA patients, higher OA grade determined by Kellgren-Lawrence score was associated with lower T-score in the hip of the affected side. CONCLUSIONS Osteoporosis is present in a considerable frequency of rheumatic patients with end-stage OA, and THA and TKA patients show distinct frequencies and risk factors of low BMD. Our findings point to a potential value of DXA regarding preoperative evaluation of bone status.
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Affiliation(s)
- Moritz Mühlenfeld
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - André Strahl
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ulrich Bechler
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nico Maximilian Jandl
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Germany
| | - Jan Hubert
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Tim Rolvien
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Germany.
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52
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Freitag T, Kutzner KP, Bieger R, Reichel H, Ignatius A, Dürselen L. Biomechanics of a cemented short stem: a comparative in vitro study regarding primary stability and maximum fracture load. Arch Orthop Trauma Surg 2021; 141:1797-1806. [PMID: 33755800 PMCID: PMC8437915 DOI: 10.1007/s00402-021-03843-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In total hip arthroplasty, uncemented short stems have been used more and more frequently in recent years. Especially for short and curved femoral implants, bone-preserving and soft tissue-sparing properties are postulated. However, indication is limited to sufficient bone quality. At present, there are no curved short stems available which are based on cemented fixation. METHODS In this in vitro study, primary stability and maximum fracture load of a newly developed cemented short-stem implant was evaluated in comparison to an already well-established cemented conventional straight stem using six pairs of human cadaver femurs with minor bone quality. Primary stability, including reversible micromotion and irreversible migration, was assessed in a dynamic material-testing machine. Furthermore, a subsequent load-to-failure test revealed the periprosthetic fracture characteristics. RESULTS Reversible and irreversible micromotions showed no statistical difference between the two investigated stems. All short stems fractured under maximum load according to Vancouver type B3, whereas 4 out of 6 conventional stems suffered a periprosthetic fracture according to Vancouver type C. Mean fracture load of the short stems was 3062 N versus 3160 N for the conventional stems (p = 0.84). CONCLUSION Primary stability of the cemented short stem was not negatively influenced compared to the cemented conventional stem and no significant difference in fracture load was observed. However, a clear difference in the fracture pattern has been identified.
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Affiliation(s)
- Tobias Freitag
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Ralf Bieger
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Medical Centre, Helmholtzstr. 14, 89081, Ulm, Germany
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53
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Nishi M, Yoshikawa Y, Kaji Y, Okano I, Inagaki K. Multi-Site Insufficiency Pelvic Fracture Following Total Hip Arthroplasty. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927776. [PMID: 33372173 PMCID: PMC7780195 DOI: 10.12659/ajcr.927776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Female, 47-year-old Final Diagnosis: Pelvic fracture Symptoms: Hip pain Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Masanori Nishi
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yasushi Yoshikawa
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Yasutaka Kaji
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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54
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García Rey E, Cruz Pardos A, Ortega Chamarro J. Mortality as a competition risk factor in the survival analysis of the results of the type of fixation of the total hip prosthesis in octogenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:99-107. [PMID: 33172799 DOI: 10.1016/j.recot.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Total hip replacement (THR) is challenging in octogenarians due to associated comorbidities and controversy regarding fixation type. We ask whether cemented THR is superior to uncemented THR in patients above the age of 80 years. MATERIAL AND METHODS A total of 382 patients (441 hips) aged 80 years or older who underwent THR between 2004 and 2015 were analysed. A cemented THR was implanted in 196 hips (group 1), an uncemented THR with a grit-blasted stem in 121 (group 2), or with a porous-coated stem in 124 (group 3). Patients in group 1 had a higher mean age, more comorbidities and osteoporotic bone. Survival analysis was calculated using cumulative incidence function to account for the competing risk of death. RESULTS Medical complications rate was similar. There were 3post-operative fractures: one in group 2 and 2in group 3. Competing risk analysis showed that the cumulative incidence of revision for any cause was 2.3 in group 1, 6.0 in group 2 and 4.1 in group 3 at 10years, and the cumulative incidence of revision for aseptic loosening was 1.2 in group 1, 3.7 in group 2 and 0 in group 3 at the same period. CONCLUSIONS THR presents an acceptable number of adverse events for octogenarian patients. Despite uncemented fixation was satisfactory, the higher peri-prosthetic fracture rate worsens results in this group.
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Affiliation(s)
- E García Rey
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España.
| | - A Cruz Pardos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España
| | - J Ortega Chamarro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-Idi Paz, Madrid, España
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55
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Kheir MM, Drayer NJ, Chen AF. An Update on Cementless Femoral Fixation in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:1646-1661. [PMID: 32740265 DOI: 10.2106/jbjs.19.01397] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael M Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas J Drayer
- Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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56
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Johnson AJ, Desai S, Zhang C, Koh K, Zhang LQ, Costales T, O'Toole RV, Manson TT. A Calcar Collar Is Protective Against Early Torsional/Spiral Periprosthetic Femoral Fracture: A Paired Cadaveric Biomechanical Analysis. J Bone Joint Surg Am 2020; 102:1427-1433. [PMID: 32816417 DOI: 10.2106/jbjs.19.01125] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic fracture is a leading reason for readmission following total hip arthroplasty. Most of these fractures occur during the early postoperative period before bone ingrowth. Before ingrowth occurs, the femoral component can rotate relative to the femoral canal, causing a spiral fracture pattern. We sought to evaluate, in a paired cadaver model, whether the torsional load to fracture was higher in collared stems. The hypothesis was that collared stems have greater load to fracture under axial and torsional loads compared with collarless stems. METHODS Twenty-two cadaveric femora (11 matched pairs) with a mean age of 77 ± 10.2 years (range, 54 to 90 years) were harvested. Following dissection, the femora were evaluated with use of a dual x-ray absorptiometry scanner and T scores were recorded. We utilized a common stem that is available with the same intraosseous geometry with and without a collar. For each pair, 1 femur was implanted with a collared stem and the contralateral femur was implanted with a collarless stem with use of a standard broaching technique. A compressive 68-kg load was applied to simulate body weight during ambulation. A rotational displacement was then applied until fracture occurred. Peak torque prior to fracture was measured with use of a torque meter load cell and data acquisition software. RESULTS The median torque to fracture was 65.4 Nm for collared stems and 43.1 Nm for uncollared stems (p = 0.0014, Wilcoxon signed-rank test). The median T score was -1.95 (range, -4.1 to -0.15). The median difference in torque to fracture was 29.18 Nm. As expected in each case, the mode of failure was a spiral fracture around the implant. CONCLUSIONS Collared stems seemed to offer a protective effect in torsional loading in this biomechanical model comparing matched femora. CLINICAL RELEVANCE These results may translate into a protective effect against early periprosthetic Vancouver B2 femoral fractures that occur before osseous integration has occurred.
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Affiliation(s)
- Aaron J Johnson
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland
| | - Shivam Desai
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland
| | - Chunyang Zhang
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland
| | - Kyung Koh
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland
| | - Li-Qun Zhang
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland.,Department of Bioengineering, University of Maryland School of Engineering, College Park, Maryland
| | - Timothy Costales
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland
| | - Theodore T Manson
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland
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57
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Ragland K, Reif R, Karim S, Sexton KW, Cherney SM, Stambough JB, Mears SC. Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision. Geriatr Orthop Surg Rehabil 2020; 11:2151459320939550. [PMID: 32733772 PMCID: PMC7372608 DOI: 10.1177/2151459320939550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction: Periprosthetic femur fractures (PPFX) are complications of both total hip and
knee arthroplasty and may be treated with open reduction and internal
fixation (ORIF) or revision arthroplasty. Differences in treatment and
fracture location may be related to patient demographics and lead to
differences in cost. Our study examined the effects of demographics and
treatment of knee and hip PPFXs on length of stay (LOS) and cost. Methods: Of all, 932 patients were identified with hip or knee PPFXs in the National
Inpatient Sample from January 2013 to September 2015. Age, gender, race,
mortality, comorbidity level, LOS, total cost, procedure type, geographic
region, and hospital type were recorded. A generalized linear regression
model was conducted to analyze the effect of fracture type on LOS and
cost. Results: Differences in gender (66% vs 83.7% female, P < .01),
comorbidities (fewer in hips, P < .01), and costs (US$30
979 vs US$27 944, P < .01) were found between the hip
and knee groups. Knees had significantly higher rates of ORIF treatment
(80.7% vs 39.1%) and lower rates of revision arthroplasties (19.3% vs 60.9%)
than hip PPFXs (P < .01). Within both groups, patients
with more comorbidities, revision surgery, and blood transfusions were more
likely to have a longer LOS and higher cost. Conclusion: Periprosthetic femur fractures patients are not homogenous and treatment
varies between hip and knee locations. For knee patients, those treated with
ORIF were younger, with fewer comorbidities than those treated with
revision. Conversely, hip patients treated with ORIF were older, with more
comorbidities than those treated with revision. Hips had higher costs than
knees, and cost correlated with revision arthroplasty and more
comorbidities. In both hip and knee groups, longer LOS was associated with
more comorbidities and being treated in urban teaching hospitals. Total cost
had the strongest associations with revision procedures as well as number of
comorbidities and blood product use.
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Affiliation(s)
- Katelyn Ragland
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca Reif
- Department of Health Policy and Management, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Saleema Karim
- Department of Health Policy and Management, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin W Sexton
- Department of Health Policy and Management, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven M Cherney
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Gislason MK, Lupidio F, Jónsson H, Cristofolini L, Esposito L, Bifulco P, Fraldi M, Gargiulo P. Three dimensional bone mineral density changes in the femur over 1 year in primary total hip arthroplasty patients. Clin Biomech (Bristol, Avon) 2020; 78:105092. [PMID: 32590143 DOI: 10.1016/j.clinbiomech.2020.105092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare the bone mineral density changes between unmatched patients undergoing total hip arthroplasty receiving uncemented and cemented type of implants. Previous studies have used DEXA or a two dimensional analysis to estimate the bone quality following total joint replacement, whereas this study presents the changes in three dimensions. METHODS Fifty subjects both male and females receiving both cemented and uncemented type of implant were recruited. Two CT scans were taken of each subject, the first at 24 h post surgery and the second one 1 year after surgery. The scans were calibrated using a phantom converting the Hounsfield units to bone mineral density values in g/cm3. The two scans were registered together using anatomical landmarks and resliced to compare the two femurs in the identical frame of reference. The bone density gain and loss was calculated by comparing density values between the two sets of scans. FINDINGS The results showed that most of the bone loss was located around the Lesser Trochanter and some bone density gain at the distal tip of the implant. The three dimensional density changes occur differently between individuals and the study showed no correlation of bone loss with age. INTERPRETATION The bone loss occurred mostly at the proximal femur, which is in agreement with previously presented studies. By carrying out three dimensional analysis on the bone gain and loss on the femur, it is possible to identify the patients that are showing high degree of bone loss.
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Affiliation(s)
| | - Francesca Lupidio
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; University of Bologna, Department of Industrial Engineering, Italy
| | - Halldór Jónsson
- Landspitali University Hospital, Department of Orthopaedics, Iceland
| | | | - Luca Esposito
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Bifulco
- University of Naples Federico II, Department of Electrical Engineering and Information Technologies, Italy
| | - Massimiliano Fraldi
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; Department of Science, Landspitali University Hospital, Iceland
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Blankstein M, Lentine B, Nelms NJ. The Use of Cement in Hip Arthroplasty: A Contemporary Perspective. J Am Acad Orthop Surg 2020; 28:e586-e594. [PMID: 32692094 DOI: 10.5435/jaaos-d-19-00604] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Notable advances in hip arthroplasty implants and techniques over the past 60 years have yielded excellent survivorship of fully cemented, hybrid, and reverse hybrid total hip replacements as demonstrated in joint registries worldwide. Major advances in noncemented implants have reduced the use of cement, particularly in North America. Noncemented implants predominate today based on procedural efficiency, concern related to thromboembolic risk, and a historic belief that cement was the primary cause of osteolysis and implant loosening. With the decline of cemented techniques, press-fit fixation has become common even in osteoporotic elderly patients. Unfortunately, there is a troubling rise in intraoperative, as well as early and late postoperative periprosthetic fractures associated with the use of noncemented implants. Despite the success of noncemented fixation, an understanding of modern cement techniques and cemented implant designs is useful to mitigate the risk of periprosthetic fractures. Cemented acetabular components can be considered in elderly patients with osteoporotic or pathologic bone. Cemented stems should be considered with abnormal proximal femoral morphology, conversion of failed hip fixation, inflammatory arthritis, patient age over 75 (especially women), osteoporotic bone (Dorr C), and in the treatment of femoral neck fractures.
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Affiliation(s)
- Michael Blankstein
- From the The University of Vermont Medical Center, Orthopedics and Rehabilitation Center (Dr. Blankstein and Dr. Nelms), and the Department of Orthopaedics and Rehabilitation (Dr. Lentine), The Robert Larner, M.D., College of Medicine at The University of Vermont, Burlington, VT
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60
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Guo Y, Ma S, Wang J, Zhang Q, Wang S, Du Z. Cemented versus uncemented total knee arthroplasty in younger patients: A protocol of retrospective cohort trial. Medicine (Baltimore) 2020; 99:e20087. [PMID: 32358393 PMCID: PMC7440262 DOI: 10.1097/md.0000000000020087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recently, controversy still exists regarding the clinical effects of cemented or cementless technique in young patients in total knee arthroplasty (TKA). In this context, the present study aimed to determine the functional outcomes and clinical reliability of cementless components versus those of conventional cemented components for young patients in primary TKA. METHODS A retrospective review of primary TKAs performed with cementless or cemented fixation between May 2010 and February 2019 was conducted with Institutional Review Board approval. All cases were performed by a single surgeon. Institutional review board approval was obtained prior to conducting chart review and analysis. The primary outcome compared between the 2 fixation groups was the rate of postoperative complications and revision related to TKA, occurring at any point in follow-up. Secondary outcome measures included surgical time, Oxford Knee Score, range of motion, and radiographic outcomes such as progressive radiolucent lines, osteolysis, or component migration. RESULTS We were able to directly compare the outcomes of cemented versus cementless techniques and might reveal a better technique in TKA. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry5459).
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Affiliation(s)
- Yuning Guo
- Department of orthopaedics, Yuncheng central hospital, Eighth Clinical Medical College of ShanXi Medical University. ShanXi
| | - Shufang Ma
- Department of rheumatology and immunology, The 4th Central Hospital of Baoding City, Hebei
| | - Junbo Wang
- Department of Radiology, Yuncheng central hospital, Eighth Clinical Medical College of ShanXi Medical University
| | - Qin Zhang
- Department of orthopaedics, Yuncheng central hospital, Eighth Clinical Medical College of ShanXi Medical University. ShanXi
| | - Shaowei Wang
- The Second Hospital of Shanxi Medical University, ShanXi
| | - Zhipo Du
- Department of orthopaedics, The 4th Central Hospital of Baoding City, Hebei, China
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On-Table and Short-Term Mortality: A Single-Institution Experience With Cementing All Hip Arthroplasties for Neck of Femur Fractures. J Arthroplasty 2020; 35:1095-1100. [PMID: 31870579 DOI: 10.1016/j.arth.2019.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND To review on-table, day 0, day 1, day 7, and day 30 mortality after hemiarthroplasty or total hip arthroplasty (THA) using cemented femoral stems for femoral neck fractures in order to evaluate risk factors for perioperative and short-term mortality. METHODS The medical records of 751 consecutive cases with neck of femur fractures who underwent hemiarthroplasty (n = 602) or THA (n = 149) with cemented stems between January 2011 and December 2016 were retrospectively reviewed from a prospectively gathered database. The primary outcome measures were on-table, day 0, day 1, day 7, and day 30 mortality. Univariate and multivariate analyses were performed in order to identify various contributing patient and surgical variables. RESULTS There were 2 on-table deaths (0.27%): one patient had a cardiorespiratory arrest at the time of inserting the femoral stem and the other had a cardiorespiratory arrest at the end of wound closure some 20 minutes after cementing. There were 3 further day 0 deaths meaning the day 0 mortality rate was 0.67% (5/751). All 5 patients were older than 80 years and had an American Society of Anesthesiologists grade 3 or more. The 1-day, 7-day, and 30-day mortality rates were 0.93% (7 patients), 2.7% (20 patients), and 6.8% (51 patients), respectively. There is significantly higher 30-day mortality risk associated with increasing American Society of Anesthesiologists grade (P < .001) when adjusted for age, gender, and type of surgery (hemiarthroplasty compared with THA). CONCLUSION In our neck of femur fracture patients who were operated with cemented stems, 7-day and 30-day mortality rates were 2.7% and 6.8%, respectively. Cemented stems should be used with caution in elderly hip fracture patients with multiple comorbidities who are at high risk of perioperative mortality.
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62
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Risk Factors for Periprosthetic Femur Fracture and Influence of Femoral Fixation Using the Mini-Anterolateral Approach in Primary Total Hip Arthroplasty. J Arthroplasty 2020; 35:774-778. [PMID: 31685395 DOI: 10.1016/j.arth.2019.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The mini-anterolateral (AL) approach for total hip arthroplasty (THA) has gained popularity. In contrast to other approaches, risk factors for periprosthetic femur fractures have not been well established for the AL approach. METHODS Six hundred eighty-four primary THAs performed using the AL approach were retrospectively reviewed for risk factors associated with perioperative periprosthetic femur fractures within 3 months of surgery. Risk factors evaluated were gender, age, body mass index, laterality, and Dorr ratio of the proximal femur. Cemented stems and collared uncemented stems were compared to uncemented tapered-wedge and meta-diaphyseal stems. A Student's t-test was used for continuous variables, and a chi-squared test was used for categorical variables. RESULTS Of 684 primary THAs performed, 57 (8.3%) resulted in fracture. Twenty-eight (4.1%) occurred intraoperatively and 29 (4.2%) occurred postoperatively within 90 days. All intraoperative fractures were fixed at the time of surgery and healed uneventfully. Of the postoperative fractures, 15 (2.2%) were amenable to nonoperative management and healed. Fourteen (2.0%) required revision arthroplasty. There was a significantly lower rate of fracture in patients receiving cemented or collared stems (0%, n = 101) than in those receiving tapered-wedge or meta-diaphyseal fitting stems (9.8%, n = 583; P = .0009). Odds of fracture increased with female gender (P = .0063) and increasing Dorr ratio (P = .0003). Analysis showed a trend toward increased risk with older age, but did not achieve statistical significance. Body mass index and laterality showed no statistically significant effect. CONCLUSION Performing primary THA via the AL approach, 2.0% of patients had a postoperative fracture requiring revision within the first 3 months. With cemented and collared stems, the fracture rate was significantly lower. Surgeons should consider using cemented or collared stems in high-risk patients.
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Murat M, Ermutlu C, Unkar EA, Topalhafızoglu S, Şenel A, Öztürkmen Y. Bone Loss Following Cementless Hemiarthroplasty for the Treatment of Femoral Neck Fracture. Indian J Orthop 2020; 54:454-462. [PMID: 32549960 PMCID: PMC7270220 DOI: 10.1007/s43465-019-00009-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/27/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND With the advances in medicine, an increasing number of the ageing population are a public health concern in terms of age-related complications. Among them, displaced neck fractures often require surgical intervention or arthroplasty to achieve the mobilization of the elderly and good life quality. The aim of the study is to monitor the changes in bone mineral density (BMD) around the femoral stem and the effects on functional outcomes in patients treated with cementless hemiarthroplasty following femoral neck fracture. MATERIALS AND METHODS Seventy-one patients aged 70 years or older who were treated with cementless hemiarthroplasty for a displaced femoral neck fracture were prospectively followed for 2 years. The percent change in the periprosthetic BMD in each Gruen zone was compared to the baseline using dual-energy X-ray absorptiometry (DEXA). Demographic factors [age, body mass index (BMI), and sex] that could possibly influence BMD and the clinical outcome were evaluated. RESULTS Fifty-one patients were available for the final follow-up. The mean age was 76.5 (range 70-89) years. The mean BMI was 28.9 (range 22.7-37.2). The mean Harris hip score at the final follow-up was 84.3 (range 72-93). There was a significant decrease in BMD in all Gruen zones (p < 0.001), except in zone 3 (R3, p = 0.547). The reduction in BMD was highest in the calcar and the greater trochanter region. The femur diaphysis was relatively spared, with zone 3 showing no significant bone mineral loss. The age and BMI of the patients were not correlated with the postoperative change in BMD in any of the Gruen zones. The degree of reduction in bone density was not correlated with the clinical outcome. CONCLUSIONS Cementless hemiarthroplasty for the treatment of femoral neck fracture in elderly patients achieves a good clinical outcome despite significant bone loss around the femoral stem. The reduction in BMD is more pronounced in the metaphyseal region.
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Affiliation(s)
- Mert Murat
- Department of Orthopaedic Surgery, Yeniyuzyil University Medical School, Istanbul, Turkey
| | - Cenk Ermutlu
- Department of Orthopedics and Traumatology, Uludag University Medical School, Bursa, Turkey
| | - Ethem Ayhan Unkar
- Department of Orthopaedic Surgery, Istanbul Metin Sabanci Baltalimanı Training and Research Hospital for Bone Diseases, Istanbul, Turkey
| | - Sertaç Topalhafızoglu
- Department of Orthopaedic Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Şenel
- Department of Orthopaedic Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Öztürkmen
- Department of Orthopaedic Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
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