101
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Sevaldsen K, S Husby O, B Lian Ø, S Husby V. Does the line-to-line cementing technique of the femoral stem create an adequate cement mantle? Hip Int 2021; 31:618-623. [PMID: 32551930 PMCID: PMC8488641 DOI: 10.1177/1120700020934368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The line-to-line cementing technique is proposed to create a press-fit in the femoral canal, which is contrary to modern cementing techniques. The term 'French paradox' has been used to describe the acceptable results associated with this technique. It has been suggested that the quality of the mantle may not be satisfactory, predisposing to early failure and aseptic loosening. METHODS The line-to-line cementing technique, where the femoral stem was oversized by 1 size compared to the broach, was compared to the standard cementing technique using corresponding sized broaches and stems, in 6 pairs of human cadaver femora with taper-slip design C-stems. Cement pressure was measured, and cement mantle thickness was analysed. A mixed effects model with random intercepts was used to examine the relationship between thickness of mantle and cementing technique and between pressure and cementing technique. RESULTS Line-to-line cementing results in significantly higher pressurisation for longer periods of time leading to better interdigitation but a thinner mantle in some areas. CONCLUSIONS The results of this study describe the in-vitro advantages and disadvantages of the line-to-line cementing technique.
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Affiliation(s)
- Kirsti Sevaldsen
- Department of Orthopaedic Surgery, Kristiansund Hospital, Kristiansund, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway,Kirsti Sevaldsen, Kristiansund Sykehus, Herman Døhlensv, 1, Kristiansund, 6518, Norway.
| | - Otto S Husby
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway,Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olavs hospital HF, Trondheim, Norway
| | - Øystein B Lian
- Department of Orthopaedic Surgery, Kristiansund Hospital, Kristiansund, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Vigdis S Husby
- Department of Orthopaedic Surgery, Clinic of Orthopaedics, Rheumatology and Dermatology, St. Olavs hospital HF, Trondheim, Norway,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway,Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Norway
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102
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Park JW, Lim HJ, Kang HG, Kim JH, Kim HS. Percutaneous Cementoplasty for the Pelvis in Bone Metastasis: 12-Year Experience. Ann Surg Oncol 2021; 29:1413-1422. [PMID: 34448054 PMCID: PMC8390074 DOI: 10.1245/s10434-021-10640-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/24/2021] [Indexed: 01/20/2023]
Abstract
Background In advanced cancer patients, pelvic bone metastasis often causes pain and gait disturbance. The use of percutaneous bone cement [polymethylmethacrylate (PMMA)] injection for pain management and strengthening in pelvic bone metastasis has rarely been reported. To evaluate this method, we aimed to determine surgical outcomes and complications over a long-term follow-up period using a large patient group. Patients and Methods We retrospectively collected data from 178 patients who underwent percutaneous cementoplasty for pelvic metastatic lesions, 201 in total. Surgical outcomes evaluated included pain reduction and improvement of ambulation. Mortality within 1 month after procedure and pulmonary embolism caused by thrombus, fat, tumor emboli, or bone cement were investigated as surgical complications. For long-term survivors, pain relapse and mechanical failure were analyzed. The mean follow-up period was 12.6 months, and there were 159 fatalities at last follow-up. Results The mean regional pain numerical rating scale scores decreased from 6.1 preoperatively to 2.4 1 month after procedure (p < 0.01). Gait function was maintained, worsened, and uncheckable in 68%, 24%, and 8% of patients, respectively, 1 month after procedure. Of long-term survivors followed up for > 12 months (n = 53), there were no significant changes in serial plain radiographs, and regional pain aggravation was observed in 9%. Pulmonary cement embolism and bone cement implantation syndrome was observed in 11% and 10%, respectively. However, all patients with these complications were asymptomatic. Conclusions Percutaneous cement injection into the pelvis is a feasible and safe palliative surgical option for patients with advanced malignancy in terms of pain reduction and maintenance of ambulatory function under regional anesthesia.
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Affiliation(s)
- Jong Woong Park
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.,Division of Convergence Technology, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Hyun-Ju Lim
- Department of Radiology, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Hyun Guy Kang
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea. .,Division of Convergence Technology, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
| | - June Hyuk Kim
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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103
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Wan RCW, Liu WH, Ng RWK, Tso CY, Chow SKH, Cheung WH, Tang N, Wong RMY. Dangers with cementation under low-viscosity state: Cement arterio-venogram and bone cement implantation syndrome. Trauma Case Rep 2021; 35:100517. [PMID: 34401442 PMCID: PMC8353468 DOI: 10.1016/j.tcr.2021.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/30/2022] Open
Abstract
Cement arterio-venogram is a rare event with cement extrusion into femoral nutrient vessels. In literature it is known to be benign with no significant clinical sequelae. It is postulated that it is due to high cement implantation pressure, that results in optimal cement filling quality. All previously reported cases were female patients, and it is thought to be a female only phenomenon due to the relatively narrow femoral canal leading to higher pressures during cementation. In this case series we report 3 cases different to existing literature. All 3 patients showed a cement arterio-venogram together with bone cement implantation syndrome and hypotension intraoperatively. It was also observed that during implantation the cement was of low viscosity. We postulate low cement viscosity during implantation with pressurization is also a contributing factor to these phenomena. This case series also demonstrates the first 2 male cases, showing this the even can occur in males too. The cement arteriovenogram is located at 41%–42% femur length which is within the ‘third sixth’ of the length of the femur. Good cementation techniques and prevention is also highlighted in this report.
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Affiliation(s)
- Raymond Chung Wai Wan
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Wing Hong Liu
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Raymond Wai Kit Ng
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ning Tang
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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104
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Lo EY, Rizkalla J, Montemaggi P, Majekodunmi T, Krishnan SG. Clinical and radiographic outcomes of cementless reverse total shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 2021; 30:1949-1956. [PMID: 33359397 DOI: 10.1016/j.jse.2020.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (RTSA) has demonstrated successful outcomes in the treatment of both acute and chronic proximal humeral fractures (PHFs). The traditional RTSA surgical technique uses a methyl methacrylate cemented humeral component to restore and maintain both humeral height and retroversion. However, use of humeral bone cement has been associated intraoperatively with cardiopulmonary risk, increased operative cost, and postoperatively with difficulty if revision arthroplasty is required. We report the clinical and radiographic outcomes of a completely cementless RTSA technique for PHF surgery. METHODS Between 2013 and 2018, 60 consecutive patients underwent surgical management of a PHF with cementless RTSA. All surgical procedures were performed by a single senior shoulder surgeon using a modified deltopectoral approach and a completely uncemented RTSA technique. Fractures were defined as either acute or chronic based on a 4-week injury-to-surgery benchmark. The mean age was 67 years (range, 47-85 years). There were 18 acute and 42 chronic fractures. The mean time from injury to surgery was 2 weeks (range, 0.4-4 weeks) for acute fractures and 60 months (range, 1-482 months) for chronic fractures. We excluded 17 cases from postoperative evaluation because of revision and/or loss to follow-up. The remaining 43 cases underwent clinical and radiographic evaluation by 2 independent fellowship-trained shoulder surgeons at a mean of 21 months (range, 10-46 months) postoperatively. Independent statistical analysis was performed using the paired t test and Wilcoxon signed rank test. RESULTS At final review, mean active anterior elevation was 157° (range, 100°-170°); active external rotation, 52° (range, 6°-80°); and active internal rotation, 66° (range, 0°-80°). Improvements were seen in the visual analog scale pain score (from 6 to 0.2, P < .001), Simple Shoulder Test score (from 9 to 93, P < .001), American Shoulder and Elbow Surgeons score (from 19 to 91, P < .001), and Single Assessment Numeric Evaluation score (from 21% to 89%, P < .001). Overall, 39 of 43 greater tuberosities (91%) demonstrated osseous healing to the humeral shaft. No significant differences in clinical and radiographic outcomes were found in acute vs. chronic cases, as well as cases with minimum follow-up of 1 year vs. 2 years. Overall, there were 4 major complications necessitating surgical revision (6.7%) and no cases of aseptic humeral stem loosening. CONCLUSION Cementless RTSA for acute and chronic PHFs demonstrates clinical and radiographic outcomes similar to those after traditional cemented RTSA. The successful greater tuberosity healing and absence of humeral stem loosening in this short-term cohort are encouraging for the continued long-term success of this technique. By avoiding cemented humeral implants, surgeons may minimize intraoperative complications, operative cost, and postoperative revision difficulty.
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Affiliation(s)
- Eddie Y Lo
- The Shoulder Center, Baylor Scott & White Research Institute, Dallas, TX, USA; Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX, USA.
| | - James Rizkalla
- The Shoulder Center, Baylor Scott & White Research Institute, Dallas, TX, USA; Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX, USA
| | | | - Temilola Majekodunmi
- The Shoulder Center, Baylor Scott & White Research Institute, Dallas, TX, USA; Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX, USA
| | - Sumant G Krishnan
- The Shoulder Center, Baylor Scott & White Research Institute, Dallas, TX, USA; Baylor University Medical Center, Baylor Scott & White Health, Dallas, TX, USA
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105
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Huang WC, Lee P, Ling Wong TG, Tiong Tan JK, Hwang NC. Diagnosis of bone cement implantation syndrome using point of care ultrasound examination. Ann Card Anaesth 2021; 24:372-374. [PMID: 34269272 PMCID: PMC8404584 DOI: 10.4103/aca.aca_202_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Once regarded as a rare complication, the potentially fatal bone cement implantation syndrome (BCIS) has been increasingly reported. BCIS can present as transient desaturation, hypotension, cardiac dysrhythmias, and cardiovascular collapse. Diagnosis of BCIS is often clinical and confirmed with computed tomography (CT) imaging postoperatively. However, point of care ultrasound (POCUS) examination could be a helpful and timely tool to clinch the diagnosis in a sudden cardiovascular collapse. We present a case of Grade 3 BCIS where POCUS examination revealed a massive clot in the right atrium, which supports the diagnosis.
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Affiliation(s)
| | - Pang Lee
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | | | - Jerry Keng Tiong Tan
- Department of Anaesthesiology, Singapore General Hospital; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
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106
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Parker MJ, Johansen A, Griffiths R. Bone cement and hip fractures. Injury 2021; 52:1655-1656. [PMID: 34030862 DOI: 10.1016/j.injury.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/04/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Martyn J Parker
- Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU PO Box 211, Bretton Gate, Peterborough, PE3 9GZ, UK.
| | - Antony Johansen
- University Hospital of Wales, Cardiff, CF14 4XW, UK; National Hip Fracture Database (NHFD), Royal College of Physicians, London, UK.
| | - Richard Griffiths
- Peterborough and Stamford Hospital NHS Foundation Trust, Peterborough City Hospital, UK.
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107
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Wang Y, Wang Z, Tian S, Tan Z, Zhu Y, Chen W, Zhang Y. Cemented versus uncemented hemiarthroplasty for femoral neck fractures in patients with neuromuscular diseases: a minimum of 2 years' follow-up study. J Orthop Surg Res 2021; 16:418. [PMID: 34210343 PMCID: PMC8247077 DOI: 10.1186/s13018-021-02572-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the outcomes of cemented and uncemented hemiarthroplasty for femoral neck fractures in patients with neuromuscular disease. METHODS We reviewed 156 patients with neuromuscular disease who underwent hemiarthroplasty between June 2015 and December 2019. Patients were divided into cemented group (n = 105) and uncemented group (n = 51), with a minimum follow-up of 2 years. Factors including preoperative features, duration of surgery, intraoperative blood loss, complications, pain, Harris hip scores (HHS), and quality of life were compared across groups, and Kaplan-Meier curves were used to estimate survival. RESULTS In the uncemented group, the mean duration of surgery was 16.0 min. shorter (p = 0.001) and the mean intraoperative blood loss was 71.1 mL less (p = 0.01). Visual analog scales (VAS), HHS, and European Quality of Life-5 Dimensions (EQ-5D) scores were not different between the groups. Despite a few potential trends, we did not observe a difference in complications such as periprosthetic fractures and dislocations. The rates of mortality were similar between groups (p=0.821). CONCLUSIONS Both arthroplasties may be used with good medium-term results in the treatment of femoral neck fractures in patients with neuromuscular diseases.
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Affiliation(s)
- Yuchuan Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Siyu Tian
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Zhanchao Tan
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
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108
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Ogawa T, Yoshii T, Okawa A, Fushimi K, Jinno T. Association Between Cemented vs Cementless Hemiarthroplasty and Short-Term Change of In-Hospital Mortality in Elderly Patients with Femoral Neck Fracture: A Propensity-Score Matching Analysis in a Multicenter Database. Clin Interv Aging 2021; 16:1151-1159. [PMID: 34188458 PMCID: PMC8232875 DOI: 10.2147/cia.s315090] [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] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Cemented hemiarthroplasty is recommended for the vulnerable hip fracture population because of beneficial long-term outcomes. However, the association between cemented hemiarthroplasty and short-term mortality is controversial. To increase a preparedness of potential complication after cemented hemiarthroplasty, we aimed to evaluate the trajectory of the effect of cemented hemiarthroplasty on short-term in-hospital outcomes. Methods We investigated in-hospital mortality and complications between cemented hemiarthroplasty and cementless hemiarthroplasty using a nationwide multicenter database from 2010 to 2016 with a propensity-score matching analysis. We analyzed in-hospital mortality from 1 to 14 days after surgery. We also investigated in-hospital complications that may associate with mortality. Results After matching of 31,322 cases, we found no significant difference in 30-day in-hospital mortality between the cemented and cementless hemiarthroplasty groups (hazard ratio, HR [95% confidence interval, CI], 1.2 [0.89-1.6], p = 0.23). However, the 1- to 10-day postoperative mortality rates were significantly higher in the cemented group and the association becomes weaker as the postoperative period increased (day 1; HR [95% CI]: 3.5 [1.6-7.68]; day 10; HR [95% CI]: 1.59 [1.07-2.37]). The incidence of stroke and intensive care unit (ICU) admission was also significantly higher in the cemented group. Conclusion Cemented hemiarthroplasty was not significantly associated with an increase in overall in-hospital mortality but was significantly associated with short-term mortality from 1-day to 10-day after surgery. The incidence of stroke and ICU admission was also significantly higher in the cemented group. Surgeons should pay more attention to the risk of mortality and stroke in patients undergoing cemented hemiarthroplasty, especially in the early days of hospitalization.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.,Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
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109
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Kim YH, Jang YS. Long-Term Clinical and Radiographic Results of an Ultra-Short Metaphyseal-Fitting Non-Anatomic Cementless Stem in Patients with Femoral Neck Fracture. J Arthroplasty 2021; 36:2105-2109. [PMID: 33573812 DOI: 10.1016/j.arth.2021.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to determine the clinical and radiographic outcomes, mortality rate, complication rate, and revision rate of this ultra-short non-anatomic cementless femoral stem in elderly patients with a femoral neck fracture. METHODS We reviewed the results of 284 total hip arthroplasties performed with an ultra-short non-anatomic cementless stem in 280 previously active patients with a mean age of 72.8 ± 13 years (range 49-83). The mean follow-up was 9.3 years (range 7-13). RESULTS The mean Harris Hip Score was 86 ± 14 points at final follow-up. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 24 ± 6 points at the final follow-up. The mean University of California, Los Angeles activity score was 6 points at final follow-up. Osseointegration was seen in all acetabular (100%) and in 276 femoral components (97%). Kaplan-Meier survivorship analysis revealed that the survival rate of the femoral component at 8.3 years was 97% (95% confidence interval 91-100) and that of the acetabular component was 100% (95% confidence interval 94-100) with aseptic loosening or revision as the end point. CONCLUSION An ultra-short non-anatomic cementless femoral stem in patients with good bone quality (Dorr A and some Dorr type B bone) is a safe treatment for femoral neck fracture. In patients with poor bone quality (Dorr C type), the results were very poor, and use of this stem should be avoided.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Seoul Metropolitan Seonam Hospital, Seoul, Republic of Korea
| | - Young-Soo Jang
- The Joint Replacement Center, Seoul Metropolitan Seonam Hospital, Seoul, Republic of Korea
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110
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Murphy EP, Fenelon C, Akoud AI, Kearns SR, Shannon FJ, Murphy CG. Perioperative Mortality and Periprosthetic Fracture: A Single-Center Experience of 857 Uncemented Hemiarthroplasties for Displaced Femoral Neck Fractures. J Arthroplasty 2021; 36:2044-2048. [PMID: 33583668 DOI: 10.1016/j.arth.2021.01.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/20/2020] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Uncemented hemiarthroplasty (UHA) for displaced femoral neck fracture (FNF) is favored by some surgeons because of the reduced rate of perioperative mortality and operative time. However higher rates of intraoperative and postoperative periprosthetic fractures (PPFs) have been reported. The aim of the study was to review day-0, day-1, day-2, day-30, and one-year mortality as well as intraoperative and postoperative PPF after UHA for displaced FNF and compare this with cemented hemiarthroplasties (CHAs) performed. Secondary objectives were to assess whether femoral stem geometry and alignment were associated with PPF in UHA. METHODS A retrospective observational study was conducted of patients treated with a hemiarthroplasty for a displaced FNF over an eleven-year period. Radiographic analysis was conducted of femoral geometry and stem alignment. RESULTS Over the 11-year study period, 857 UHAs and 247 CHAs were performed. There were no on-table, day-0, day-1, or day-2 deaths in UHA. Intraoperative PPF occurred in 3.6% UHA and 2% CHA and postoperative PPF in 2.4% UHA and 4.8% CHA. Intraoperative PPF was not associated with increased mortality (P = .15), postoperative PPF, or all-cause revision in UHA. Valgus stem alignment was a risk factor for a postoperative PPF and additional surgery in UHA (P = .004). CONCLUSION UHA was associated with no perioperative deaths and a 30-day mortality rate of 5% in this series. It can be considered in patients with multiple medical comorbidities. Careful surgical planning and technique is important to optimize stem alignment particularly in Dorr C type femurs.
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Affiliation(s)
- Evelyn P Murphy
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Christopher Fenelon
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Ahmed I Akoud
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Stephen R Kearns
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Fintan J Shannon
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Colin G Murphy
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
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111
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Cemented versus uncemented hemiarthroplasty for the management of femoral neck fractures in the elderly: a meta-analysis and systematic review. Arch Orthop Trauma Surg 2021; 141:1043-1055. [PMID: 33423078 DOI: 10.1007/s00402-020-03737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/19/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Hemiarthroplasty is commonly used to treat unstable femoral neck fractures in older patients. However, there is no consensus on the use of cement during hemiarthroplasty. Therefore, we performed a systematic review to focus on the outcomes of cemented and uncemented hemiarthroplasty for the treatment of femoral neck fractures in older patients. MATERIALS AND METHODS Pubmed, Cochrane Central Register of Controlled Trials, and Ovid were searched for studies related comparison of cemented versus uncemented hemiarthroplasty for unstable femoral neck fractures from inception to Jan 20, 2020. The quality of the included randomized controlled trials (RCTs) was assessed using the Cochrane Collaboration tool. The meta-analysis was performed using the RevMan 5.2 software. RESULTS Eleven RCTs were included in the meta-analysis. Cemented hemiarthroplasty was found to be superior to uncemented arthroplasty with respect to reoperation rate (RR 0.6, 95% CI 0.38-0.96, p = 0.03), complications related to prosthesis (RR 0.39, 95% CI 0.23-0.68, p = 0.0008), residual pain (RR 0.66, 95% CI 0.52-0.83, p = 0.0004), and operation time (MD 8.22, 95% CI 6.30-10.14, p < 0.00001). There were no significant between-group differences with respect to local and general complications, duration of hospital stay, hip function, and mortality. CONCLUSIONS This meta-analysis showed cemented hemiarthroplasty might be an optimum choice for treating unstable femoral neck fractures in older patients. However, the results of this meta-analysis should be interpreted cautiously owing to some limitations. Further studies are required to provide more robust evidence.
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112
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Zhou W, Zhang WJ, Zhao GQ, Li K. Bone cement implantation syndrome during hip replacement in a patient with pemphigus and Parkinson’s disease: A case report. World J Clin Cases 2021; 9:3342-3349. [PMID: 34002143 PMCID: PMC8107892 DOI: 10.12998/wjcc.v9.i14.3342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is characterized by hypotension, arrhythmia, diffuse pulmonary microvascular embolism, shock, cardiac arrest, any combination of these factors, or even death following bone cement implantation.
CASE SUMMARY An 80-year-old patient with pemphigus and Parkinson’s disease underwent total hip replacement under spinal subarachnoid block and developed acute pulmonary embolism after bone cement implantation. The patient received mask mechanical ventilation with a continuous intravenous infusion of adrenaline (2 μg/mL) at a rate of 30 mL/h. Subsequently, the symptoms of BCIS were markedly alleviated, and the infusion rate of adrenaline was gradually reduced until the infusion was completely stopped 45 min later. The patient was then transferred to the Department of Orthopedics, and anticoagulation therapy began at 12 h postoperatively. No other complications were observed.
CONCLUSION This is a rare case of BCIS in a high-risk patient with pemphigus and Parkinson’s disease.
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Affiliation(s)
- Wei Zhou
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Wen-Jing Zhang
- Department of Anesthesiology, China Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guo-Qing Zhao
- Department of Anesthesiology, China Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Kai Li
- Department of Anesthesiology, China Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
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113
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Elmenshawy AF, Salem KH. Cemented versus cementless bipolar hemiarthroplasty for femoral neck fractures in the elderly. EFORT Open Rev 2021; 6:380-386. [PMID: 34150332 PMCID: PMC8183153 DOI: 10.1302/2058-5241.6.200057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The management of femoral neck fractures remains controversial. Treatment options include a wide variety of internal fixation methods, unipolar or bipolar hemiarthroplasty or total hip replacement.We carried out a systematic review of the available literature to detect differences between cemented and cementless fixation of bipolar prostheses in treating femoral neck fractures in patients aged 60 years or older.Thirteen studies involving a total of 1561 bipolar hemiarthroplasties (770 cemented and 791 uncemented) were identified. Uncemented hemiarthroplasty was associated with significantly lower blood loss (p < 0.0001), shorter operative time (p < 0.0001), less infection (p = 0.03) and lower risk of heterotopic ossification (p = 0.007). On the other hand, patients with cemented hemiarthroplasty suffered significantly less postoperative thigh pain than those with cementless implantation (p < 0.00001).The existing evidence indicates that uncemented bipolar hemiarthroplasty offers shorter operative time, less blood loss, lower local complications and a similar rate of systemic complications and reoperations as compared to cemented implantation. Cite this article: EFORT Open Rev 2021;6:380-386. DOI: 10.1302/2058-5241.6.200057.
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Affiliation(s)
| | - Khaled Hamed Salem
- Department of Orthopaedic Surgery, RWTH Aachen University, Aachen, Germany.,Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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114
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Schuetze K, Ehinger S, Eickhoff A, Dehner C, Gebhard F, Richter PH. Cement augmentation of the proximal femur nail antirotation: is it safe? Arch Orthop Trauma Surg 2021; 141:803-811. [PMID: 32710347 DOI: 10.1007/s00402-020-03531-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cement augmentation of the proximal femur nail antirotation (PFNA; Fa. DePuy Synthes) showed good biomechanical and clinical results regarding increased stability and functional outcome [Linden et al. in J Orthop Res 24:2230-2237, 2006;Kammerlander et al. in Injury 49:1436-1444, 2018;]. Cement-associated complications are well known in orthopedic procedures like hip arthroplasty, vertebra- and kyphoplasty. This study investigates outcome and safety of augmentation of the proximal femur nail blade. MATERIALS AND METHODS The retrospective review of the 299 patients (mean age 80 ± 13 years; 205 women and 94 men) focused on perioperative complications after augmentation which was performed with Traumacem V+ Cement (Fa. DePuy Synthes) in 152 cases. The decision for augmentation of the blade was made by the attending surgeon and based on the factors age, bone quality, and fracture pattern. Primary outcome measures were changes in blood pressure, heart rate or oxygen saturation, and the number of needed vasoactive drugs during augmentation. Secondary outcome measures where the rate of cement leakage into the joint, mechanical failure, and perioperative complications like pulmonary embolism, stroke, or heart attack. RESULTS In 152 augmented cases, no leakage of cement into the joint could be detected. No signs of mechanical failure like cut-out of the blade were seen after 6 weeks and 3 months. Also, augmentation did not show a higher rate of mortality or postoperative complications like stroke, heart attack, embolism, or infection. 57 of 152 augmented cases received an intraoperative intervention with vasoactive medication at the time of augmentation either prophylactically or because of a blood pressure fall. Out of the non-augmented cases, 21 of 147 needed vasoactive medication in the second half of the operation. The difference between these groups was significant (p < 0.05). In the cases without an intervention, there was a significant blood pressure fall of about 8 ± 7.4 mmHg during the augmentation (p < 0.001). Still, none of the augmented cases showed a change in heart rate or oxygen saturation. CONCLUSION The augmentation of the PFNA blade proved to be a safe procedure. Cement augmentation will not increase postoperative complications or mortality. The risk for leakage of cement into the joint is low and mechanical cut-out might be prevented. The decision for augmentation should be made carefully and always be declared loud and in advance to allow the anesthetist to prepare, because blood pressure changes can occur.
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Affiliation(s)
- Konrad Schuetze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - S Ehinger
- Department of Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - A Eickhoff
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - C Dehner
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - F Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - P H Richter
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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115
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E George N. CORR Insights®: What Are the Frequency, Related Mortality, and Factors Associated with Bone Cement Implantation Syndrome in Arthroplasty Surgery? Clin Orthop Relat Res 2021; 479:764-766. [PMID: 33570859 PMCID: PMC8083936 DOI: 10.1097/corr.0000000000001658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Nicole E George
- N. E. George, Resident, Aultman Hospital, Graduate Medical Education, Canton, OH, USA
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116
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Rassir R, Schuiling M, Sierevelt IN, van der Hoeven CWP, Nolte PA. What Are the Frequency, Related Mortality, and Factors Associated with Bone Cement Implantation Syndrome in Arthroplasty Surgery? Clin Orthop Relat Res 2021; 479:755-763. [PMID: 33165048 PMCID: PMC8083844 DOI: 10.1097/corr.0000000000001541] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, and the loss of consciousness during cemented arthroplasty; it may result in death. Its incidence has only been explored for hemiarthroplasty and THA after fracture or cancer. To our knowledge, there are no studies that comprehensively explore and compare the incidence of BCIS in other arthroplasty procedures. QUESTIONS/PURPOSES (1) To report the incidence of BCIS in TKA, unicondylar knee arthroplasty, hip hemiarthroplasty, THA, shoulder arthroplasty, TKA, and revision THA and TKA; (2) to determine whether severe BCIS is associated with an increased risk of death within 30 days of surgery; and (3) to identify factors associated with the development of severe BCIS. METHODS All patients undergoing cemented arthroplasty for any reason (TKA [11% cemented, 766 of 7293], unicondylar knee arthroplasty [100% cemented, 562 procedures], hip hemiarthroplasty for femur fractures [100% cemented, 969 procedures], THA [8% cemented, 683 of 8447], shoulder arthroplasty [84% cemented, 185 of 219], and revision arthroplasty of the hip and knee [36% cemented, 240 of 660]) between January 2008 and August 2019 were considered for inclusion in the current retrospective observational study. Fixation choice was dependent on surgeon preference (THA and TKA), prosthesis design (shoulder arthroplasty), or bone quality (revision arthroplasty). The following procedures were excluded because of insufficient data: < 1% (1 of 766) of TKAs, 1% (4 of 562) of unicondylar knee arthroplasties, 6% (54 of 969) of hip hemiarthroplasties, 1% (6 of 683) of THAs, 6% (12 of 185) of shoulder arthroplasties, and 14% (34 of 240) of revision procedures. This resulted in a final inclusion of 3294 procedures (765 TKAs [23%], 558 unicondylar knee arthroplasties [17%], 915 hip hemiarthroplasties [28%], 677 THA [21%], 173 shoulder arthroplasties [5%], and 206 revision arthroplasties [6%]), of which 28% (930 of 3294) had an emergent indication for surgery. Of the patients, 68% (2240 of 3294) were females, with a mean age of 75 ± 11 years. All anesthetic records were extracted from our hospital's database, and the severity of BCIS was retrospectively scored (Grade 0 [no BCIS], Grade 1 [O2% < 94% or fall in systolic blood pressure of 20% to 40%], Grade 2 [O2% < 88% or fall in systolic blood pressure of > 40%], and Grade 3 [cardiovascular collapse requiring CPR]). Procedures were dichotomized into no or moderate BCIS (Grades 0 and 1) and severe BCIS (Grades 2 and 3). The adjusted 30-day mortality of patients with severe BCIS was assessed with a multivariate Cox regression analysis. A multivariate logistic regression analysis was performed to identify factors associated with the development of severe BCIS. RESULTS BCIS occurred in 26% (845 of 3294) of arthoplasty procedures. The incidence was 31% (282 of 915) in hip hemiarthroplasty, 28% (210 of 765) in TKA, 24% (165 of 677) in THA, 23% (47 of 206) in revision arthroplasty, 20% (113 of 558) in unicondylar knee arthroplasty, and 16% (28 of 173) in shoulder arthroplasty. Patients with severe BCIS were more likely (hazard ratio 3.46 [95% confidence interval 2.07 to 5.77]; p < 0.001) to die within 30 days of the index procedure than were patients with less severe or no BCIS. Factors independently associated with the development of severe BCIS were age older than 75 years (odds ratio 1.57 [95% CI 1.09 to 2.27]; p = 0.02), American Society of Anesthesiologists Class III or IV (OR 1.58 [95% CI 1.09 to 2.30]; p = 0.02), and renal impairment (OR 3.32 [95% CI 1.45 to 7.46]; p = 0.004). CONCLUSION BCIS is common during cemented arthroplasty; severe BCIS is uncommon, but it is associated with an increased risk of death within 30 days of surgery. Medically complex patients undergoing hip hemiarthroplasty may be at particular risk. Patients at high risk for severe BCIS (renal impairment, ASA III/IV, and age older than 75 years) should be identified and preventive measures such as medullary lavage before cementation, femoral venting, and avoidance of excessive pressurization of implants should be taken to reduce the likelihood and consequences of BCIS. Because of the increased risk of periprosthetic fractures in uncemented hip stems, factors associated with the development of BCIS should be weighed against the risk factors for sustaining periprosthetic fractures (poor bone quality, female sex) to balance the risks of fixation method against those of BCIS for each patient. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Rachid Rassir
- R. Rassir, M. Schuiling, I. N. Sierevelt, C. W. P. van der Hoeven, P. A. Nolte, Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
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117
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Biodegradable cement augmentation of gamma nail osteosynthesis reduces migration in pertrochanteric fractures, a biomechanical in vitro study. Clin Biomech (Bristol, Avon) 2021; 84:105327. [PMID: 33773169 DOI: 10.1016/j.clinbiomech.2021.105327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cut-out of gamma nail often results from poor primary bone stability, suboptimal reduction (varus) and excentric placement of the head element which may lead to "instability" and frequently requires revision. Various studies have shown that augmentation with polymethylmethacrylate cement increases the primary stability of osteosynthesis. However, it has not yet been widely used in fracture treatment due to certain disadvantages, e.g., the lack of osteointegration, the formation of an interface membrane or the presence of toxic monomers. Few studies show that biodegradable bone cements increase the stability of osteosynthesis in different anatomical regions and therefore could be an alternative to polymethylmethacrylate cement in the treatment of pertrochanteric fractures. METHODS Two biomechanical situations were simulated using 24 Sawbones (simple and multifragmentary pertrochanteric fractures; AO-classification 31-A1 and 31-A2. Both groups were stabilized using the Gamma3® nailing system with and without biodegradable bone cement. Sawbones underwent the same cyclic loading test, simulating 10.000 gait cycles loading the bones with three times body weight. Migration was determined by comparing computed tomography scans recorded before and after the mechanical testing. The three-dimensional migration of the lag screw was calculated, and the rotation of the head around the longitudinal axis was determined. FINDINGS Biodegradable cement reduced migration by approximately 35% in 31-A1 fractures (25.4% in 31-A2 fractures) and the rotation of the head around the lag screw by approximately 37% in 31-A1 fractures (17.8%, 31-A2). INTERPRETATION Use of biodegradable bone cement improved the primary stability of gamma nail osteosynthesis in the biomechanical model.
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118
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Waldvogel S, Zutter A, Krieg AH, Trachsel D. Severe Acute Lung Injury After H2O2 Irrigation of an Aneurysmal Bone Cyst in an 8-Year-Old Girl: A Case Report. A A Pract 2021; 15:e01424. [PMID: 33710986 DOI: 10.1213/xaa.0000000000001424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An 8-year-old girl developed severe acute lung injury after irrigation of a pelvic aneurysmal bone cyst with H2O2 and filling with bone cement. Sudden profound oxygen desaturation occurred on the operating table when the patient was turned from the prone to the supine position. After a brief improvement in her oxygenation, the girl developed rapidly progressing severe respiratory failure necessitating reintubation and hour-long manual ventilation, while copious amounts of hemorrhagic frothy fluids were aspirated through the endotracheal tube. The patient started to improve after 24 hours and eventually made a full recovery. We hypothesize that the incident was caused by gas embolization and pulmonary endothelial damage by H2O2.
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Affiliation(s)
| | - Andreas Zutter
- From the Division of Pediatric Intensive Care and Pulmonology.,Department of Pediatric Anesthesia
| | - Andreas H Krieg
- Department of Pediatric Orthopedic Surgery, University of Basel Children's Hospital UKBB, Basel, Switzerland
| | - Daniel Trachsel
- From the Division of Pediatric Intensive Care and Pulmonology
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119
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Midterm Survivorship of an Uncemented Hydroxyapatite-Coated Titanium Femoral Component and Clinically Meaningful Outcomes in Patients Older Than 75 Years. J Clin Med 2021; 10:jcm10051019. [PMID: 33801479 PMCID: PMC7958839 DOI: 10.3390/jcm10051019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: It remains controversial whether cementless femoral components are safe in elderly patients. The aim of this study was (1) to determine the stem survival rate in patients >75 years of age who were treated with an uncemented femoral component and (2) to report clinically significant results on a mid-term follow-up. Methods: 107 total hip arthroplasties (THA) were retrospectively evaluated in 97 patients over 75 years of age (mean age 78 years, range 75–87) treated with an uncemented femoral stem. The minimum follow-up was five years (mean 6.4 years, range 5–8). Stem survival rates, clinically meaningful outcomes, and incidence of complications were evaluated. Results: Kaplan-Meier survival analysis, with the endpoint revision for any reason, showed a 6.4-year survival rate of 98% (95% CI, 95–99%; 63 hips at risk). The survival rates were comparable for male and female patients (log-rank test, p = 0.58). The modified Harris Hip Score (mHHS) improved from 42.2 (12 to 85) points to 81.1 (22 to 97) points (p < 0.0001). Mid-term minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were 25, 84, and 70, respectively. Conclusion: An uncemented stem is a viable option in patients over 75 years with good clinical outcomes and survivorship. Periprosthetic fractures were not a relevant failure mechanism with the stem used.
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120
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Hernandez NM, Gausden EB, Taunton MJ. Cemented Femoral Fixation Using a Direct Anterior Approach: Background, Indications, and Surgical Technique. J Am Acad Orthop Surg 2021; 29:207-212. [PMID: 33539057 DOI: 10.5435/jaaos-d-20-00800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
The use of the direct anterior approach (DAA) in total hip arthroplasty has increased dramatically over the past decade. Potential benefits of the DAA include earlier functional recovery and lower risk of periprosthetic dislocation, but issues with periprosthetic fracture and femoral loosening have been reported, particularly in elderly patients. Cemented femoral fixation may offer a means to decrease early femoral failure in elderly patients undergoing the DAA. Here, we will present a step-by-step technique for cementing the femoral implant through the DAA.
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Affiliation(s)
- Nicholas M Hernandez
- From the Department of Orthopaedic Surgery (Dr. Gausden), Hospital for Special Surgery, New York, NY, Department of Orthopaedic Surgery (Dr. Taunton), Mayo Clinic, Rochester, MN, and the Department of Orthopaedic Surgery (Dr. Hernandez), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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121
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Price LC, Martinez G, Brame A, Pickworth T, Samaranayake C, Alexander D, Garfield B, Aw TC, McCabe C, Mukherjee B, Harries C, Kempny A, Gatzoulis M, Marino P, Kiely DG, Condliffe R, Howard L, Davies R, Coghlan G, Schreiber BE, Lordan J, Taboada D, Gaine S, Johnson M, Church C, Kemp SV, Wong D, Curry A, Levett D, Price S, Ledot S, Reed A, Dimopoulos K, Wort SJ. Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement. Br J Anaesth 2021; 126:774-790. [PMID: 33612249 DOI: 10.1016/j.bja.2021.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. METHODS A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. RESULTS Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. CONCLUSIONS With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.
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Affiliation(s)
- Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Guillermo Martinez
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - Aimee Brame
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | | | | | - David Alexander
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Benjamin Garfield
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Tuan-Chen Aw
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Bhashkar Mukherjee
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Carl Harries
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Gatzoulis
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Philip Marino
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - David G Kiely
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Rachel Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free Hospital, London, UK
| | | | - James Lordan
- National Pulmonary Hypertension Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - Dolores Taboada
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Samuel V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Davina Wong
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Andrew Curry
- Cardiothoracic Anaesthesia, University Hospital Southampton, Southampton, Hampshire, UK
| | - Denny Levett
- Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Anna Reed
- National Heart and Lung Institute, Imperial College London, London, UK; Respiratory and Lung Transplantation, Harefield Hospital, Uxbridge, UK
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephen John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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Ukaj S, Veslko M, Krasniqi S, Podvorica V, Ukaj F, Ahmeti A, Hernigou P, Cimerman M. Cemented stems in healthy elderly patients result in higher hypoxia despite a paradoxical lower femoral increase of intramedullary pressure. INTERNATIONAL ORTHOPAEDICS 2021; 45:915-922. [PMID: 33528632 DOI: 10.1007/s00264-021-04955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Hypoxia is a well-known complication in cemented arthroplasty; however, it is not known whether the level of hypoxia is related to the intramedullary pressure or to the age of the patient; therefore, we studied the intramedullary pressure and level of hypoxia in patients undergoing cemented arthroplasty. METHODS A prospective study was performed during cemented arthroplasties in 25 patients with an average age of 66.2 ± 12.1 years old. The intramedullary pressure (IMP) was measured by placing a pressure transducer within the bone while simultaneously measuring the pulse oximetry arterial oxygen saturation (SpO2), pulse, and blood pressure. These variables were obtained immediately after spinal anaesthesia, five minutes after cementation, and 15 minutes after prosthesis insertion. RESULTS One hundred percent of patients had hypoxia at some level, but 83% of elderly patients (older than 66.5 years) had hypoxia (SpO2 <94%) as compared to only 23% of younger patients (p = 0.006). In the group of young patients, IMP was roughly increased 32 times as compared with baseline level, with as consequences a decrease of 4% of SpO2 (from 98.3 to 94.15%); in the elderly group, the IMP was only increased 20 times, but a decrease of 6% of SpO2 (from 97.25 to 91%) was observed. CONCLUSIONS This series demonstrated higher hypoxia in elderly healthy patients despite a paradoxical lower femoral increase of intramedullary pressure as compared with younger patients. This hypoxia is probably not only related to the cement but also to the patient's age with decline of maximum oxygen uptake capacity and increase bone porosity. CLINICAL TRIALS ClinicalTrials.gov Identifier: NCT03930537 https://clinicaltrials.gov/ct2/show/NCT03930537.
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Affiliation(s)
- Skender Ukaj
- University of Ljubljana, Ljubljana, Slovenia.,Orthopaedic and Traumatology Department, University Clinical Center of Prishtina, Prishtina, Kosovo.,Faculty of Medicine "Fehmi Agani", University of Gjakova, Gjakova, Kosovo
| | | | - Shaip Krasniqi
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Vlora Podvorica
- Orthopaedic and Traumatology Department, University Clinical Center of Prishtina, Prishtina, Kosovo
| | - Fatime Ukaj
- National Institute of Public Health, Prishtina, Kosovo
| | - Arben Ahmeti
- Orthopaedic and Traumatology Department, University Clinical Center of Prishtina, Prishtina, Kosovo
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Maydanshahi MR, Kachooei AR, Eygendaal D, Ebrahimzadeh MH, Nazarian A, Mousavi Shaegh SA. 3D printing-assisted fabrication of patient-specific antibacterial radial head prosthesis with high periprosthetic bone preservation. Biomed Mater 2021; 16. [PMID: 33524959 DOI: 10.1088/1748-605x/abe217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/01/2021] [Indexed: 11/12/2022]
Abstract
We present a novel fabrication and surgical approach for anatomical reconstruction of a fractured radial head using patient-specific radial head prosthesis made of polymethylmethacrylate (PMMA) bone cement. To this end, the use of PMMA bone cement for prosthesis fabrication was initially investigated using computational modeling and experimental methods. The radial head prosthesis was fabricated through casting of PMMA bone cement in silicone mold in the operation room before implantation. To enhance the precision of bony preparation for replacement of the radial head, patient-specific surgical guide for accurate resection of the radial neck with the desired length was developed. Post-surgical clinical examinations revealed biomechanical restoration of elbow function, owing to the use of patient-specific radial head prosthesis and surgical guide. Importantly, follow-up radiographs after a mean follow-up of 18 months revealed bone preservation at the bone-prosthesis interface without any signs of erosion of the capitellum. Taken together, our method demonstrated the safety and efficacy of the PMMA radial head prosthesis in restoring elbow biomechanics. This also provides a very safe and cost-effective method for making various patient-specific prostheses with localized antibacterial delivery and close mechanical properties to native bone for improved periprosthetic bone regeneration.
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Affiliation(s)
- Mohammad Reza Maydanshahi
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Orthopedic research center, Ghaem hospital, Mashhad University of Medical Sciences,Ahmadabad street, Mashhad, Mashhad, Razavi Khorasan, 00000, Iran (the Islamic Republic of)
| | - Amir Reza Kachooei
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Orthopedic research center, Ghaem hospital, Mashhad University of Medical Sciences, Ahmadabad street, Mashhad, Mashhad, Razavi Khorasan, 00000, Iran (the Islamic Republic of)
| | - Denise Eygendaal
- Amsterdam University Medical Centers, Department of Orthopaedic Surgery, University of Amsterdam, University of Amsterdam, Amsterdam University Medical Centers, Department of Orthopaedic Surgery Amsterdam, Noord-Holland, Amsterdam, Noord-Holland, 1100 DD , NETHERLANDS
| | - Mohammad Hossein Ebrahimzadeh
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Orthopedic research center, Ghaem hospital, Mashhad University of Medical Sciences,Ahmadabad street, Mashhad, Mashhad, Razavi Khorasan, 00000, Iran (the Islamic Republic of)
| | - Ara Nazarian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA, Boston, Massachusetts, 02215, UNITED STATES
| | - Seyed Ali Mousavi Shaegh
- Mashhad University of Medical Sciences, Clinical Research Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, 00000, Iran (the Islamic Republic of)
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Emara AK, Ng M, Krebs VE, Bloomfield M, Molloy RM, Piuzzi NS. Femoral Stem Cementation in Hip Arthroplasty: The Know-How of a "Lost" Art. Curr Rev Musculoskelet Med 2021; 14:47-59. [PMID: 33453016 PMCID: PMC7930165 DOI: 10.1007/s12178-020-09681-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW To describe the (1) indications, (2) preoperative precautions, and (3) stepwise technical details of modern femoral stem cemented fixation. RECENT FINDINGS Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or aberrant anatomy. Unfamiliarity with the details of modern cementation techniques among trainees who may lack frequent exposure to cementing femoral stems may preclude them from offering this viable option to suitable patients in later stages of their careers. As such, maximizing benefit from cemented femoral stem fixation among suitable candidates is contingent upon the meticulous use of modern cementation techniques. In addition to proper patient selection, modern cementation techniques emphasize the use of (1) pulsatile lavage of the femoral canal, (2) utilization of epinephrine-soaked swabs, (3) vacuum cement mixing, (4) retrograde cement introduction, (5) cement pressurization, and (6) the use of stem centralizers. Furthermore, identifying and optimizing the preoperative status of at-risk patients with pre-existing cardiopulmonary compromise, in addition to intraoperative vigilance, are essential for mitigating the risk of developing bone cement implantation syndrome. Further research is required to assess the utility of cemented femoral stem fixation among younger patients.
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Affiliation(s)
- Ahmed K Emara
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Mitchell Ng
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Viktor E Krebs
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | | | - Robert M Molloy
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA.
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Pedersen AB, Mailhac A, Garland A, Overgaard S, Furnes O, Lie SA, Fenstad AM, Rogmark C, Kärrholm J, Rolfson O, Haapakoski J, Eskelinen A, Mäkelä KT, Hailer NP. Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database. Acta Orthop 2021; 92:47-53. [PMID: 33143515 PMCID: PMC7919915 DOI: 10.1080/17453674.2020.1842003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Current literature indicates no difference in 90-day mortality after cemented compared with cementless total hip arthroplasty (THA). However, previous studies are hampered by potential selection bias and suboptimal adjustment for comorbidity confounding. Therefore, we examined the comorbidity-adjusted mortality up to 90 days after cemented compared with cementless THA performed due to osteoarthritis.Patients and methods - Using the Nordic Arthroplasty Register Association database, 2005-2013, we included 108,572 cemented and 80,034 cementless THA due to osteoarthritis. We calculated the Charlson comorbidity index of each patient based on data from national patient registers. The Kaplan-Meier method was used to estimate unadjusted all-cause mortality. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for 14, 30-, and 90-day mortality comparing cemented with cementless THA, adjusting for age, sex, comorbidity, nation, and year of surgery.Results - Cumulative all-cause mortality within 90 days was 0.41% (CI 0.37-0.46) after cemented and 0.26% (CI 0.22-0.30) after cementless THA. The adjusted HR for cemented vs. cementless fixation was 0.97 (CI 0.79-1.2), and similar risk estimates were obtained for mortality within 14 (adjusted HR 0.91 [CI 0.64-1.3]) and 30 days (adjusted HR 0.94 [CI 0.71-1.3]). We found no clinically relevant differences in mortality between cemented and cementless THA in analyses stratified by age, sex, Charlson comorbidity index, or year of surgery.Interpretation - After adjustment for comorbidity as an important confounder, we observed similar early mortality between the 2 fixation techniques.
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Affiliation(s)
- Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; ,Correspondence:
| | - Aurélie Mailhac
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;
| | - Anne Garland
- Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden; ,The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden;
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark, and the Danish Hip Arthroplasty Register;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Norway;
| | - Stein Atle Lie
- Department of Clinical Medicine, University of Bergen, Norway; ,Department of Clinical Dentistry, University of Bergen, Bergen, Norway;
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Cecilia Rogmark
- Department of Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden; ,The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden;
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden;
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden; ,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden;
| | - Jaason Haapakoski
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland;
| | - Antti Eskelinen
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; ,Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Keijo T Mäkelä
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; ,Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Nils P Hailer
- Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden; ,The Swedish Hip Arthroplasty Registry, Registercentrum Västra Götaland, Gothenburg, Sweden;
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Fenelon C, Murphy EP, Pomeroy E, Murphy RP, Curtin W, Murphy CG. Perioperative Mortality After Cemented or Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures-A Systematic Review and Meta-analysis. J Arthroplasty 2021; 36:777-787.e1. [PMID: 32943317 DOI: 10.1016/j.arth.2020.08.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/24/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Debate surrounds the use of cemented or uncemented prostheses for the treatment of displaced femoral neck fractures (FNF). Many guidelines recommend the use of the cemented hemiarthroplasty (CHA). Proponents of CHA point out the increased re-operation rate while proponents of uncemented hemiarthroplasty (HA) highlight the increased mortality rate in the perioperative period. The aim of this study was to systematically review the literature to evaluate perioperative mortality after HA for displaced FNFs. METHODS A systematic review and meta-analysis was performed of MEDLINE, Cochrane Library, and Embase databases evaluating perioperative mortality after HA for displaced FNFs. Randomized control trials and observational studies were included comparing current-generation stem designs. A meta-analysis was performed on studies that directly compared the different modes of fixation. RESULTS Twenty-two studies were included (seven randomized control trials and 15 observational studies), with a total of 183,167 HAs for treatment of a displaced FNF. Fourteen studies were included in the meta-analysis. There was a higher cumulative odds of death within the first 48 hours in those with CHA compared with uncemented HA (OR: 1.64; 95% CI: 1.35, 2.00; P ≤ .01). No difference was found in mortality at 7 days, 30 days, and one year. CONCLUSION CHA is associated with an increased mortality rate within the first two days of surgery with no difference at 7 days, 30 days, and one year. Surgeons should consider tailoring their stem choice based on the physiological status of the patient when planning HA for FNFs. Techniques to reduce the risk of bone cement implantation syndrome should be used.
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Affiliation(s)
- Christopher Fenelon
- Department of Orthopaedic Surgery, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Evelyn P Murphy
- Department of Orthopaedic Surgery, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Eoghan Pomeroy
- Department of Orthopaedic Surgery, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Robert P Murphy
- Department of Orthogeriatric Medicine, Galway University Hospital, Galway, Ireland
| | - William Curtin
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Colin G Murphy
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
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Weingärtner K, Störmann P, Schramm D, Wutzler S, Zacharowski K, Marzi I, Lustenberger T. Bone cement implantation syndrome in cemented hip hemiarthroplasty-a persistent risk. Eur J Trauma Emerg Surg 2021; 48:721-729. [PMID: 33495852 PMCID: PMC9001528 DOI: 10.1007/s00068-020-01587-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
Background Every year, ~ 210,000 initial implantations of hip endoprostheses are carried out in Germany alone. The “bone cement implantation syndrome” (BCIS) is considered a severe peri- and early-postoperative complication when implanting cemented prostheses. The origin of the BCIS and its impact on the clinical outcome are still uncertain. This study investigates the clinical progression after BCIS cases in patients with cemented hemiarthroplasty. Risk factors for the occurrence of BCIS are evaluated. Material and methods Clinical data of all patients with a proximal femur fracture and which received a cemented hemiarthroplasty within a period of 9.5 years have been collected. BCIS (+) patients and BCIS (−) patients were compared with respect to their demographics and clinical outcome. Risk factors for the development of BCIS were identified. Results A total of 208 patients could be included with complete data sets. The mean age was 81.1 ± 10.0 years. Overall, 37% of the patients showed symptoms of BCIS. In comparison to BCIS (−) patients there was a significantly higher rate of cardiovascular complications (27.3% vs. 13.7%, p = 0.016) and a higher in-hospital mortality rate (15.6% vs. 4.6%, p = 0.006) in BCIS (+) patients. Age, absence of a femoral borehole and ASA status were identified as statistically significant risk factors of BCIS. Conclusion BCIS is frequently observed and in some cases severe complication. The therapy is exclusively symptomatic; identifying preventional measures might reduce the occurrence of BCIS.
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Affiliation(s)
- Karoline Weingärtner
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Philipp Störmann
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - David Schramm
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
- Department of Trauma, Hand and Orthopedic Surgery, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Street 100, 65199, Wiesbaden, Germany
| | - Sebastian Wutzler
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
- Department of Trauma, Hand and Orthopedic Surgery, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Ludwig-Erhard-Street 100, 65199, Wiesbaden, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Lustenberger
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt/Main, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany.
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Bokov AE, Bulkin AA, Bratsev IS, Kalinina SY, Mlyavykh SG, Anderson DG. Augmentation of Pedicle Screws Using Bone Grafting in Patients with Spinal Osteoporosis. Sovrem Tekhnologii Med 2021; 13:6-10. [PMID: 35265344 PMCID: PMC8858411 DOI: 10.17691/stm2021.13.5.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/14/2022] Open
Abstract
The aim of the study was to develop a new method of vertebral augmentation based on autologous and allogeneic bone chips to be used in pedicle screw fixation and to compare this method with the technique based on polymethyl methacrylate (PMMA).
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Affiliation(s)
- A E Bokov
- Head of the Department of Oncology and Neurosurgery, Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A A Bulkin
- Staff Neurosurgeon, Department of Oncology and Neurosurgery, Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - I S Bratsev
- Staff Neurosurgeon, Department of Oncology and Neurosurgery, Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S Ya Kalinina
- Staff Neurosurgeon, Department of Oncology and Neurosurgery, Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S G Mlyavykh
- Director of the Institute of Traumatology and Orthopedics Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - D G Anderson
- Professor, Departments of Orthopaedic and Neurological Surgery; Clinical Director of the Spine Section, Orthopaedic Research Laboratory Thomas Jefferson University, 130 S., 9 St., Philadelphia, PA, 19107, USA
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Dradjat RS, Pradana AS, Putra DP, Hexa Pandiangan RA, Cendikiawan F, Mustamsir E. Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report. Int J Surg Case Rep 2020; 78:331-335. [PMID: 33388512 PMCID: PMC7787938 DOI: 10.1016/j.ijscr.2020.12.076] [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] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022] Open
Abstract
Early and aggressive resuscitation is the cornerstone of treating BCIS. Fluid resuscitation to maintain preload and inotropes to support ventricular contractility are recommended. Patients with comorbidities and risk factors should be monitored closely during and after bone cementation. A good response time and high-quality cardiopulmonary resuscitation (CPR) also takes a major role in treating BCIS. Good coordination among the operation team is needed escpecially for an arthroplasty surgery.
Introduction Bone Cement Implantation Syndrome (BCIS) is a lethal condition with complex physiological changes after the insertion of Methyl Methacrylate (MMA) cement during intraoperative arthroplasty. Despite the etiology and the pathophysiology of BCIS has not been fully understood, several mechanisms have been discovered. Some clinical manifestations of BCIS are hypotension, hypoxemia, a decrease of consciousness, arrhythmia, pulmonary hypertension, and cardiac arrest. Presentation of case A 67 years old woman underwent cemented hemiarthroplasty operation due to intertrochanteric fracture in her right femur. The hemodynamic was stable before and during operation, but suddenly the patient went into cardiac arrest as the cement inserted. Immediate resuscitation was performed successfully and stable hemodynamic was achieved. Discussion Several risk factors including underlying cardiovascular disease, advanced age, osteoporosis (enlarged porous cavities increase the risk of emboli generation), fracture type, metastatic bone disease, femoral canal diameter of more than 21 mm, previously non-instrumented femoral canal, and patent foramen ovale (paradoxical embolus). Some studies have shown usage of H1 and H2 antagonists, methylprednisolone, inotropes, vasopressor, and some alterations in surgical technique, can prevent the progression of the BCIS. Communication between the orthopaedic surgeon and anesthesiologist and high-quality cardiopulmonary resuscitation (CPR) will become a good basis in treating BCIS. Conclusion Preoperative optimization by increasing oxygen inspiration concentration, usage of inotropes and vasopressor, and avoiding intravascular volume depletion during operation is essential in cemented arthroplasty procedure. Both orthopaedic surgeon and anesthesiologist should recognize the clinical presentation of BCIS and well-prepared for the management of BCIS including any supportive measures.
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Affiliation(s)
- Respati Suryanto Dradjat
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Ananto Satya Pradana
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Domy Pradana Putra
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Ray Asaf Hexa Pandiangan
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Felix Cendikiawan
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Edi Mustamsir
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar General Hospital, Malang, East Java, Indonesia.
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Grzeskowiak RM, Schumacher J, Dhar MS, Harper DP, Mulon PY, Anderson DE. Bone and Cartilage Interfaces With Orthopedic Implants: A Literature Review. Front Surg 2020; 7:601244. [PMID: 33409291 PMCID: PMC7779634 DOI: 10.3389/fsurg.2020.601244] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
The interface between a surgical implant and tissue consists of a complex and dynamic environment characterized by mechanical and biological interactions between the implant and surrounding tissue. The implantation process leads to injury which needs to heal over time and the rapidity of this process as well as the property of restored tissue impact directly the strength of the interface. Bleeding is the first and most relevant step of the healing process because blood provides growth factors and cellular material necessary for tissue repair. Integration of the implants placed in poorly vascularized tissue such as articular cartilage is, therefore, more challenging than compared with the implants placed in well-vascularized tissues such as bone. Bleeding is followed by the establishment of a provisional matrix that is gradually transformed into the native tissue. The ultimate goal of implantation is to obtain a complete integration between the implant and tissue resulting in long-term stability. The stability of the implant has been defined as primary (mechanical) and secondary (biological integration) stability. Successful integration of an implant within the tissue depends on both stabilities and is vital for short- and long-term surgical outcomes. Advances in research aim to improve implant integration resulting in enhanced implant and tissue interface. Numerous methods have been employed to improve the process of modifying both stability types. This review provides a comprehensive discussion of current knowledge regarding implant-tissue interfaces within bone and cartilage as well as novel approaches to strengthen the implant-tissue interface. Furthermore, it gives an insight into the current state-of-art biomechanical testing of the stability of the implants. Current knowledge reveals that the design of the implants closely mimicking the native structure is more likely to become well integrated. The literature provides however several other techniques such as coating with a bioactive compound that will stimulate the integration and successful outcome for the patient.
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Affiliation(s)
- Remigiusz M. Grzeskowiak
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Jim Schumacher
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - Madhu S. Dhar
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - David P. Harper
- The Center for Renewable Carbon, Institute of Agriculture, University of Tennessee, Knoxville, TN, United States
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
| | - David E. Anderson
- Large Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States
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Masoni V, Staletti L, Berlusconi M, Castagna A, Morenghi E. Cementless Hemiarthroplasty for Intracapsular Femoral Neck Fractures in the Octa- and Nonagenarians. Clin Orthop Surg 2020; 13:10-17. [PMID: 33747372 PMCID: PMC7948040 DOI: 10.4055/cios20023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022] Open
Abstract
Backgroud Current evidence supports the use of cemented hemiarthroplasty for treatment of intracapsular femoral neck fractures since it is associated with a lower risk of implant-related complications. However, many medical centers employ the cementless technique for the frail elderly population because it is faster and has lower cardiovascular risks and perioperative mortality. This observational study reports the outcomes of cementless bipolar hemiarthroplasty for intracapsular femoral neck fractures in patients aged 80 years and older. Methods A total of 424 patients (female, 77.1%) with a mean age of 86.9 years were operated for intracapsular femoral neck fractures between January 2009 and December 2017. Of those, 66.7% had an American Society of Anaesthesiologists (ASA) score of 3 or more. All operations were performed with the posterolateral surgical approach and all patients received a cementless stem. Intraoperative and perioperative values and in-hospital outcomes were evaluated, and clinical and radiographical follow-up was done at 40 days, 90 days, and when possible between 5 months and 12 months postoperatively. Multivariate analysis was performed to evaluate if there were factors affecting mortality. Results The mean operative time was 50 minutes. There were no deaths intraoperatively. Intraoperative periprosthetic fractures occurred in 2.1% of the cases with 66.7% of them fixed through cerclage wires intraoperatively. The median length of hospitalization was 11 days (interquartile range, 8.75–15) and 2.4% of patients died while in hospital after surgery. Approximately 91.5% of patients presented with perioperative anemia. Only 1.9% of the complications were related to the implant, 62.5% of which were dislocations. More than 90% of patients were ambulatory either autonomously or with support at each follow-up assessment. Age, male sex, and higher ASA score were related to increased mortality. Conclusions Despite some limitations, this observational study underlines that a cementless femoral stem of modern design can give good clinical outcomes, thus being an appropriate solution especially for the frail elderly.
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Affiliation(s)
- Virginia Masoni
- Department of Traumatology and Orthopedic Surgery, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Leda Staletti
- Department of Traumatology and Orthopedic Surgery, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Marco Berlusconi
- Department of Traumatology and Orthopedic Surgery, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Alessandro Castagna
- Department of Traumatology and Orthopedic Surgery, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Emanuela Morenghi
- Department of Traumatology and Orthopedic Surgery, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
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132
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Yang TH, Yang RS, Lin CP, Tseng TH. Bone Cement Implantation Syndrome in Bone Tumor Surgeries: Incidence, Risk Factors, and Clinical Experience. Orthop Surg 2020; 13:109-115. [PMID: 33274603 PMCID: PMC7862161 DOI: 10.1111/os.12842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the incidence and risk factors of bone cement implantation syndrome (BCIS) in bone tumor surgeries. Methods This was a retrospective observational study. We investigated patients who underwent bone tumor surgeries requiring cementation as part of the surgery between March 2016 and January 2018. We reviewed medical records, including formal anesthesia records and operation notes. Patients with complete data files were included. To investigate the general incidence of BCIS in tumor surgeries, patients of all ages, genders and tumor types were included. Vital signs, including oxygen saturation, blood pressure, heart rate, and respiratory rate, were checked and recorded once every 1–2 min after cementation. Accurate time points of cementation were recorded on formal anesthesia record sheets by the anesthesiologists. The definition and severity of BCIS were based on the classification system proposed in previous studies: grade I, moderate hypoxia (SpO2 <94%) or hypotension (fall in systolic blood pressure >20%); grade II, severe hypoxia (SpO2 <88%) or hypotension (fall in systolic blood pressure >40%) or unexpected loss of consciousness; and grade III, cardiovascular collapse requiring cardiopulmonary resuscitation. We also compared the incidence of BCIS between those patients with and without possible risk factors, including intraoperative blood loss, arthroplasty, use of an intramedullary device, patient age, gender, tumor location, and preexisting lung cancer or lung metastasis. Results A total of 88 patients were included. BCIS occurred in 23 patients, with an incidence of 26.1%. Among them, 19 had grade I and 4 had grade II BCIS. There was no patients with grade III BCIS. The lowest blood pressure occurred within 10 min in 21 (87.5%) patients and within 20 min for all patients. A total of 9 grade I BCIS were self‐limiting. The other 10 grade I hypotension cases and all grade II hypotension cases recovered after administration of a vasoconstrictor medication. Preexisting lung cancer or lung metastasis was the risk factor for BCIS; 40.0% of patients (16 in 40 patients) with preexisting lung cancer or metastasis had BCIS, whereas only 14.6% of patients (7 in 48 patients) without lung lesions had BCIS. There was no risk difference in terms of arthroplasty, old age, and increased blood loss. Apart from grades I and II bone cement implantation syndrome, there were no other major complications, including death, cardiovascular events, or cerebrovascular events. Conclusion Bone cement implantation syndrome is not unusual in bone tumor surgeries, and preexisting lung cancer or lung metastasis is a risk factor.
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Affiliation(s)
- Tsung-Han Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Rong-Sen Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Richardson CG, Lethbridge LN, Dunbar MJ. Increased Mortality with the Use of Cementless Fixation for Femoral Neck Fractures: Analysis of 5883 Hip Arthroplasty Cases. J Arthroplasty 2020; 35:3627-3630. [PMID: 32753265 DOI: 10.1016/j.arth.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of cemented fixation for hip arthroplasty for femoral neck fractures has been advocated to limit the postoperative and intraoperative risk of periprosthetic fractures. However, there are concerns with the potential effects of cementing on patient mortality, particularly at the time of cementation. METHODS This study examined the mortality rates of cemented compared to cementless hip arthroplasty fixation in a group of 5883 femoral neck fracture patients from 2001 to 2017. The data were derived from large administrative databases and census data. Confounders were identified and controlled with a multivariate analysis. The data were also stratified into 2 time frames, 2001-2008 and 2009-2017, to determine if there was an effect of more recent improvements in patient care or implant technology. RESULTS Cemented fixation had a statistically significant reduction in mortality rates at 30, 90, and 365 days after surgery. There was no difference in mortality in 0, 1, or ≤7 days after discharge or during the admission. The mortality rate decreased but was still significantly increased with cementless fixation when the subjects were grouped from 2001 to 2008 and 2009 to 2017. CONCLUSION Based on this evidence, the cemented fixation of hip arthroplasty should be considered for patients with femoral neck fractures.
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Affiliation(s)
| | | | - Michael J Dunbar
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Jerome JTJ, Mercier F, Mudgal CS, Arenas-Prat J, Vinagre G, Goorens CK, Rivera-Chavarría IJ, Sechachalam S, Mofikoya B, Thoma A, Medina C, Rivera-Chavarría IJ, Henry M, Afshar A, Dailiana ZH, Prasetyono TO, Artiaco S, Madhusudhan TR, Ukaj S, Reigstad O, Hamada Y, Bedi R, Poggetti A, Al-Qattan MM, Siala M, Viswanathan A, Romero-Reveron R, Hong JP, Khalid KA, Bhaskaran S, Venkatadass K, Leechavengvongs S, Goorens CK, Nazim S, Georgescu AV, Tremp M, Nakarmi KK, Ellabban MA, Chan P, Aristov A, Patel S, Moreno-Serrano CL, Rai S, Kanna RM, Malshikare VA, Tanabe K, Thomas S, Gokkus K, Baek SH, Brandt J, Rith Y, Olazabal A, Saaiq M, Patil V, Jithendran N, Parekh H, Minamikawa Y, Atagawi AA, Hadi JA, Berezowsky CA, Moya-Angeler J, Altamirano-Cruz MA, Galvis R LA, Antezana A, Paczesny L, Fernandes CH, Asadullah M, Yuan-Shun L, Makelov B, Dodakundi C, Regmi R, Pereira GU, Zhang S, Sayoojianadhan B, Callupe I, Rakha MI, Papes D, Ganesan RP, Mohan M, Jeyaraman A, Prabhakar P, Rajniashokan A, Geethan I, Chandrasekar S, Löw S, Thangavelu K, Giudici LD, Palanisamy Y, Vaidyanathan S, Boretto J, Ramirez MA, Goundar TS, Kuppusamy T, Kanniyan K, Srivastava A, Chiu YC, Bhat AK, Gopinath NR, Vasudevan VP, Abraham V. Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease. J Hand Microsurg 2020; 12:135-162. [PMID: 33408440 PMCID: PMC7773504 DOI: 10.1055/s-0040-1713964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
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Affiliation(s)
- J. Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Tamil Nadu, India
| | | | - Chaitanya S. Mudgal
- Harvard Medical School, Massachusetts, United States; Hand Surgery Services, Massachusetts General Hospital, Boston, Massachusetts, United States
- Hand Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Joan Arenas-Prat
- Department of Orthopaedics, ServeisMedics Penedes, Barcelona, Catalonia, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chul Ki Goorens
- Department of Orthopaedics, Regional Hospital Tienen, Tienen, Belgium
| | | | | | - Bolaji Mofikoya
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Zoe H. Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theddeus O.H. Prasetyono
- Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | - Ole Reigstad
- Hand Surgery Unit, Oslo University Hospital, Oslo, Norway
| | - Yoshitaka Hamada
- Hand Surgery Unit, Kansai Medical University Medical Center, Moriguchi City, Osaka, Japan
| | | | - Andrea Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Florence, Italy
| | | | - Mahdi Siala
- Service d’Orthopedie, chu de purpan, Toulouse, France
| | | | - Rafael Romero-Reveron
- Trauma and Orthopaedic Departamento, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Joon Pio Hong
- Hand and Reconstructive Microsurgery Unit, Asan Medical Center, Songpagu Seoul, Korea
| | - Kamarul Ariffin Khalid
- Department of Orthopedics, IIUM Medical Centre, Jalan Sultan Ahmad Shah, Kuantan, Pahang, Malaysia
| | | | | | | | - Chul Ki Goorens
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Sifi Nazim
- Department of Orthopaedics, Algiers Faculty of Medicine, Algiers, Algeria
| | | | - Mathias Tremp
- Department of Orthopaedics, Dorfplatz 1, Cham, Switzerland
| | | | - Mohamed A. Ellabban
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt
| | - Pingtak Chan
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | | | | | | | | | | | | | - Katsuhisa Tanabe
- Department of Orthopaedics, Nishinomiya Municipal Central Hospital, Hayashidacho, Nishinomiya, Japan
| | - Simon Thomas
- Department of Ort hopaedics, Rohini, Delhi, India
| | - Kemal Gokkus
- Alanya Research and Practice Center, Baskent University School of Medicine, Saray Mah, Antalya, Turkey
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | | | - Yin Rith
- Department of Orthopaedics, Cambodia
| | | | - Muhammad Saaiq
- Department of Hand Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Vijay Patil
- Orthopedics, Hand and Microsurgery Unit, Basildon Unive rsity Hospital, Basildon, Essex, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Lukasz Paczesny
- Orvit Clinic, Citomed Healthcare Center, Sklodowskiej, Torun, Poland
| | | | - Md. Asadullah
- Orthopedics and Hand surgery Unit, Eman Medical College Hospital, Savar, Dhaka, Bangladesh
| | | | | | | | - Rabindra Regmi
- Department of Orthopedics and Reconstructive Microsurgery, National Trauma Centre, Kathmandu, Nepal
| | | | - Shuwei Zhang
- Department of Spine and Bone Tumor Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binoy Sayoojianadhan
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, St James Hospital, Chalakudy, Kerala, India
| | | | - Mohamed I. Rakha
- Orthopedic Department, Suez Canal university hospital, Ismailia, Egypt
| | - Dino Papes
- Department of surgery (Ped and Vasc), University Hospital Center Zagreb, Zagreb, Croatia
| | - Ramesh Prabu Ganesan
- Department of Orthopedics, KAP Viswanatham Government Medical College, Trichy, India
| | | | | | - Ponnaian Prabhakar
- Orthopaedics and Joint Replacement Care Hospitals, Nampally Hyderabad, India
| | | | | | | | - Steffen Löw
- Clinic for Trauma and Hand Surgery, Bad Mergentheim, Germany
| | | | - Luca Dei Giudici
- Ortopedia e Traumatologia, Chirurgiaarticolare di Spalla e Ginocchio, Albodei Medici e Chirurghi di Latina, Cagliari, Italy
| | | | | | | | | | | | - Thirumavalavan Kuppusamy
- Department of Orthopedics, Trauma and Joint Replacement, Shri Bharani Hospital, Villupuram, Tamil Nadu, India
| | | | | | - Yung-Cheng Chiu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Anil K Bhat
- Department of Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Vineet Abraham
- Department of Orthopaedics, Mahatma Gandhi Medical College, Pondicherry, India
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Predictors of Medical Serious Adverse Events in Hip Fracture Patients Treated With Arthroplasty. J Orthop Trauma 2020; 34 Suppl 3:S42-S48. [PMID: 33027165 DOI: 10.1097/bot.0000000000001935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM Patients with hip fractures are often frail with multiple comorbidities and at risk of medical serious adverse events (SAEs). We investigated the HEALTH trial patient population to ascertain predictors of SAEs. METHODS We performed a multivariable Cox regression analysis. Occurrence of SAEs was included as the dependent variable with 31 potential prognostic factors being included as independent variables. RESULTS One thousand four hundred forty-one patients were included in this analysis. Three hundred seventy (25.6%) patients suffered from an SAE. The most common events were cardiac (38.4%, n = 105), respiratory (20.8%, n = 77), and neurological (14.1%, n = 77). The majority of SAEs (50.8%, n = 188) occurred in the first 90 days after hip fracture with 35.4% occurring in the first 30 days (n = 131). Body mass index (BMI) between 18.5 and 24.9 compared with BMI between 25 and 29.9 [hazard ratio (HR) 1.32, P = 0.03] and receiving a total hip arthroplasty compared with a bipolar hemiarthroplasty (HR 1.36, P = 0.03) were associated with a higher risk of a medical SAE within 24 months of femoral neck fracture. Age (P = 0.09), use of femoral cement (P = 0.59), and use of canal pressurization (P = 0.37) were not associated with a medical SAE. CONCLUSION Total hip arthroplasty is associated with more SAEs in the immediate postoperative period, and care should be taken in selecting patients for this treatment compared with a hemiarthroplasty. A higher BMI may be protective in hip fracture patients while age alone does not predict SAEs and neither does the use of femoral cement and/or pressurization. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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136
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Garríguez-Pérez D, García-Coiradas J, Otero-Otero J, Marco-Martínez F. Cement arteriovenogram after hip arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Schnake KJ, Scheyerer MJ, Spiegl UJA, Perl M, Ullrich BW, Grüninger S, Osterhoff G, Katscher S, Sprengel K. [Minimally invasive stabilization of thoracolumbar osteoporotic fractures]. Unfallchirurg 2020; 123:764-773. [PMID: 32613278 DOI: 10.1007/s00113-020-00835-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Minimally invasive stabilization of thoracolumbar osteoporotic fractures (OF) in neurologically intact patients is well established. Various posterior and anterior surgical techniques are available. The OF classification and OF score are helpful for defining the indications and choice of operative technique. OBJECTIVE This article gives an overview of the minimally invasive stabilization techniques, typical complications and outcome. MATERIAL AND METHODS Selective literature search and description of surgical techniques and outcome. RESULTS Vertebral body augmentation alone can be indicated in painful but stable fractures of types OF 1 and OF 2 and to some extent for type OF 3. Kyphoplasty has proven to be an effective and safe procedure with a favorable clinical outcome. Unstable fractures and kyphotic deformities (types OF 3-5) should be percutaneously stabilized from posterior. The length of the pedicle screw construct depends on the extent of instability and deformity. Bone cement augmentation of the pedicle screws is indicated in severe osteoporosis but increases the complication rate. Restoration of stability of the anterior column can be achieved through additional vertebral body augmentation or rarely by anterior stabilization. Clinical and radiological short and mid-term results of the stabilization techniques are promising; however, the more invasive the surgery, the more complications occur. CONCLUSION Minimally invasive stabilization techniques are safe and effective. The specific indications for the individual procedures are guided by the OF classification and the individual clinical situation of the patient.
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Affiliation(s)
- Klaus John Schnake
- Zentrum für Wirbelsäulen- und Skoliosetherapie, Malteser Waldkrankenhaus St. Marien, Rathsberger Str. 57, 91054, Erlangen, Deutschland.
| | - Max Josef Scheyerer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Merseburger Str. 165, 06112, Halle, Deutschland
| | - Ulrich Josef Albert Spiegl
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Mario Perl
- Unfallchirurgische Klinik - Orthopädische Chirurgie, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Bernhard Wilhelm Ullrich
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Merseburger Str. 165, 06112, Halle, Deutschland
| | - Sebastian Grüninger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - Georg Osterhoff
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Sebastian Katscher
- Interdisziplinäres Wirbelsäulenzentrum und Neurotraumatologie, Sana Kliniken Leipziger Land GmbH, Klinikum Borna, Rudolf-Virchow-Str. 2, 04552, Borna, Deutschland
| | - Kai Sprengel
- Klinik für Traumatologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Schweiz
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Fegley MW, Gupta RG, Elkassabany N, Augoustides JG, Werlhof H, Gutsche JT, Kornfield ZN, Patel N, Sanders J, Fernando RJ, Morris BN. Elective Total Knee Replacement in a Patient With a Left Ventricular Assist Device-Navigating the Challenges With Spinal Anesthesia. J Cardiothorac Vasc Anesth 2020; 35:662-669. [PMID: 33183934 DOI: 10.1053/j.jvca.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Mark W Fegley
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ragini G Gupta
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nabil Elkassabany
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Hazel Werlhof
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zev N Kornfield
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nimesh Patel
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, School of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI
| | - Joseph Sanders
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, School of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI
| | - Rohesh J Fernando
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Benjamin N Morris
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
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Ramos JGR, Zhang R, Maher B, Hardidge A, Weinberg L, Robbins R, Peyton PJ, Bellomo R, Jones D. Characteristics and outcomes of rapid response team activations for hypotension in orthopaedic patients. Intern Med J 2020; 50:61-69. [PMID: 31111607 DOI: 10.1111/imj.14374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/11/2019] [Accepted: 05/13/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypotension following orthopaedic surgery has been associated with increased morbidity and mortality. Rapid response teams (RRT) review patients on hospital wards with hypotension. AIM To evaluate the epidemiology of hypotensive RRT activations in adult orthopaedic patients to identify contributing factors and areas for future quality improvement. METHODS Timing of RRT activations, presumed causes of hypotension and associated treatments were assessed. RESULTS Among 963 RRT activations in 605 patients over 3 years, the first calls of 226 of 605 patients were due to hypotension, and 213 (94.2%) of 226 had sufficient data for analysis. The median age was 79 (interquartile range 66-87) years; 58 (27.2%) were male, and comorbidities were common. Most (68%) surgery was emergent, and 75.1% received intraoperative vasopressors for hypotension. Most activations occurred within 24 h of surgery, and hypovolaemia, infection and arrhythmias were common presumed causes. Fluid boluses occurred in 173 (81.2%), and the time between surgery and RRT activation was 10 (4.0-26.5) h. in cases where fluid boluses were given, compared with 33 (15.5-61.5) h. where they were not (P < 0.001). Blood transfusion (30, 14.1%) and withholding of medications were also common. Hospital mortality was 8.5% (18), and 13.6% (29) were admitted to critical care at some stage. In-hospital death was associated with older age, functional dependence, arrhythmia and presumed infection. CONCLUSIONS Hypotension-related RRT calls in orthopaedic patients are common. Future interventional studies might focus on perioperative fluid therapy and vaso-active medications, as well as withholding of anti-hypertensive medications preoperatively.
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Affiliation(s)
- João G R Ramos
- Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil.,UNIME Medical School, Lauro de Freitas, Brazil
| | - Richard Zhang
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Brendan Maher
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Hardidge
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Melbourne, Victoria, Australia
| | - Ray Robbins
- Business Intelligence Unit, Austin Health, Melbourne, Victoria, Australia
| | - Phillip J Peyton
- Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia.,Department of Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Data Analytics and Evaluation (DARE) Centre, Austin Health, Melbourne, Victoria, Australia.,Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Jones
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Intensive Care Unit, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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140
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Nantha Kumar N, Kunutsor SK, Fernandez MA, Dominguez E, Parsons N, Costa ML, Whitehouse MR. Effectiveness and safety of cemented and uncemented hemiarthroplasty in the treatment of intracapsular hip fractures. Bone Joint J 2020; 102-B:1113-1121. [DOI: 10.1302/0301-620x.102b9.bjj-2020-0282.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. Methods PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures. Results A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty. Conclusion There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: Bone Joint J 2020;102-B(9):1113–1121.
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Affiliation(s)
- Nakulan Nantha Kumar
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
| | - Setor K. Kunutsor
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Miguel A. Fernandez
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Elizabeth Dominguez
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
| | - Nick Parsons
- Statistics and Epidemiology Unit, University of Warwick, Coventry, UK
| | - Matt L. Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Michael R. Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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141
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Garríguez-Pérez D, García-Coiradas J, Otero-Otero J, Marco-Martínez F. Cement arteriovenogram after hip arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:388-392. [PMID: 32807695 DOI: 10.1016/j.recot.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/05/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022] Open
Abstract
Modern cement implantation techniques during hip arthroplasty rely on high intramedullary pressures which can result in cement extrusion towards femoral nutrient vessels, and thus, the occurrence of a particular image in postoperative radiographs (bone cement arterio-venogram). We report a case series of 14 patients in whom a bone cement arterio-venogram was observed after undergoing a cemented hip arthroplasty. No local or systemic complications developed after cementing nor during a mean follow-up of three years. Bone cement arterio-venogram is a radiologic sign that indicates a good cement pressurisation during surgery and is not associated to medical complications or periprosthetic femoral fractures.
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Affiliation(s)
- D Garríguez-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - J García-Coiradas
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - J Otero-Otero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco-Martínez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
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142
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Sarrigiannidis S, Moussa H, Dobre O, Dalby MJ, Tamimi F, Salmeron-Sanchez M. Chiral Tartaric Acid Improves Fracture Toughness of Bioactive Brushite-Collagen Bone Cements. ACS APPLIED BIO MATERIALS 2020; 3:5056-5066. [PMID: 32904797 PMCID: PMC7461128 DOI: 10.1021/acsabm.0c00555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023]
Abstract
Brushite cements are promising bone regeneration materials with limited biological and mechanical properties. Here, we engineer a mechanically improved brushite-collagen type I cement with enhanced biological properties by use of chiral chemistry; d- and l-tartaric acid were used to limit crystal growth and increase the mechanical properties of brushite-collagen cements. The impact of the chiral molecules on the cements was examined with Fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy (SEM). A 3-point bend test was utilized to study the fracture toughness, and cell attachment and morphology studies were carried out to demonstrate biocompatibility. XRD and SEM analyses showed that l-, but not d-tartaric acid, significantly restrained brushite crystal growth by binding to the {010} plane of the mineral and increased brushite crystal packing and the collagen interaction area. l-Tartaric acid significantly improved fracture toughness compared to traditional brushite by 30%. Collagen significantly enhanced cell morphology and focal adhesion expression on l-tartaric acid-treated brushite cements.
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Affiliation(s)
- Stylianos
O. Sarrigiannidis
- Centre
for the Cellular Microenvironment, University
of Glasgow, Rankine Building, 79−85 Oakfield Ave, Glasgow G12 8LT, United
Kingdom
| | - Hanan Moussa
- Faculty
of Dentistry, McGill University, Strathcona Building, 3640 University
Street, Montreal, Quebec H3A 2B2, Canada
- Faculty
of Dentistry, Benghazi University, Benghazi 9504, Libya
| | - Oana Dobre
- Centre
for the Cellular Microenvironment, University
of Glasgow, Rankine Building, 79−85 Oakfield Ave, Glasgow G12 8LT, United
Kingdom
| | - Matthew J. Dalby
- Centre
for the Cellular Microenvironment, University
of Glasgow, Joseph Black Building, University Pl, Glasgow G12 8QQ, United Kingdom
| | - Faleh Tamimi
- Faculty
of Dentistry, McGill University, Strathcona Building, 3640 University
Street, Montreal, Quebec H3A 2B2, Canada
- College
of Dental Medicine, Qatar University, Doha, Qatar
| | - Manuel Salmeron-Sanchez
- Centre
for the Cellular Microenvironment, University
of Glasgow, Rankine Building, 79−85 Oakfield Ave, Glasgow G12 8LT, United
Kingdom
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143
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Liu B, Li A, Wang J, Wang H, Zhai G, Ma H, Lian X, Zhang B, Liu L, Gao Y. Cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck: A PRISMA-compliant meta-analysis of randomized controlled trial. Medicine (Baltimore) 2020; 99:e21731. [PMID: 32872057 PMCID: PMC7437858 DOI: 10.1097/md.0000000000021731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This meta-analysis was performed to incorporate newly published, high-quality randomized controlled trials (RCTs) to determine the effects of cemented versus uncemented hemiarthroplasty for elderly patients with displaced fracture of the femoral neck. METHODS The following electronic databases were extensively searched from the inception of the database through December 2018: EMBASE, Medline, the Cochrane Library, and Web of Science. RCTs focusing on the outcomes of cemented and uncemented hemiarthroplasty were reviewed and screened for eligibility. We used the Cochrane Collaboration's Review Manager Software to perform meta-analyses. Two independent reviewers extracted the data and assessed the study quality and bias risk through the Cochrane Collaboration tool. Use fixed effect model or random effect model to pooled data. Cochran's Q statistic was used to evaluate heterogeneity, and I statistic was used to quantify heterogeneity. RESULTS Fifteen RCTs were enrolled (n = 3790) (uncemented hemiarthroplasty group = 1015; cemented hemiarthroplasty group = 1037) (mean age ranged from 70-85.3 years; all patients > 65 years). The meta-analysis showed that cemented hemiarthroplasty has a longer operating time (weighted mean difference, 8.03; 95% confidence interval (CI) 4.83-11.23; P < .00001), less pain (odds ratio, 0.48; 95% CI 4.83-11.23; P = .02), lower mortality 1-year (odds ratio, 0.78; 95% CI 0.62-0.98; P = .03) and fewer implant-related complications (odds ratio, 0.20; 95% CI 0.13-0.30; P < .00001) than Uncemented hemiarthroplasty. However, there are still some limitations in our study, such as the uniformity of the surgery administration programme and rehabilitation scheme, and the small sample size of the included studies. CONCLUSIONS Cemented hemiarthroplasty for elderly patients with displaced fracture of femoral neck may acquire better functional results.
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144
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Vasilyev AV, Kuznetsova VS, Bukharova TB, Grigoriev TE, Zagoskin Y, Korolenkova MV, Zorina OA, Chvalun SN, Goldshtein DV, Kulakov AA. Development prospects of curable osteoplastic materials in dentistry and maxillofacial surgery. Heliyon 2020; 6:e04686. [PMID: 32817899 PMCID: PMC7424217 DOI: 10.1016/j.heliyon.2020.e04686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/02/2019] [Accepted: 08/07/2020] [Indexed: 12/21/2022] Open
Abstract
The article presents classification of the thermosetting materials for bone augmentation. The physical, mechanical, biological, and clinical properties of such materials are reviewed. There are two main types of curable osteoplastic materials: bone cements and hydrogels. Compared to hydrogels, bone cements have high strength features, but their biological properties are not ideal and must be improved. Hydrogels are biocompatible and closely mimic the extracellular matrix. They can be used as cytocompatible scaffolds for tissue engineering, as can protein- and nucleic acid-activated structures. Hydrogels may be impregnated with osteoinductors such as proteins and genetic vectors without conformational changes. However, the mechanical properties of hydrogels limit their use for load-bearing bone defects. Thus, improving the strength properties of hydrogels is one of the possible strategies to achieve the basis for an ideal osteoplastic material.
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Affiliation(s)
- A V Vasilyev
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia.,Research Centre of Medical Genetics, Moscow, Russia
| | - V S Kuznetsova
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia.,Research Centre of Medical Genetics, Moscow, Russia
| | | | | | | | - M V Korolenkova
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia
| | - O A Zorina
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia
| | | | | | - A A Kulakov
- Central Research Institute of Dental and Maxillofacial Surgery, Moscow, Russia
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145
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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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146
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Fazal MA, Shah S, Subramanian P. Hydroxyapatite coated hip hemiarthroplasty: Morbidity and mortality. J Clin Orthop Trauma 2020; 11:S568-S572. [PMID: 32774030 PMCID: PMC7394800 DOI: 10.1016/j.jcot.2020.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Use of uncemented femoral stems for treating displaced intra capsular hip fractures in elderly is increasing worldwide. The aim of our study is to evaluate morbidity and mortality of treatment with a modular fully hydroxyapatite-coated collared femoral stem. MATERIAL AND METHODS 259 consecutive patients were included in the study. Patients were followed up for12 months. Outcomes were perioperative mortality, perioperative fractures, 30, 120 and 365-day mortality, revision surgery within 30 days and twelve months, length of stay, discharge destination and mobility. RESULTS Mean age was 85.4 years. 71.8% were female. 63.3% of patients were ASA grade III and IV. 87.6% of patients were operated within 36 h of attendance to hospital. The mortality rate at 30, 120, and 365 days was 8.2%, 15%, and 18.4% respectively with no peri-operative mortality. 0.8% of the patients sustained a peri-operative fracture below the lesser trochanter. Infection and dislocation were 1.1% and 1.5% respectively. 3.4% of the patient underwent further surgery within thirty days but no further surgery in next twelve months. Mean inpatient acute length of stay was 16.8 days, 41.5% of the patients returned to their own or sheltered accomodation within thirty days. 68% of the patients were mobile outdoors prior to the fracture that dropped to 25% at one year after surgery. DISCUSSION Our study demonstrates that treatment of displaced intracapsular femoral neck fractures in elderly with a full hydroxyapatite coated collared stem has satisfactory outcomes, no perioperative mortality, low one-year mortality and low revision hence a dependable option.
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Affiliation(s)
- Muhammad Ali Fazal
- Corresponding author. Department of Trauma & Orthopaedics, Royal Free NHS Foundation Trust, The Ridgeway, Enfield, EN2 8JL, United Kingdom.
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147
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Oliva MS, Vitiello R, Cauteruccio M, Pesare E, Rovere G, Meschini C, Liuzza F, Maccauro G, Ziranu A. Cemented versus cementless megaprosthesis in proximal femur metastatic disease: A systematic review. Orthop Rev (Pavia) 2020; 12:8689. [PMID: 32913616 PMCID: PMC7459367 DOI: 10.4081/or.2020.8689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
The proximal femur is the long bone most commonly affected by metastatic disease. There are many treatment options, such as hip megaprostheses. A topic still widely debated in literature is the use of cemented or uncemented megaprostheses in this kind of patients. The purpose of this review is to examine both these surgical options to understand which of them should be preferred in metastatic patients. Twelve articles were finally included in the review. Eight authors used cemented mega - prostheses, two cementless megaprostheses and two authors used both techniques. Better functional outcomes and lower infection rates were found in cementless mega - prostheses. More studies have to be performed to choose the better technique and improve patients’ quality of life.
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Affiliation(s)
- Maria Serena Oliva
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Cauteruccio
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Pesare
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Cesare Meschini
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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148
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Long acting anti-infection constructs on titanium. J Control Release 2020; 326:91-105. [PMID: 32580044 DOI: 10.1016/j.jconrel.2020.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/23/2020] [Accepted: 06/14/2020] [Indexed: 01/12/2023]
Abstract
Peri-prosthetic joint infections (PJI) are a serious adverse event following joint replacement surgeries; antibiotics are usually added to bone cement to prevent infection offset. For uncemented prosthesis, alternative antimicrobial approaches are necessary in order to prevent PJI; however, despite elution of drug from the surface of the device being shown one of the most promising approach, no effective antimicrobial eluting uncemented device is currently available on the market. Consequently, there is a clinical need for non-antibiotic antimicrobial uncemented prosthesis as these devices present numerous benefits, particularly for young patients, over cemented artificial joints. Moreover, non-antibiotic approaches are driven by the need to address the growing threat posed by antibiotic resistance. We developed a multilayers functional coating on titanium surfaces releasing chlorhexidine, a well-known antimicrobial agent used in mouthwash products and antiseptic creams, embedding the drug between alginate and poly-beta-amino-esters. Chlorhexidine release was sustained for almost 2 months and the material efficacy and safety was proven both in vitro and in vivo. The coatings did not negatively impact osteoblast and fibroblast cells growth and were capable of reducing bacterial load and accelerating wound healing in an excisional wound model. As PJI can develop weeks and months after the initial surgery, these materials could provide a viable solution to prevent infections after arthroplasty in uncemented prosthetic devices and, simultaneously, help the fight against antibiotic resistance.
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149
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Hamajima K, Ozawa R, Saruta J, Saita M, Kitajima H, Taleghani SR, Usami D, Goharian D, Uno M, Miyazawa K, Goto S, Tsukinoki K, Ogawa T. The Effect of TBB, as an Initiator, on the Biological Compatibility of PMMA/MMA Bone Cement. Int J Mol Sci 2020; 21:ijms21114016. [PMID: 32512780 PMCID: PMC7312717 DOI: 10.3390/ijms21114016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Abstract
Acrylic bone cement is widely used in orthopedic surgery for treating various conditions of the bone and joints. Bone cement consists of methyl methacrylate (MMA), polymethyl methacrylate (PMMA), and benzoyl peroxide (BPO), functioning as a liquid monomer, solid phase, and polymerization initiator, respectively. However, cell and tissue toxicity caused by bone cement has been a concern. This study aimed to determine the effect of tri-n-butyl borane (TBB) as an initiator on the biocompatibility of bone cement. Rat spine bone marrow-derived osteoblasts were cultured on two commercially available PMMA-BPO bone cements and a PMMA-TBB experimental material. After a 24-h incubation, more cells survived on PMMA-TBB than on PMMA-BPO. Cytomorphometry showed that the area of cell spread was greater on PMMA-TBB than on PMMA-BPO. Analysis of alkaline phosphatase activity, gene expression, and matrix mineralization showed that the osteoblastic differentiation was substantially advanced on the PMMA-TBB. Electron spin resonance (ESR) spectroscopy revealed that polymerization radical production within the PMMA-TBB was 1/15–1/20 of that within the PMMA-BPO. Thus, the use of TBB as an initiator, improved the biocompatibility and physicochemical properties of the PMMA-based material.
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Affiliation(s)
- Kosuke Hamajima
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, 1-1-100 Kusumoto-cho, Chikusa-ku, Nagoya, Aichi 464-8650, Japan; (K.M.); (S.G.)
| | - Ryotaro Ozawa
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral Interdisciplinary Medicine (Prosthodontics & Oral Implantology), Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan
| | - Juri Saruta
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan;
| | - Makiko Saita
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral Interdisciplinary Medicine (Prosthodontics & Oral Implantology), Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan
| | - Hiroaki Kitajima
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Samira Rahim Taleghani
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
| | - Dan Usami
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
| | - Donya Goharian
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
| | - Mitsunori Uno
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Department of Prosthodontics, Division of Oral Functional Science and Rehabilitation, Asahi University School of Dentistry, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Ken Miyazawa
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, 1-1-100 Kusumoto-cho, Chikusa-ku, Nagoya, Aichi 464-8650, Japan; (K.M.); (S.G.)
| | - Shigemi Goto
- Department of Orthodontics, School of Dentistry, Aichi Gakuin University, 1-1-100 Kusumoto-cho, Chikusa-ku, Nagoya, Aichi 464-8650, Japan; (K.M.); (S.G.)
| | - Keiichi Tsukinoki
- Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan;
| | - Takahiro Ogawa
- Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA; (K.H.); (R.O.); (J.S.); (M.S.); (H.K.); (S.R.T.); (D.U.); (D.G.); (M.U.)
- Correspondence: ; Tel.: +1-310-825-0727; Fax: +1-310-825-6345
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Liang ZC, Chong MSY, Sim MA, Lim JL, Castañeda P, Green DW, Fisher D, Ti LK, Murphy D, Hui JHP. Surgical Considerations in Patients with COVID-19: What Orthopaedic Surgeons Should Know. J Bone Joint Surg Am 2020; 102:e50. [PMID: 32341309 PMCID: PMC7219827 DOI: 10.2106/jbjs.20.00513] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Zhen Chang Liang
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Mark Seng Ye Chong
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Ming Ann Sim
- Department of Anesthesia, National University of Singapore, National University Health System, Singapore
| | - Joel Louis Lim
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Pablo Castañeda
- Department of Pediatric Orthopaedic Surgery, NYU Langone Medical Center, New York, NY
| | - Daniel W. Green
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Infectious Disease, National University Hospital, Singapore
| | - Lian Kah Ti
- Department of Anesthesia, National University of Singapore, National University Health System, Singapore
| | - Diarmuid Murphy
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
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