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Kirsch M, Kremer H, Fabbri C, Capdevielle P, Collignon F, Mainard D. Osseointegration of a hydroxyapatite-coated stem in femoral neck fractures in the over-80 s. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1535-1541. [PMID: 38267791 DOI: 10.1007/s00590-024-03835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE In the over-80 s, femoral bone is often osteoporotic and unlikely to be conducive to periprosthetic bone rehabitation. This observation often leads to cemented fixation for hemiarthroplasty in femoral neck fracture. Hydroxyapatite is a bioactive coating that has already demonstrated its osteoinductive properties. Our hypothesis is that hydroxyapatite enables prosthetic osseointegration in patients over 80, as well as periprosthetic cortical thickening. The objective was to evaluate the osseointegration of a hydroxyapatite-coated femoral stem in femoral neck fractures in the over-80 s, and the evaluation of the periprosthetic bone regeneration permitted by hydroxyapatite. METHODS This was a retrospective study. Osseointegration and periprosthetic bone regeneration were assessed on pre-operative, immediate post-operative and last follow-up radiographs with Engh score, O-SS score, cortical index, Canal Bone Ration (CBR) and Canal Fill Ratio (CFR). RESULTS One hundred and forty-six patients were included. At last follow-up, 99.3% (n = 145) of stems were osseointegrated. The mean Engh score was 19.9 [SD 3.1]. The mean O-SS score was 19.1 [SD 2.4], corresponding to very good osseointegration. The mean CBR at last follow-up was 0.48 [SD 0.07], corresponding to a non-osteoporotic femur. There was a significant difference with pre-operative CBR (p < 0,001). The pre-operative cortical index and the index at the last follow-up were significantly different for all levels of measurement (p < 0,001). The CFR at last follow-up was also significantly different with the post-operative CFR (p < 0,001). CONCLUSION This study shows the value of using a hydroxyapatite-coated stem on senile, osteoporotic bone to improve cortical thickness along the entire length of femoral bone.
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Affiliation(s)
- Mathias Kirsch
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France.
| | - Hugo Kremer
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Camille Fabbri
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Pierre Capdevielle
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Florian Collignon
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
| | - Didier Mainard
- Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France
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Schouten B, Baartmans M, van Eikenhorst L, Gerritsen GP, Merten H, van Schoten S, Nanayakkara PWB, Wagner C. Fatal Adverse Events in Femoral Neck Fracture Patients Undergoing Hemiarthroplasty or Total Hip Arthroplasty-A Retrospective Record Review Study in a Nationwide Sample of Deceased Patients. J Patient Saf 2024:01209203-990000000-00202. [PMID: 38466141 DOI: 10.1097/pts.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVES Patient safety is a core component of quality of hospital care and measurable through adverse event (AE) rates. A high-risk group are femoral neck fracture patients. The Dutch clinical guideline states that the treatment of choice is cemented total hip arthroplasty (THA) or hemiarthroplasty (HA). We aimed to identify the prevalence of AEs related to THA/HA in a sample of patients who died in the hospital. METHODS We used data of a nationwide retrospective record review study. Records were systematically reviewed for AEs, preventability and contribution to the patient's death. We drew a subsample of THA/HA AEs and analyzed these cases. RESULTS Of the 2998 reviewed records, 38 patients underwent THA/HA, of whom 24 patients suffered 25 AEs (prevalence = 68.1%; 95% confidence interval, 51.4-81.2), and 24 contributed to death. Patients with a THA/HA AE were of high age (median = 82.5 y) and had severe comorbidity (Charlson score ≥5). The majority of THA/HA AEs had a patient-related cause and was considered partly preventable. Examples of suggested actions that might have prevented the AEs: refraining from surgery, adhering to medication guidelines, uncemented procedures, comprehensive presurgical geriatric assessment, and better postsurgical monitoring. DISCUSSION Our study shows a high prevalence of (fatal) adverse events in patients undergoing THA/HA. This seems particularly valid for cemented implants in frail old patients, indicating room for improvement of patient safety in this group. Therefore, we recommend physicians to engage in comprehensive shared decision making with these patients and decide on a treatment fitting to a patient's preexisting health status, preferences, and values.
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Affiliation(s)
- Bo Schouten
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Mees Baartmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht
| | | | - Gooitzen P Gerritsen
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Hanneke Merten
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Steffie van Schoten
- From the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam
| | - Prabath W B Nanayakkara
- Amsterdam UMC location Vrije Universiteit Amsterdam, Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Gjertsen JE, Nilsen D, Furnes O, Hallan G, Kroken G, Dybvik E, Fenstad AM. Promoting cemented fixation of the femoral stem in elderly female hip arthroplasty patients and elderly hip fracture patients: a retrospective cohort study from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register. Acta Orthop 2024; 95:130-137. [PMID: 38391278 PMCID: PMC10885817 DOI: 10.2340/17453674.2024.40073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND PURPOSE Uncemented stems increase the risk of revision in elderly patients. In 2018, we initiated a national quality improvement project aiming to increase the proportion of cemented stems in elderly female total hip arthroplasty (THA) and hip fracture hemiarthroplasty (HA) patients. We aimed to evaluate the association of this project on the frequency of cemented stems and the risk of secondary procedures in the targeted population. METHODS 10,815 THAs in female patients ≥ 75 years in the Norwegian Arthroplasty Register and 19,017 HAs in hip fracture patients ≥ 70 years in the Norwegian Hip Fracture Register performed in 2015-2017 and 2019-2021 at all Norwegian hospitals were included in this retrospective cohort study. The quality improvement project was implemented at 19 hospitals (8,443 patients). 1-year revision risk (THAs) and reoperation risk (HAs) were calculated for uncemented and cemented stems by Kaplan-Meier and Cox adjusted hazard rate ratios (aHRRs) with all-cause revision/reoperation as main endpoint. RESULTS The use of cemented stem fixation in the targeted population increased from 26% to 80% for THAs and from 27% to 91% for HAs. For THAs, the 1-year revision rate decreased from 3.7% in 2015-2017 to 2.1% in 2019-2021 (aHRR 0.7, 95% confidence interval [CI] 0.5-0.9) at the intervention hospitals. For HAs, the reoperation rate decreased from 5.9% in 2015-2017 to 3.3% in 2019-2021 (aHRR 0.6, CI 0.4-0.8) at the intervention hospitals. CONCLUSION The quality improvement project resulted in a significant increase in the proportion of cemented stems and reduced risk of secondary procedures for both THAs and HAs.
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Affiliation(s)
- Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen.
| | - Daniel Nilsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Gard Kroken
- Directorate of Fisheries, Section for Analysis and Risk Assessment, Bergen, Norway
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
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Moore J, Berney M, Walsh M, Hurson C, Rowan F, Cleary M, Brent L. Intracapsular hip fractures: A comparative study of cemented and uncemented hemiarthroplasties in the Irish hip fracture database. Surgeon 2023:S1479-666X(23)00148-8. [PMID: 38135630 DOI: 10.1016/j.surge.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The aim of this study was to analyse the association between use of cement for stem fixation in hip hemiarthroplasty and the outcomes of mobility, mortality, and discharge destination. METHODS The Irish Hip Fracture Database was examined from 2016 to 2020 to assess for any difference in post op mobility, 7-day, 14-day and inpatient mortality, and discharge destination. RESULTS A total of 7109 hemi-arthroplasties were identified from 2016 to 2020. 71.6 % were cemented (n = 5,172), with 28.4 % uncemented (1,937). There was no difference in day 1 post op mobilisation (79.7 % vs 80.9 %) or cumulative ambulatory score on discharge (2.5 vs 2.4). The mortality rate was equivocal at all time points between the cemented and uncemented groups (7 day (.9 % vs 1.2 %), 14 day (1.9 % vs 2.3 %), inpatient (4 % vs 5.1 %)). There was no difference in length of stay (11 vs 12 days) or discharge to home directly (21 % vs 27 %). CONCLUSION The use of cement did not have any significant difference on post op mortality, mobility or discharge destination.
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Affiliation(s)
- Joss Moore
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland.
| | - Mark Berney
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Mary Walsh
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Conor Hurson
- St Vincent's University Hospital, Dublin, Ireland
| | - Fiachra Rowan
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - May Cleary
- University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Louise Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, Ireland
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Jeong SH, Lee HJ, Kim SH, Park EC, Jang SY. Effect of dementia on all-cause mortality in hip fracture surgery: a retrospective study on a nationwide Korean cohort. BMJ Open 2023; 13:e069579. [PMID: 37173102 DOI: 10.1136/bmjopen-2022-069579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of dementia on the 1-year all-cause mortality in elderly patients who underwent hip fracture surgery, using a nationwide cohort in Korea. DESIGN, SETTING, AND PARTICIPANTS This was a nationwide, retrospective study. Elderly patients (≥60 years) with and without dementia who underwent hip fracture surgery between January 2005 and December 2012 were distinguished using the data from the Korean National Health Insurance Service-Senior cohort. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES The mortality rates with 95% CIs and the impact of dementia on all-cause mortality were calculated using a generalised linear model with Poisson distribution and a multivariable-adjusted Cox proportional hazards model, respectively. RESULTS Among the 10 833 patients who underwent hip fracture surgery, 13.4% were diagnosed with dementia. During the 1-year follow-up period, 1586 patients with hip fracture without dementia died in 8356.5 person-years (incidence rate (IR)=189.2 per 1000 person-years, 95% CI 179.91 to 198.99), while 340 deaths were confirmed in patients with hip fracture with dementia in 1240.8 person-years (IR, 273.1 per 1000 person-years, 95% CI 244.94 to 304.58). Patients with hip fracture and dementia were 1.23 times more likely to die than those in the control group in the same period (HR=1.23, 95% CI 1.09 to 1.39). CONCLUSION Dementia is a risk factor for 1-year all-cause mortality after hip fracture surgery. To improve the postoperative outcomes of patients with dementia who have undergone hip fracture surgery, effective treatment models such as multidisciplinary diagnosis and strategic rehabilitation should be established.
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Affiliation(s)
- Sung Hoon Jeong
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Ji Lee
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Seung Hoon Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Park JW, Ko YS, Park S, Kim SH, Lee YK, Koo KH. Cemented versus Cementless Total Hip Arthroplasty for Femoral Head Osteonecrosis: A Study Based on National Claim Data in South Korea. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00001. [PMID: 37134143 PMCID: PMC10155893 DOI: 10.5435/jaaosglobal-d-23-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The purpose of this study was to compare the rates of revision, periprosthetic joint infection (PJI), and periprosthetic fracture (PPF) between patients with osteonecrosis of the femoral head (ONFH) undergoing noncemented total hip arthroplasty (THA) and cemented THA using a national claim data in South Korea. METHODS We identified patients who received THA for ONFH from January 2007 to December 2018 using ICD diagnosis codes and procedural codes. Patients were categorized into two groups according to the fixation method: with or without cement. The survivorship of THA was calculated using the following end points: revision of both the cup and stem, revision of the single component, any type of revision, PJI, and PPF. RESULTS A total of 40,606 patients: 3,738 patients (9.2%) with cement and 36,868 patients (90.7%) without cement, received THA for ONFH. The mean age of the noncemented fixation group (56.2 ± 13.2 years) was significantly lower than that of the cemented fixation group (57.0 ± 15.7 years, P = 0.003). The risk of revision and PJI was notably higher in cemented THA (hazard ratio: 1.44 [1.21 to 1.72] and 1.66 [1.36 to 2.04], respectively). Noncemented THA had a higher 12-year survivorship compared with cemented THA with any revision and PJI as the end point. DISCUSSION Noncemented fixation had better survivorship than cemented fixation in patients with ONFH.
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Affiliation(s)
- Jung-Wee Park
- From the Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea (Dr. J-W. Park, Dr. Ko, Dr. Lee, and Dr. Koo); the Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Korea (Ms. S. Park); the Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea (Mr. Kim); the Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea (Dr. Lee); and the Department of Orthopaedic Surgery, Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, South Korea (Dr. Koo)
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Fu M, Shen J, Ren Z, Lv Y, Wang J, Jiang W. A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old. Front Med (Lausanne) 2023; 10:1085485. [PMID: 36817792 PMCID: PMC9932906 DOI: 10.3389/fmed.2023.1085485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Currently, whether bone cement can be applied in bipolar hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. The aim of this systematic review and meta-analysis was to compare the effectiveness and safety of cemented bipolar hemiarthroplasty (CBH) versus uncemented bipolar hemiarthroplasty (UCBH) in the treatment of FNFs among elderly patients over 60 years old. Materials and methods The Pubmed, Web of science, Cochrane Library and EMBASE databases were searched comprehensively for relevant articles from their inception to May 2022. Studies about comparing outcomes between CBH and UCBH for FNFs in elderly patients aged more than 60 years were included. Outcomes including operation time, intra-operative blood loss, length of hospital stay, wound infections, residual pain, revisions, re-operations, complications related to prosthesis, general complications, and mortality. The Review Manager 5.3 software provided by the Cochrane Collaboration Network was used to perform the meta-analysis of comparable data. Results A total of 6 randomized controlled trials (RCTs) and 9 observational studies were included in this analysis, with 33,118 patients (33,127 hips). Results of the meta-analysis indicated that the operation time [WMD = 13.01 min, 95% CI (10.79, 15.23)], intra-operative blood loss [WMD = 80.57 ml, 95% CI (61.14, 99.99)], incidence of heterotrophic ossification [OR = 2.07, 95% CI (1,14, 3.78)], were increased in the CBH group but the incidence of intra-operative fractures [OR = 0.24, 95% CI (0.07, 0.86)], periprosthetic fractures [OR = 0.24, 95% CI (0.18, 0.31)], aseptic loosening of prosthesis [OR = 0.20, 95% CI (0.09, 0.44)], wound infections [OR = 0.80, 95% CI (0.68, 0.95)] and re-operation rates [OR = 0.61, 95% CI (0.54, 0.68)] were lower in the CBH group by comparison with the UCHB group. However, there were no significant differences in residual pain, length of hospital stay, prosthetic dislocation, prosthetic subsidence (> 5 mm), acetabulum erosion, revisions, pulmonary infections, pulmonary embolisms, urinary tract infections, deep venous thromboses, decubitus, cardiovascular accidents (arrhythmia/myocardial infarction), and respiratory failure between the two groups. In terms of mortality, perioperative mortality (within 72 h) [OR = 2.39, 95% CI (1.71, 3.32)] and 1-week mortality postoperatively [OR = 1.22, 95% CI (1.05, 1.41)] in CBH group were higher than those in UCBH group, but there were no significant differences in mortality at 1 month, 3 months, 1 year, and 2 years postoperatively between CBH group and UCBH group. Conclusion This meta-analysis found that elderly patients over 60 years old with FNFs who underwent CBH had longer operation time, higher incidence of heterotrophic ossification, intra-operative blood loss, and mortality within 72 h of operation and at 1-week postoperatively, but lower incidence of periprosthetic fractures, aseptic loosening of prosthesis, intra-operative fractures, wound infections and re-operations. Other outcomes were not significantly different between the two groups. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021274253.
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Affiliation(s)
- Mengyu Fu
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Jieliang Shen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhoukui Ren
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Yingwen Lv
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China
| | - Jiangang Wang
- Department of Orthopaedics, The Thirteenth People’s Hospital of Chongqing (The Geriatric Hospital of Chongqing), Chongqing, China,*Correspondence: Jiangang Wang,
| | - Wei Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Wei Jiang,
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Dahl OE, Pripp AH, Jaradeh M, Fareed J. The Bone Cement Hypercoagulation Syndrome: Pathophysiology, Mortality, and Prevention. Clin Appl Thromb Hemost 2023; 29:10760296231198036. [PMID: 37792504 PMCID: PMC10552457 DOI: 10.1177/10760296231198036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 10/06/2023] Open
Abstract
Since Charnley introduced acrylic cement to seal metallic hip prostheses in the 1950s, reports of perioperative fatal cardiorespiratory and vascular dysfunctions have been published. Studies on humans and animals have shown neurogenic stimulation and substantial local and systemic activation of coagulation are caused by surgical bone marrow damage and chemical cell destruction by toxic monomeric methyl methacrylate from the implanted cement and other tissue-released substances. Venous blood-borne cell fragments and conjugates of activated cells from the surgical site are sequestered and trapped in the pulmonary microcirculation. A substantial hypercoagulation occurs in the lung circulation. Hypercoagulable blood is passed over to the arterial side and may cause vessel obliteration and organ damage. This process may affect the brain, heart, and kidneys and, through the release of vasoactive substances, introduce hemodynamic imbalances that can lead to fatal outcomes in susceptible populations such as elderly patients with hip fractures. The main underlying pathophysiologic processes leading to these occasionally devastating outcomes are a substantial activation of coagulation and cell destruction caused by the toxic substance released by curing bone cement and several vasoactive substances.
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Affiliation(s)
- Ola E. Dahl
- Centre of Medical Science, Education, and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are Hugo Pripp
- Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mark Jaradeh
- Department of Molecular Pharmacology & Neuroscience, Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Department of Molecular Pharmacology & Neuroscience, Loyola University Medical Center, Maywood, IL, USA
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Dahl OE, Pripp AH. Response to the Letter to the Editor: Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated With Cemented and Cementless Implants? A Meta-analysis of Large, National Registries. Clin Orthop Relat Res 2022; 480:2470-2471. [PMID: 36332005 PMCID: PMC10538910 DOI: 10.1097/corr.0000000000002475] [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: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ola E. Dahl
- Centre of Medical Science, Education and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Shi P, Li N, Zhou S, Hua K. Letter to the Editor: Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated With Cemented and Cementless Implants? A Meta-analysis of Large, National Registries. Clin Orthop Relat Res 2022; 480:2468-2469. [PMID: 36374582 PMCID: PMC10538899 DOI: 10.1097/corr.0000000000002443] [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: 07/17/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Pengfei Shi
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
| | - Na Li
- Department of Anesthesiology, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
| | - Shenghu Zhou
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
| | - Kangle Hua
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, PR China
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Dominguez ED, Kumar NN, Whitehouse MR, Sayers A. Mortality associated with cemented and uncemented fixation of hemiarthroplasty and total hip replacement in the surgical management of intracapsular hip fractures: A systematic review and meta-analysis. Injury 2022; 53:2605-2616. [PMID: 35595550 DOI: 10.1016/j.injury.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of bone cement for implant fixation in the surgical management of intracapsular hip fractures (IHFs) remains controversial. Although UK national guidance supports cementation, many surgeons remain cautious of its use. In this systematic review and meta-analysis, we aimed to evaluate evidence surrounding post-operative mortality associated with cemented and uncemented total hip replacement and hemiarthroplasty implants. METHODS We conducted a search of MEDLINE and Embase databases for randomised controlled trials (RCTs) from commencement until 17 June 2020. Articles reporting mortality or patient survival as an outcome following total hip replacement (THR) or hemiarthroplasty (HA) to manage IHFs were included. Articles not comparing cemented and uncemented fixation were excluded. A meta-analysis on mortality stratified by post-operative follow-up period was conducted using a fixed-effects model. The Revised Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. RESULTS Our initial search found 77 references, 13 of which were eligible for full-text review. Mortality data from 12 studies were pooled and included in the meta-analysis. 1 599 operations were reported: 882 involved cemented fixation; 717, uncemented. Mortality outcome reporting ranged from less than 7 days to 5 years post-operation. No significant difference was observed between the two groups in mortality at any follow-up period. Study quality assessment revealed low certainty in mortality estimates. CONCLUSION Existing evidence indicates that cementation has no effect on mortality at any reported follow-up time period. Even with the use of evidence synthesis, the sample size remains relatively low for mortality outcomes and insufficiently powered to reliably determine differences between groups.
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Affiliation(s)
- Elizabeth D Dominguez
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Nakulan N Kumar
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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12
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Dahl OE, Pripp AH. Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated with Cemented and Cementless Implants? A Meta-analysis of Large, National Registries. Clin Orthop Relat Res 2022; 480:343-350. [PMID: 34491939 PMCID: PMC8747483 DOI: 10.1097/corr.0000000000001952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although current recommendations suggest that hip hemiarthroplasties performed for femoral neck fractures be implanted with bone cement, it is known to cause cardiorespiratory and hemodynamic reactions that in some patients can be fatal. Older patients may be at particular risk of this complication, but because of its relative infrequency, large studies-perhaps even larger than can be achieved in the context of single-country national registries-are needed to get reasonably precise estimates as to its frequency. Pooling results from national registries reporting on death within 48 hours of cement exposure in this setting may therefore be helpful. QUESTION/PURPOSE In a systematic review of studies based on large national registries, we asked: Does the risk of death within 48 hours of hip hemiarthroplasty differ between patients treated with cemented and cementless implants? METHODS MEDLINE and Embase data sources were searched for cohort studies on patients with hip fractures treated with cement or cementless hip hemiprostheses based on results from national registries that tracked perioperative deaths within 48 hours of surgery, from 2010 or later (to include only studies that used contemporary cement techniques). We excluded registry research on elective THAs for other indications (such as degenerative joint disease), mixed populations (registries that combined patients having arthroplasty for fracture and for other diagnoses like osteoarthritis, such that we could not separate them), and overlapping data from the same registers (to avoid double and triple publications of similar data). Five studies met our inclusion criteria. The cohorts ranged from about 11,000 to about 25,000 patients. About 31% of the patients were in the cementless group. Two studies reported the age ranges of participating patients, and three studies communicated mean ages (which were 82 years for both sexes). Twice as many females as males were present in both the cemented and cementless group. When reported, more than 50% in both groups were in the American Society of Anesthesiologists physical status classification 3 or 4. Study quality was deemed good according to the Newcastle-Ottawa Scale. Publication bias was assessed using a funnel plot and the Egger test, and study heterogeneity was evaluated using the I2 heterogeneity statistic and Cochran Q heterogeneity test. There was some heterogeneity between the studies, with a Cochran Q statistics of 8.13 (degrees of freedom = 4; p = 0.08) and an I2 statistic of 50.8%. There was evidence for a small amount of publication bias (Egger test; p = 0.02). The pooled risk ratio (RR) from a random-effects model is presented with 95% confidence intervals. The primary endpoint was the occurrence of any fatalities within 48 hours of hip fracture treatment with cementless compared with cemented prostheses. We performed a sensitivity analysis to assess the needed association of a potential unmeasured or uncontrolled confounding, and we made an estimate of the amount of unmeasured confounding that would need to be present in order to change the direction of the result. We summarized this using a parameter known as the "E-value." Based on that sensitivity analysis, we found it unlikely that an unmeasured hypothetical confounder could explain the significant association between cemented and cementless implants and risk of death within 48 hours of hip hemiarthroplasty. RESULTS Compared with the cementless group, mortality was increased in the cemented group (RR 1.63 [95% CI 1.31 to 2.02]; p < 0.001). The number needed to harm from the pooled data was 1 of 183 operated patients; that is, for every 183 patients treated with cemented implants, one death would be expected. CONCLUSION Bone cement is associated with a higher risk of fatalities within 48 hours of surgery compared with cementless prostheses. However, numerous prior studies have found a higher risk of serious complications resulting in additional surgical procedures associated with cementless devices in this population; those complications, as well, may result in death. Based on our study alone, we cannot recommend cementless implants in this setting. Large, national registries should evaluate fixation choice in older patients with hip fractures, and those studies should consider both early death and the potential for later harms. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ola E. Dahl
- Centre of Medical Science, Education and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
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13
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Viberg B, Pedersen AB, Kjærsgaard A, Lauritsen J, Overgaard S. Risk of mortality and reoperation in hip fracture patients undergoing cemented versus uncemented hemiarthroplasty : a population-based study from Danish National Registries. Bone Joint J 2022; 104-B:127-133. [PMID: 34969285 DOI: 10.1302/0301-620x.104b1.bjj-2021-0523.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the association of mortality and reoperation when comparing cemented and uncemented hemiarthroplasty (HA) in hip fracture patients aged over 65 years. METHODS This was a population-based cohort study on hip fracture patients using prospectively gathered data from several national registries in Denmark from 2004 to 2015 with up to five years follow-up. The primary outcome was mortality and the secondary outcome was reoperation. Hazard ratios (HRs) for mortality and subdistributional hazard ratios (sHRs) for reoperations are shown with 95% confidence intervals (CIs). RESULTS A total of 17,671 patients with primary HA were identified (9,484 uncemented and 8,187 cemented HAs). Compared to uncemented HA, surgery with cemented HA was associated with an absolute risk difference of 0.4% for mortality within the period zero to one day after surgery and an adjusted HR of 1.70 (95% CI 1.22 to 2.38). After seven days, there was no longer any association, with an adjusted HR of 1.07 (95% CI 0.90 to 1.28). This continued until five years after surgery with a HR of 1.01 (95% CI 0.96 to 1.06). There was a higher proportion of reoperations due to any reason after five years in the uncemented group with 10.2% compared to the cemented group with 6.1%. This yielded an adjusted sHR of 0.65 (95% CI 0.57 to 0.75) and difference continued up until five years after the surgery, demonstrating a sHR of 0.70 (95% CI 0.59 to 0.83). CONCLUSION In a non-selected cohort of hip fracture patients, surgery with cemented HA was associated with a higher relative mortality during the first postoperative day compared to surgery with uncemented HA, but there was no difference after seven days up until five years after. In contrast, surgery with cemented HA was associated with lower risk of reoperation up to five years postoperatively compared with surgery with uncemented HA. There was a higher relative mortality on the first postoperative day for cemented HA versus uncemented HA. There was no difference in mortality after seven days up until five years after surgery. There were 6.1% reoperations for cemented HA compared to 10.2% for uncemented HA after five years. Cite this article: Bone Joint J 2022;104-B(1):127-133.
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Affiliation(s)
- Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Lauritsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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14
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Chen X, Zhang J, Zhang Y, Lin Y, Liu Z, Wang X, Sun T. Serum lactate concentration on admission to hospital predicts the postoperative mortality of elderly patients with hip fractures 30 days after surgery. Am J Transl Res 2021; 13:10363-10371. [PMID: 34650704 PMCID: PMC8507077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To determine whether serum lactate concentration on admission to hospital is a predictor for 30-day and 1-year mortality for patients who underwent hip-surgery. METHODS Data from elderly patients with hip fractures admitted to our hospital (Jan 2012-Dec 2016) were reviewed. The lactate concentration on admission was assessed using a cut-off value of 2.0 mmol/L and then a new cut-off value was determined by maximizing the Youden index. Multivariate logistic regression was employed to verify whether a higher lactate concentration compared with the cutoff value was an independent risk factor for postoperative mortality after 30 days or at 1 year. RESULTS A total of 1,004 patients were enrolled. There were differences in the incidence of postoperative complications (28.6% vs. 21.9%, P=0.022), length of stay (13.56±8.66 vs. 12.47±7.81 days, P=0.047), 30-day mortality (10.8% vs. 1.3%, P<0.001), 1-year mortality (23.3% vs. 11.8%, P<0.001) and survival time (23.92±16.58 vs. 28.81±16.54 months, P<0.001) between the ≥2.0 mmol/L (n=315) and <2 mmol/L (n=689) groups. Serum lactate concentration was a good predictor of 30-day mortality (AUC=0.829, P<0.001) with a cutoff value of lactate =2.35 mmol/L (sensitivity =0.744, specificity =0.834). Multivariate analysis revealed that a serum lactate concentration ≥2.35 mmol/L at admission was an independent risk factor for 30-day (OR=9.93, P<0.001) and 1-year (OR=2.23, P<0.001) mortality. CONCLUSION The admission lactate concentration (≥2.35 mmol/L) following hip fracture derived by this study was a significant predictor of mortality 30 days after surgery, which might help physicians to stratify the risk for these patients.
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Affiliation(s)
- Xiaobin Chen
- Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical UniversityBeijing 100730, China
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General HospitalBeijing 100700, China
| | - Jianzheng Zhang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General HospitalBeijing 100700, China
| | - Yang Zhang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General HospitalBeijing 100700, China
| | - Yiyun Lin
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General HospitalBeijing 100700, China
| | - Zhi Liu
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General HospitalBeijing 100700, China
| | - Xiaowei Wang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General HospitalBeijing 100700, China
| | - Tiansheng Sun
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General HospitalBeijing 100700, China
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15
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Xing W, Qiang H, Fuxing P. Letter to the Editor: 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; 16:515. [PMID: 34416897 PMCID: PMC8377880 DOI: 10.1186/s13018-021-02670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- Wang Xing
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
| | - Huang Qiang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Pei Fuxing
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
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16
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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: 1] [Impact Index Per Article: 0.3] [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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17
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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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18
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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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19
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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: 22] [Impact Index Per Article: 7.3] [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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20
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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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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: 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: 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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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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25
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"Cement Disease" in hip fracture patients - fact or fiction? Injury 2020; 51:2097-2098. [PMID: 32684308 DOI: 10.1016/j.injury.2020.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023]
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26
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Yu Y, Lu S, Xu J. Uncemented vs Cemented Hemiarthroplasty for Hip Fracture. JAMA 2020; 324:709-710. [PMID: 32808999 DOI: 10.1001/jama.2020.9061] [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] [Indexed: 11/14/2022]
Affiliation(s)
- Yang Yu
- Department of Orthopaedics, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Shitao Lu
- Department of Orthopaedics, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Jianzhong Xu
- Department of Orthopaedics, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
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27
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Duijnisveld BJ, Koenraadt KLM, van Steenbergen LN, Bolder SBT. Mortality and revision rate of cemented and uncemented hemiarthroplasty after hip fracture: an analysis of the Dutch Arthroplasty Register (LROI). Acta Orthop 2020; 91:408-413. [PMID: 32285730 PMCID: PMC8023919 DOI: 10.1080/17453674.2020.1752522] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Femoral neck fractures are commonly treated with cemented or uncemented hemiarthroplasties (HA). We evaluated differences in mortality and revision rates in this fragile patient group.Patients and methods - From January 1, 2007 until December 31, 2016, 22,356 HA procedures from the Dutch Arthroplasty Register (LROI) were included. For each HA, follow-up until death, revision, or end of follow-up (December 31, 2016) was determined. The crude revision rate was determined by competing risk analysis. Multivariable Cox regression analyses were performed to evaluate the effect of fixation method (cemented vs. uncemented) on death or revision. Age, sex, BMI, Orthopaedic Data Evaluation Panel (ODEP) rating, ASA grade, surgical approach, and previous surgery were included as potential confounders.Results - 1-year mortality rates did not differ between cemented and uncemented HA. 9-year mortality rates were 53% (95% CI 52-54) in cemented HA compared to 56% (CI 54-58) in uncemented HA. Multivariable Cox regression analysis showed similar mortality between cemented and uncemented HA (HR 1.0, CI 0.96-1.1). A statistically significantly lower 9-year revision rate of 3.1% (CI 2.7-3.6) in cemented HA compared with 5.1% (CI 4.2-6.2) in the uncemented HA was found with a lower hazard ratio for revision in cemented compared with uncemented HA (HR 0.56, CI 0.47-0.67).Interpretation - Long-term mortality rates did not differ between patients with a cemented or uncemented HA after an acute femoral neck fracture. Revision rates were lower in cemented compared with uncemented HA.
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Affiliation(s)
| | - Koen L M Koenraadt
- Foundation for Orthopaedic Research, Care and Education, Amphia Hospital, Breda
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register, Landelijke Registratie Orthopedische Implantaten (LROI), ‘s Hertogenbosch
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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Gupta A, Bansal H, Mittal S, Trikha V. Role Of Cemented Hemiarthroplasty For Unstable Intertrochanteric Fractures In Elderly Patients. Injury 2020; 51:1685. [PMID: 32467043 DOI: 10.1016/j.injury.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Anupam Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Hemant Bansal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Trikha
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
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Olsen F, Hård Af Segerstad M, Nellgård B, Houltz E, Ricksten SE. The role of bone cement for the development of intraoperative hypotension and hypoxia and its impact on mortality in hemiarthroplasty for femoral neck fractures. Acta Orthop 2020; 91:293-298. [PMID: 32237931 PMCID: PMC8023921 DOI: 10.1080/17453674.2020.1745510] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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 - The bone cement implantation syndrome characterized by hypotension and/or hypoxia is a well-known complication in cemented arthroplasty. We studied the incidence of hypotension and/or hypoxia in patients undergoing cemented or uncemented hemiarthroplasty for femoral neck fractures and evaluated whether bone cement was an independent risk factor for postoperative mortality.Patients and methods - In this retrospective cohort study, 1,095 patients from 2 hospitals undergoing hemiarthroplasty with (n = 986) and without (n = 109) bone cementation were included. Pre-, intra-, and postoperative data were obtained from electronic medical records. Each patient was classified for grade of hypotension and hypoxia during and after prosthesis insertion according to Donaldson's criteria (Grade 1, 2, 3). After adjustments for confounders, the hazard ratio (HR) for the use of bone cement on 1-year mortality was assessed.Results - The incidence of hypoxia and/or hypotension was higher in the cemented (28%) compared with the uncemented group (17%) (p = 0.003). The incidence of severe hypotension/hypoxia (grade 2 or 3) was 6.9% in the cemented, but not observed in the uncemented group. The use of bone cement was an independent risk factor for 1-year mortality (HR 1.9, 95% CI 1.3-2.7), when adjusted for confounders.Interpretation - The use of bone cement in hemiarthroplasty for femoral neck fractures increases the incidence of intraoperative hypoxia and/or hypotension and is an independent risk factor for postoperative 1-year mortality. Efforts should be made to identify patients at risk for BCIS and alternative strategies for the management of these patients should be considered.
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Affiliation(s)
- Fredrik Olsen
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mathias Hård Af Segerstad
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Houltz
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden,Correspondence:
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Reply to the Letter to the Editor: Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register. Clin Orthop Relat Res 2020; 478:687-689. [PMID: 32011373 PMCID: PMC7145057 DOI: 10.1097/corr.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Choi JT, Foster BD, Soraya Heidari K, Carney JJ, Hatch GF, Marecek GS. Effect of bariatric surgery on outcomes in the operative treatment of hip fractures. Injury 2020; 51:688-693. [PMID: 32033806 DOI: 10.1016/j.injury.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/26/2019] [Accepted: 01/19/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Few studies have evaluated the effect of prior bariatric surgery on outcomes following the operative treatment of hip fractures. The purpose of this study is to evaluate these metrics in a population of bariatric surgery patients compared to a control group who were operatively treated for hip fractures. MATERIALS AND METHODS The California Office of Statewide Health Planning & Development (OSHPD) discharge database was accessed to identify patients who sustained a hip fracture between 2000-2014. CPT codes were utilized to identify patients who had a prior history of bariatric surgery within this time period. A control cohort of patients who had undergone previous appendectomy were queried similarly. The study evaluated complication rates and inpatient mortality at 30- and 90-days postoperatively as well as 30- and 90-day readmission rates. RESULTS There were 1,327 bariatric and 2,127 control patients identified. Survival rates were significantly lower in bariatric patients compared to controls (87.2% vs. 91.8%, p = 0.048) at 5 years. After controlling for confounders, bariatric patients had higher 30- (OR 1.46, p = 0.005) and 90-day (OR 1.38, p = 0.011) readmission rates. There were no differences in all-cause complication and inpatient mortality rates between groups at 30 or 90 days. DISCUSSION Bariatric surgery patients are at increased risk of readmission after hip fracture surgery. Further research is warranted to delineate potential risk factors and mitigate readmission in these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jihoon T Choi
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1200N. State St. GNH 3900, Los Angeles, CA 90033, United States.
| | - Brock D Foster
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1200N. State St. GNH 3900, Los Angeles, CA 90033, United States
| | - K Soraya Heidari
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1200N. State St. GNH 3900, Los Angeles, CA 90033, United States
| | - John J Carney
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1200N. State St. GNH 3900, Los Angeles, CA 90033, United States
| | - George F Hatch
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1200N. State St. GNH 3900, Los Angeles, CA 90033, United States
| | - Geoffrey S Marecek
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1200N. State St. GNH 3900, Los Angeles, CA 90033, United States
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Letter to the Editor: Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register. Clin Orthop Relat Res 2020; 478:685-686. [PMID: 32011377 PMCID: PMC7145078 DOI: 10.1097/corr.0000000000001122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Li N, Zhong L, Wang C, Xu M, Li W. Cemented versus uncemented hemi-arthroplasty for femoral neck fractures in elderly patients: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19039. [PMID: 32080078 PMCID: PMC7034642 DOI: 10.1097/md.0000000000019039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIM To compare the efficacy and safety of cemented and uncemented hemiarthroplasty in elderly patients with femoral neck fracture. MATERIALS AND METHODS We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with uncemented hemiarthroplasty in elderly patients with a femoral neck fracture. The search was not limited to language, time, or other factors. The quality of each study was assessed using the revised Jadad scale. Two researchers independently extracted data from all selected studies, including the following base line data: study period, fracture stage, number of patients, male female ratio, average age, and per-protocol (PP) or intent-to-treat (ITT), and the interest outcomes: the mortality at 12 months, operative time, hospital stay, common complications, prosthetic-related complications, blood loss and Harris Hip Score (HHS). Fixed-effects or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine heterogeneity of the included studies. RESULTS A total of 8 studies involving 1577 hips (782 uncemented and 795 cemented) were included in this meta-analysis. The meta-analysis is indicated that the operation time of cemented hemiarthroplasty was longer than uncemented hemiarthroplasty and there was statistical significance between two groups (OR = -7.30, 95%CI, -13.13, -1.46; P = .01). However, there was no significant difference between the two methods of fixation in mortality at 12 months (OR = 1.22, 95%CI, 0.94-1.59; P = .14), hospital stay (OR = 0.26, 95%CI, -0.41, 0.93; P = .44), blood loss (OR = -17.94, 95%CI, -65.83, 29.95; P = .46), and HHS score. There were significant differences in the common complications of pulmonary embolism between the two groups, but there were no differences in the other five common complications. The results showed that uncemented hemiarthroplasty could reduce the incidence of pulmonary embolism after operation. Moreover, the outcomes of prosthetic-related complications showed that there were significant differences between the two groups in periprosthetic fracture (OR = 8.32, 95%CI, 3.85-17.98; P < .00001) and prosthetic subsidence and loosening (OR = 5.33, 95%CI, 2.18-13.00; P = .0002). CONCLUSIONS Our study shows that uncemented prosthesis can shorten the operation time and reduce the incidence of pulmonary embolism, but it does not reduce mortality, blood loss, and hospital stay. Most importantly, the incidence of prosthetic-related complications was higher in uncemented patients.
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Affiliation(s)
- Na Li
- Department of Orthopedics, The Second Hospital of Jilin University
- Center for Applied Statistical Research and College of Mathematics, Jilin University
| | - Lei Zhong
- Department of Orthopedics, The Second Hospital of Jilin University
| | - Chang Wang
- Center for Applied Statistical Research and College of Mathematics, Jilin University
| | - Meng Xu
- Department of Orthopedics, The Second Hospital of Jilin University
| | - Wei Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin, China
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Abstract
BACKGROUND A displaced femoral neck fracture in patients older than 70 years is a serious injury that influences the patient's quality of life and can cause serious complications or death. Previous national guidelines and a Cochrane review have recommended cemented fixation for arthroplasty to treat hip fractures in older patients, but data suggest that these guidelines are inconsistently followed in many parts of the world; the effects of that must be better characterized. QUESTIONS/PURPOSES The purpose of this study was to evaluate a large group of patients in the Norwegian Hip Fracture Register to investigate whether the fixation method in hemiarthroplasty is associated with (1) the risk of reoperation; (2) the mortality rate; and (3) patient-reported outcome measures (PROMs). METHODS Longitudinally maintained registry data from the Norwegian Hip Fracture Register with high completeness (93%) and near 100% followup of deaths were used for this report. From 2005 to 2017, 104,993 hip fractures were registered in the Norwegian Hip Fracture Register. Fractures other than intracapsular femoral neck fractures and operative methods other than bipolar hemiarthroplasty, such as osteosynthesis or THA, were excluded. The selection bias risk on using cemented or uncemented hemiarthroplasty is small in Norway because the decision is usually regulated by tender processes at each hospital and not by surgeon. A total of 7539 uncemented hemiarthroplasties (70% women, mean age, 84 years [SD 6] years) and 22,639 cemented hemiarthroplasties (72% women, mean age, 84 years [SD 6] years) were eligible for analysis. Hazard risk ratio (HRR) on reoperation and mortality was calculated in a Cox regression model adjusted for age, sex, comorbidities (according to the American Society of Anesthesiologists classification), cognitive function, surgical approach, and duration of surgery. At 12 months postoperatively, 65% of patients answered questionnaires regarding pain and quality of life, the results of which were compared between the fixation groups. RESULTS A higher overall risk of reoperation for any reason was found after uncemented hemiarthroplasty (HRR, 1.5; 95% CI, 1.4-1.7; p < 0.001) than after cemented hemiarthroplasty. When assessing reoperations for specific causes, higher risks of reoperation because of periprosthetic fracture (HRR, 5.1; 95% CI, 3.5-7.5; p < 0.001) and infection (HRR, 1.2; 95% CI, 1.0-1.5; p = 0.037) were found for uncemented hemiarthroplasty than for cemented procedures. No differences were found in the overall mortality rate after 1 year (HRR, 1.0; 95% CI, 0.9-1.0; p = 0.12). Hemiarthroplasty fixation type was not associated with differences in patients' pain (19 versus 20 for uncemented and cemented hemiarthroplasties respectively, p = 0.052) or quality of life (EuroQol [EQ]-VAS score 64 versus 64, p = 0.43, EQ5D index score 0.64 versus 0.63, p = 0.061) 1 year after surgery. CONCLUSIONS Our study found that the fixation method was not associated with differences in pain, quality of life, or the 1-year mortality rate after hemiarthroplasty. Uncemented hemiarthroplasties should not be used when treating elderly patients with hip fractures because there is an increased reoperation risk.Level of Evidence Level III, therapeutic study.
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Movrin I. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: A randomized controlled trial with two years follow-up. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:83-88. [PMID: 32175901 DOI: 10.5152/j.aott.2020.01.432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this prospective randomized trial was to compare cemented (CHA) and uncemented bipolar hemiarthroplasty (UCH) in patients with femoral neck fractures (FNF). METHODS The study included 158 patients aged ≥76 years who underwent bipolar HA for displaced FNF. Patients were randomized in two groups: the cemented group (CHA, n=79) was treated with cement and the uncemented group (UCH, n=79) without cement. The groups were compared for operating time, blood loss and peroperative morbidity and mortality rates. RESULTS Both the CHA and the UCH group did not differ significantly in terms of age (86±5 vs. 84±4 years), sex (58.3% male vs. 60.7% female), and comorbidities (p=0.49). The CHA group had a significantly longer operating time (p=0.038) and a greater intraoperative blood loss (p=0.024). In the CHA group there were 8 (10.1%) events of intraoperative drop in the oxygen saturation (SaO2), whereas no such events were noted in the UCH group (p=0.009). Despite no significant difference between these two groups, we found that the CHA group was associated with a higher early postoperative mortality (8.8% in the CHA group versus 3.8% in the UCH group, p=0.009). Intraoperative fracture occurred in two patients (2.5%) of the UCH group. Over a 2-year follow-up period there were no significant differences between the groups regarding the rate of dislocation (p=0.56) or rate of postoperative periprosthetic fracture (p=0.56). There was a trend towards a better postoperative functional recovery at 6 week for the CHA group (77.1±13.1 versus 71.3±16.3), although the mean Harris Hip Score (HHS) at the end of 2 years was comparable (p=0.55). CONCLUSION Both CHA and UCH are acceptable methods for treating displaced femoral neck fractures. However, based on our results perioperative cardiovascular disturbances are less frequent and resulting in a potential lower early mortality with UCH. Therefore, UCH is particularly appropriate for elderly patients with pre-existing cardiovascular comorbidities. LEVEL OF EVIDENCE Level II, Randomized Controlled Trial.
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Affiliation(s)
- Igor Movrin
- Department of Traumatology, University Medical Centre Maribor, Maribor, Slovenia
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Tsai MC, Ng YY, Chen WM, Tsai SW, Wu SC. The effects of cement fixation on survival in elderly patients with hip hemiarthroplasty: a nationwide cohort study. BMC Musculoskelet Disord 2019; 20:628. [PMID: 31881878 PMCID: PMC6935190 DOI: 10.1186/s12891-019-3013-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip hemiarthroplasty (HHA) is a common treatment for hip fractures in the elderly population. Because of the fatal effects of bone cement implantation syndrome, the safety of cement utilization to enhance implant firmness in the femur is controversial. The aim of this study was to investigate the postoperative survival of elderly patients receiving HHA with and without cement fixation. METHODS Claim data from the National Health Insurance Database and the National Register of Deaths Database were used for analysis in this retrospective cohort study. From 2008 to 2014, 25,862 patients aged 80 years or older treated with hip hemiarthroplasty were included in the analysis. A Cox proportional risk model was used to analyse the effects of cement utilization on postoperative mortality. RESULTS The cemented group had a significantly higher mortality risk than the non-cemented group within 7, 30, 180 days and 1 year after the operation. The effect of bone cement on postoperative mortality was significantly stronger within 7 days than within 30, 180 days and 1 year. In addition, the male gender, age > 85 years and higher score on the Charlson Comorbidity Index were also risk factors for mortality (p < 0.05). Patients who received HHA in lower-volume hospitals had higher mortality rates within 180 days and 1 year than those in higher-volume hospitals. Compared with patients who were operated on by high-volume surgeons, those who received surgery performed by lower-volume surgeons were more likely to die within 30 days (aHR = 1.22), 180 days (aHR = 1.16) and 1 year (aHR = 1.19), respectively. CONCLUSIONS The postoperative mortality rate of elderly patients undergoing HHA was significantly higher in the cemented group than in the non-cemented group.
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Affiliation(s)
- Ming-Che Tsai
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yee-Yung Ng
- Department of Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan, Republic of China.
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Dale H, Børsheim S, Kristensen TB, Fenstad AM, Gjertsen JE, Hallan G, Lie SA, Furnes O. Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the -Norwegian Arthroplasty Register. Acta Orthop 2019; 91:152-158. [PMID: 31833434 PMCID: PMC7155214 DOI: 10.1080/17453674.2019.1701312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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 - There are reports on perioperative deaths in cemented total hip arthroplasty (THA), and THA revisions are associated with increased mortality. We compared perioperative (intraoperatively or within 3 days of surgery), short-term and long-term mortality after all-cemented, all-uncemented, reverse hybrid (cemented cup and uncemented stem), and hybrid (uncemented cup and cemented stem) THAs.Patients and methods - We studied THA patients in the Norwegian Arthroplasty Register from 2005 to 2018, and performed Kaplan-Meier and Cox survival analyses with time of death as end-point. Mortality was calculated for all patients, and in 3 defined risk groups: high-risk patients (age ≥ 75 years and ASA > 2), intermediate-risk patients (age ≥ 75 years or ASA > 2), low-risk patients (age < 75 years and ASA ≤ 2). We also calculated mortality in patients with THA due to a hip fracture, and in patients with commonly used, contemporary, well-documented THAs. Adjustement was made for age, sex, ASA class, indication, and year of surgery.Results - Among the 79,557 included primary THA patients, 11,693 (15%) died after 5.8 (0-14) years' follow-up. Perioperative deaths were rare (30/105) and found in all fixation groups. Perioperative mortality after THA was 4/105 in low-risk patients, 34/105 in intermediate-risk patients, and 190/105 in high-risk patients. High-risk patients had 9 (CI 1.3-58) times adjusted risk of perioperative death compared with low-risk patients. All 4 modes of fixation had similar adjusted 3-day, 30-day, 90-day, 3-30 day, 30-90 day, 90-day-10-year, and 10-year mortality risk.Interpretation - Perioperative, short-term, and long-term mortality after primary THA were similar, regardless of fixation type. Perioperative deaths were rare and associated with age and comorbidity, and not type of fixation.
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Affiliation(s)
- Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen; ,Correspondence:
| | | | - Torbjørn Berge Kristensen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
| | - Stein Atle Lie
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
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Dahl OE, Borris LC. Thromboembolism in major joint prosthetic surgery: False or fact. J Thromb Haemost 2019; 17:1623-1625. [PMID: 31571417 DOI: 10.1111/jth.14577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ola E Dahl
- Medical Science and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Lars C Borris
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Leer-Salvesen S, Engesæter LB, Dybvik E, Furnes O, Kristensen TB, Gjertsen JE. Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register. Bone Joint J 2019; 101-B:1129-1137. [PMID: 31474142 DOI: 10.1302/0301-620x.101b9.bjj-2019-0295.r1] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). PATIENTS AND METHODS A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. RESULTS Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. CONCLUSION Hospitals should operate on patients within 48 hours after fracture to reduce mortality and intraoperative complications. Cite this article: Bone Joint J 2019;101-B:1129-1137.
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Affiliation(s)
| | - Lars B Engesæter
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Eva Dybvik
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn B Kristensen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Müller F, Galler M, Zellner M, Bäuml C, Grechenig S, Kottmann T, Füchtmeier B. Total Hip Arthroplasty for Hip Fractures: Time to Surgery With Respect to Surgical Revision, Failure, and Mortality. Geriatr Orthop Surg Rehabil 2019; 10:2151459318818162. [PMID: 30643663 PMCID: PMC6322097 DOI: 10.1177/2151459318818162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/23/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction There are increasing demands to perform surgery of hip fractures without delay. However, few studies have assessed the time to surgery in relation to outcome measurements. Methods A total of 643 consecutive patients with a minimum age of 60 years underwent total hip arthroplasty (THA) for an intracapsular hip fracture. For this retrospective case series, demographic data and the outcome measurements-(1) any surgical revision, (2) implant failure, and (3) mortality-were documented from a prospective clinical database. The time from admission to surgery was also documented prospectively and then data were divided into 4 groups according to the time of surgery: (1) within 12 hours, (2) >12 to 24 hours, (3) >24 to 48 hours, and (4) later than >48 hours. The study end point was 2 years after surgery. Final evaluation was conducted for any missing data through a telephone interview. Results The patients comprised 456 women (70.9%) and 187 men (29.1%) with a mean age of 80.2 years (range 60-104 years; standard deviation ±7.4). Descriptive data were without effect in all 4 groups. Time to surgery did not significantly influence revision for any reason (P = .323), implant failure (P = .521), and mortality (P = .643). Cox regression analysis identified male sex (P < .001; 95% confidence interval (CI), 1.27-2.44), American Society of Anesthesiologists score ≥3 (P < .001; 95% CI, 2.12-21.59), C-reactive protein level >21 mg/L (P < .018; 95% CI, 1.09-2.60), hemoglobin level <12.0 g/dL (P = .033; 95% CI, 1.04-2.68), and dementia (P < .000; 95% CI, 1.50-2.86) as independent significant risk factors for mortality. Conclusion Time to surgery had no effect on revision for any reason, implant failure, and mortality in patients undergoing THA for an intracapsular hip fracture.
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Affiliation(s)
- Franz Müller
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
- Franz Müller, Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str 86, Regensburg 93049, Germany.
| | - Michael Galler
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Michael Zellner
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Christian Bäuml
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Stephan Grechenig
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
| | | | - Bernd Füchtmeier
- Clinic for Trauma, Orthopaedic and Sports Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
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Leer-Salvesen S, Dybvik E, Engesaeter LB, Dahl OE, Gjertsen JE. Low-molecular-weight heparin for hip fracture patients treated with osteosynthesis: should thromboprophylaxis start before or after surgery? An observational study of 45,913 hip fractures reported to the Norwegian Hip Fracture Register. Acta Orthop 2018; 89:615-621. [PMID: 30328746 PMCID: PMC6300732 DOI: 10.1080/17453674.2018.1519101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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 - Controversies exist regarding thromboprophylaxis in orthopedic surgery. We studied whether the thromboprophylaxis in hip fracture patients treated with osteosynthesis should start preoperatively or postoperatively. Data were extracted from the nationwide Norwegian Hip Fracture Register (NHFR). The risks of postoperative deaths, reoperations, and intraoperative bleeding were studied within 6 months after surgery. Patients and methods - After each operation for hip fracture in Norway the surgeon reports information on the patient, the fracture, and the operation to the NHFR. Cox regression analyses were performed with adjustments for age group, ASA score, sex, duration of surgery, and year of surgery. During the period 2005-2016, 96,599 hip fractures were reported to the register. Only osteosyntheses where low-molecular-weight heparin (LMWH) were given and with known information on preoperative start of the prophylaxis were included in the analyses. Dalteparin and enoxaparin were used in 58% and 42% of the operations respectively (n = 45,913). Results - Mortality (RR =1.01, 95% CI 0.97-1.06) and risk of reoperation (RR =0.99, CI 0.90-1.08) were similar comparing preoperative and postoperative start of LMWH. Postoperative start reduced the risk of intraoperative bleeding complications compared with preoperative start (RR =0.67, CI 0.51-0.90). Interpretation - The initiation of LMWH did not influence the mortality or the risk of reoperation in hip fracture patients treated with osteosynthesis. Postoperative start of LMWH could possibly decrease the risk of intraoperative bleeding.
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Affiliation(s)
- Sunniva Leer-Salvesen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; ,Correspondence:
| | - Eva Dybvik
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Lars B Engesaeter
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; ,Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Ola E Dahl
- Innlandet Hospital Trust, Elverum, Norway; ,Thrombosis Research Institute, London, UK
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; ,Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
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Chiu HC, Chen CM, Su TY, Chen CH, Hsieh HM, Hsieh CP, Shen DL. Dementia predicted one-year mortality for patients with first hip fracture: a population-based study. Bone Joint J 2018; 100-B:1220-1226. [PMID: 30168771 DOI: 10.1302/0301-620x.100b9.bjj-2017-1342.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We aimed to determine the effect of dementia and Parkinson's disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population. Patients and Methods Using a random sample of patients taken from the Taiwan National Health Insurance Research Database, this retrospective cohort study analyzed the data on 6626 elderly patients who sustained a fracture of the hip between 1997 and 2012 who had ICD-9 codes within the general range of hip fracture (820.xx). We used Cox regression to estimate the risk of death associated with dementia, Parkinson's disease or both, adjusting for demographic, clinical, treatment, and provider factors. Results Among 6626 hip fracture patients, 10.20% had dementia alone, 5.60% had Parkinson's disease alone, and 2.67% had both. Corresponding one-year mortality rates were 15.53%, 11.59%, and 15.82%, compared with 9.22% for those without neurological illness. Adjusted hazard ratio for one-year mortality was 1.45 (95% confidence intervals (CI) 1.17 to 1.79) for those with dementia, and 1.57 (95% CI 1.07 to 2.30) with both dementia and Parkinson's disease versus patients with neither. There was no significant association with death for Parkinson's disease alone. Age, male gender and comorbidities were also associated with a higher risk of mortality. Conclusion Dementia, with or without Parkinson's disease, is an independent predictor of mortality following surgery for fractures of the hip. Age, male gender and comorbidities also increase the risk of death. Parkinson's disease alone has no significant effect. Cite this article: Bone Joint J 2018;100-B:1220-6.
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Affiliation(s)
- H-C Chiu
- Research Education and Epidemiology Centre, Changhua Christian Hospital, Changhua, Taiwan, Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, Institute of Hospital Management, Tsinghua University, China, and Department of Health Policy and Management, Bloomberg School of Public Health, John Hopkins University, USA
| | - C-M Chen
- Research Education and Epidemiology Centre, Changhua Christian Hospital, Changhua, Taiwan
| | - T-Y Su
- Center of Cancer Program Development, E-DA Cancer Hospital, Kaohsiung, Taiwan
| | - C-H Chen
- Orthopedic Research Centre, Kaohsiung Medical University; Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H-M Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C-P Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - D-L Shen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
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Fisher A, Fisher L, Srikusalanukul W, Smith PN. Usefulness of simple biomarkers at admission as independent indicators and predictors of in-hospital mortality in older hip fracture patients. Injury 2018; 49:829-840. [PMID: 29559183 DOI: 10.1016/j.injury.2018.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The data on predictive value of the routinely obtained preoperative biochemical parameters in hip fracture (HF) patients are limited. The aims of this study were to examine in older HF patients (1) the relationships between a broad set of routine laboratory parameters at admission and in-hospital mortality, and (2) evaluate the prognostic value the biomarkers and clinical characteristics (alone or in combination) provide to predict a fatal outcome. PATIENTS AND METHODS In 1820 consecutive patients with low-trauma osteoporotic HF aged >60 years (mean age 82.8 ± 8.1 years; 76.4% women; 65% community-dwelling) 35 laboratory variables along with 20 clinical and socio-demographic characteristics at admission were analysed. The validation cohort included data on 455 older (≥60 years of age) HF patients (mean age 82.1 ± 8.0 years, 72.1% women). RESULTS The mortality rate was 6% (n = 109). On univariate analysis 14 laboratory and 8 clinical parameters have been associated with in-hospital mortality. Multiple regression analyses determined 7 variables at admission as independent indicators of a fatal outcome: 4 biomarkers (albumin <33 g/L; alanine aminotransferase/gamma-glutamyl transferase ratio [GGT/ALT] >2.5; parathyroid hormone [PTH] >6.8 pmol/L; 25(OH)vitamin D < 25 nmol/L) and 3 pre-fracture clinical conditions (history of myocardial infarction, chronic kidney disease [GFR <60 ml/min/1.73 m2] and chronic obstructive pulmonary disease); the area under the receiver operating characteristic curve (AUC) was 0.75 (95%CI 0.70-0.80). The risk of in-hospital death was 1.6-2.6 times higher in subjects with any of these risk factors (RFs), and increased by 2.6-6.0-fold in patients with any two RFs (versus no RFs). The mortality rate increased stepwise as the number of RFs increased (from 0.43% -none RF to 16.8%- ≥4RF). The prognostic value of a single RF was low (AUC ≤0.635) but combination of 2 or more RFs improved the prediction significantly; AUC reached 0.84(95%CI 0.77-0.90) when ≥4 RFs (versus 0-1RF) were present. In the validated and main cohorts the number of predicted by 1, 2, 3 or ≥4 RFs and observed deaths were practically similar. CONCLUSIONS In HF patients, seven easily identifiable at admission characteristics, including 4 biomarkers, are strong and independent indicators of in-hospital mortality and can be used for risk stratification and individualised management.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra, Australia; Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra, Australia; Australian National University Medical School, Canberra, ACT, Australia.
| | - Leon Fisher
- Frankston Hospital, Peninsula Health, Melbourne, Australia
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra, Australia
| | - Paul N Smith
- Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra, Australia; Australian National University Medical School, Canberra, ACT, Australia
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Sheehan KJ, Sobolev B, Guy P. Mortality by Timing of Hip Fracture Surgery: Factors and Relationships at Play. J Bone Joint Surg Am 2017; 99:e106. [PMID: 29040134 DOI: 10.2106/jbjs.17.00069] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In hip fracture care, it is disputed whether mortality worsens when surgery is delayed. This knowledge gap matters when hospital managers seek to justify resource allocation for prioritizing access to one procedure over another. Uncertainty over the surgical timing-death association leads to either surgical prioritization without benefit or the underuse of expedited surgery when it could save lives. The discrepancy in previous findings results in part from differences between patients who happened to undergo surgery at different times. Such differences may produce the statistical association between surgical timing and death in the absence of a causal relationship. Previous observational studies attempted to adjust for structure, process, and patient factors that contribute to death, but not for relationships between structure and process factors, or between patient and process factors. In this article, we (1) summarize what is known about the factors that influence, directly or indirectly, both the timing of surgery and the occurrence of death; (2) construct a dependency graph of relationships among these factors based explicitly on the existing literature; (3) consider factors with a potential to induce covariation of time to surgery and the occurrence of death, directly or through the network of relationships, thereby explaining a putative surgical timing-death association; and (4) show how age, sex, dependent living, fracture type, hospital type, surgery type, and calendar period can influence both time to surgery and occurrence of death through chains of dependencies. We conclude by discussing how these results can inform the allocation of surgical capacity to prevent the avoidable adverse consequences of delaying hip fracture surgery.
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Affiliation(s)
- Katie Jane Sheehan
- 1Department of Physiotherapy, Division of Health and Social Care Research, Kings College London, London, United Kingdom 2School of Population and Public Health (B.S.) and Centre for Hip Health and Mobility (P.G.), University of British Columbia, Vancouver, British Columbia, Canada
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Baig MN, Curtin W, Callaghan MA, Murphy CG. Catastrophic cement reaction following cementation for megaprosthesis for proximal femoral fracture. BMJ Case Rep 2017; 2017:bcr-2017-220158. [PMID: 28942397 DOI: 10.1136/bcr-2017-220158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bone cement implantation syndrome (BCIS) is a well-described and potentially fatal complication of orthopaedic surgery involving pressurised bone cement. Although also described for certain spinal procedures, it is most commonly associated with cemented hip and knee arthroplasty and with cemented hemiarthroplasty following neck of femur fracture in particular.Donaldson et alproposed the definition of BCIS as a syndrome "characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery". Other features include increased vascular resistance, cardiac arrhythmias and cardiac arrest post cement use.We describe a case of a patient who suffered a catastrophic reaction to cement during surgery for a comminuted proximal femoral fracture.
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Affiliation(s)
- Muhammad Nouman Baig
- Department of Trauma and Orthopaedics, Galway University Hospital, Galway, Ireland
| | - William Curtin
- Department of Trauma and Orthopaedics, Galway University Hospital, Galway, Ireland
| | | | - Colin G Murphy
- Department of Trauma and Orthopaedics, Galway University Hospital, Galway, Ireland
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Yoon BH, Seo JG, Koo KH. Comparison of Postoperative Infection-Related Complications between Cemented and Cementless Hemiarthroplasty in Elderly Patients: A Meta-Analysis. Clin Orthop Surg 2017; 9:145-152. [PMID: 28567215 PMCID: PMC5435651 DOI: 10.4055/cios.2017.9.2.145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this review was to assess the risk of infection-related complications following cemented and cementless hemiarthroplasty in elderly patients. Methods We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with cementless hemiarthroplasty in patients with a femoral neck fracture and more than 65 years of age. Eight randomized controlled trials were available for analysis. A meta-analysis (with a fixed-effects model) and a meta-regression analysis (with continuous variables) were performed. Results The 8 trials included 1,204 hips (608 cemented and 596 cementless). There was no significant difference between the cemented and cementless groups regarding the incidence of deep infection, superficial infection, pneumonia, and urinary tract infection. The overall incidence of postoperative deep infection was 2.3% (14/608) in the cemented group and 1.2% (7/596) in the cementless group (relative risk, 1.74; 95% confidence interval, 0.74 to 4.14; I2 = 0%; p = 0.206). No publication bias was found in the funnel plot. Conclusions Results of our meta-analysis suggest that when selecting a fixation method for hemiarthroplasty, infection-related postoperative complications are not the determinant factor to consider.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Gook Seo
- Department of Orthopaedic Surgery, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Moerman S, Mathijssen NMC, Niesten DD, Riedijk R, Rijnberg WJ, Koëter S, Kremers van de Hei K, Tuinebreijer WE, Molenaar TL, Nelissen RGHH, Vochteloo AJH. More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up. BMC Musculoskelet Disord 2017; 18:169. [PMID: 28431543 PMCID: PMC5399836 DOI: 10.1186/s12891-017-1526-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/07/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND It is unclear whether cemented or uncemented hemiarthroplasty is the best treatment option in elderly patients with displaced femoral neck fractures. Previous randomized trials comparing cemented and uncemented hemiarthroplasty have conflicting results. We conducted a randomized controlled trial to compare cemented and uncemented hemiarthroplasty. METHODS This multicenter parallel-randomized controlled trial included patients of 70 years and older with a displaced femoral neck fracture (Garden type III or IV). Inclusion was between August 2008 and June 2012. Patients were randomized between a cemented hemiarthroplasty, type Müller Straight Stem or an uncemented hemiarthroplasty, type DB-10. Primary outcomes were complications, operation time, functional outcome (measured by Timed-Up-and-Go (TUG) and Groningen Activity Restriction Scale (GARS)) and mid-thigh pain. Health Related Quality of Life (HRQoL, expressed with the SF-12) was measured as an secondary outcome. Follow up was 1 year. RESULTS In total 201 patients were included in the study (91 uncemented, 110 cemented hemiarthroplasties) The uncemented group showed more major local complications (intra- and postoperative fractures and dislocations) odds ratio (95% confidence interval) 3.36 (1.40 to 8.11). There was no difference in mean operation time (57.3 vs 55.4 min). There were no differences in functional outcomes (TUG 12.8 (9.4) vs. 13.9 (9.0), GARS 43.2 (19.7) vs. 39.2 (16.5)) and mid-thigh pain (18.6 vs 21.6%). Physical component SF-12 HRQoLwas lower in the uncemented group (30.3 vs. 35.3 p < 0.05 after six weeks, 33.8 vs 38.5 p < 0.05 after 12 weeks). CONCLUSION A cemented hemiarthroplasty in elderly patients with a displaced femoral neck fracture results in less complications compared to an uncemented hemiarthroplasty. TRIAL REGISTRATION Netherlands Trial Registry; NTR 1508 , accepted date 27 okt 2008.
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Affiliation(s)
- Sophie Moerman
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands.
| | - Nina M C Mathijssen
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - Dieu D Niesten
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | | | | | - Sander Koëter
- Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Wim E Tuinebreijer
- Department of Surgery/Traumatology, Erasmus MC, Rotterdam, The Netherlands
| | - Tim L Molenaar
- Department of Orthopaedics, Reinier de Graaf Group, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
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Nawaz SZ, Keightley AJ, Desai A, Granville-Chapman J, Elliott D, Newman K, Khaleel A. Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties. Injury 2017; 48:909-913. [PMID: 28259379 DOI: 10.1016/j.injury.2016.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/16/2016] [Indexed: 02/02/2023]
Abstract
A Cochrane review influenced new NICE guidelines, which recommended surgeons: Offer cemented implants to patients undergoing surgery with arthroplasty. However our trust routinely uses HAC uncemented stem (Taperloc®, Biomet) hemiarthroplasties. A review of a consecutive series of uncemented HAC stem hemiarthroplasties including measures such as intro-operative complications, mortality and revision surgery. Prospectively collected data between January 2008 and June 2014 was used, with medical record and radiographic reviews performed. 810 consecutive Taperloc uncemented hemiarthroplasty with monopolar heads were performed in 763 patients, with a minimum 12 month follow-up (12-90) follow-up. Mean age 83yrs; 71% female. Meantime to operation was 28.5h. 30day mortality: 4.4% (33/763). One year mortality was 11.2% (89/763). 2.5% (20/810) were admitted on a separate admission with the periprosthetic fracture. 0.6% (5/810) were revised to total hip replacement for subsidence and associated pain. Only 1% (8/810) had intraoperative calcar fractures, all of which were treated with intraoperative cabling with no evidence of clinically relevant subsidence or medium term complications requiring revision surgery within a year. To the author's knowledge this is largest outcome series for modern design uncemented hemiarthroplasty. Our study shows comparable data to cemented hemiarthroplasty but no deaths in the first 2days post-op. Our series also demonstrates a well below average mortality figures which are clearly multifactorial but believe uncemented prosthesis play a role. We believe that uncemented proven stem design hemiarthroplasty remains a safe and good surgical option for displaced intracapsular fractures.
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Affiliation(s)
- S Z Nawaz
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
| | - A J Keightley
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - A Desai
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - J Granville-Chapman
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - D Elliott
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - K Newman
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - A Khaleel
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
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Leer-Salvesen S, Dybvik E, Dahl OE, Gjertsen JE, EngesæTer LB. Postoperative start compared to preoperative start of low-molecular-weight heparin increases mortality in patients with femoral neck fractures. Acta Orthop 2017; 88:48-54. [PMID: 27658532 PMCID: PMC5251264 DOI: 10.1080/17453674.2016.1235427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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 - Controversies exist regarding thromboprophylaxis in orthopedic surgery. Using data in the nationwide Norwegian Hip Fracture Register (NHFR) with postoperative death and reoperation in the first 6 months after surgery as endpoints in the analyses, we determined whether the thromboprophylaxis in patients who undergo hemiarthroplasty for femoral neck fracture should start preoperatively or postoperatively. Patients and methods - After each operation for hip fracture in Norway, the surgeon reports information on the patient, the fracture, and the operation to the NHFR. Cox regression analyses were performed with adjustments for age, ASA score, gender, type of implant, length of surgery, and year of surgery. Results - During the period 2005-2014, 25,019 hemiarthroplasties as treatment for femoral neck fractures were reported to the registry. Antithrombotic medication was given to 99% of the patients. Low-molecular-weight heparin predominated with dalteparin in 57% of the operations and enoxaparin in 41%. Only operations with these 2 drugs and with known information on preoperative or postoperative start of the prophylaxis were included in the analyses (n = 20,241). Compared to preoperative start of thromboprophylaxis, postoperative start of thromboprophylaxis gave a higher risk of death (risk ratio (RR) = 1.13, 95% CI: 1.06-1.21; p < 0.001) and a higher risk of reoperation for any reason (RR =1.19, 95% CI: 1.01-1.40; p = 0.04), whereas we found no effect on reported intraoperative bleeding complication or on the risk of postoperative reoperation due to hematoma. The results did not depend on whether the initial dose of prophylaxis was the full dosage or half of the standard dosage. Interpretation - Postoperative start of thromboprophylaxis increased the mortality and risk of reoperation compared to preoperative start in femoral neck fracture patients operated with hemiprosthesis. The risks of bleeding and of reoperation due to hematoma were similar in patients who received low-molecular-weight heparin preoperatively and in those who received it postoperatively.
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Affiliation(s)
| | - Eva Dybvik
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ola E Dahl
- Innlandet Hospital Trust, Elverum, Norway,Thrombosis Research Institute, London, United Kingdom
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine, University of Bergen, Bergen
| | - Lars B EngesæTer
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen,Department of Clinical Medicine, University of Bergen, Bergen
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Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up. PLoS One 2016; 11:e0162097. [PMID: 27788137 PMCID: PMC5082940 DOI: 10.1371/journal.pone.0162097] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/17/2016] [Indexed: 01/26/2023] Open
Abstract
Background and Aims To determine mortality rates and predisposing factors in patients operated for a hip fracture in a 3-year follow-up period. Methods The study included patients who underwent primary surgery for a hip fracture.The inclusion criteria were traumatic, non-traumatic, osteoporotic and pathological hip fractures requiring surgery in all age groups and both genders. Patients with periprosthetic fractures or previous contralateral hip fracture surgery and patients who could not be contacted by telephone were excluded. At 36 months after surgery, evaluation was made using a structured telephone interview and a detailed examination of the hospital medical records, especially the documents written during anesthesia by the anesthesiologists and the documents written at the time of follow-up visits by the orthopaedic surgeons. A total of 124 cases were analyzed and 4 patients were excluded due to exclusion criteria. The collected data included demographics, type of fracture, co-morbidities, American Society of Anesthesiologists (ASA) scores, anesthesia techniques, operation type (intramedullary nailing or arthroplasty; cemented-noncemented), peroperative complications, refracture during the follow-up period, survival period and mortality causes. Results The total 120 patients evaluated comprised 74 females(61.7%) and 46 males(38.3%) with a mean age of 76.9±12.8 years (range 23–95 years). The ASA scores were ASA I (0.8%), ASA II (21.7%), ASA III (53.3%) and ASA IV (24.2%). Mortality was seen in 44 patients (36.7%) and 76 patients (63.3%) survived during the 36-month follow-up period. Of the surviving patients, 59.1% were female and 40.9% were male.The survival period ranged between 1–1190 days. The cumulative mortality rate in the first, second and third years were 29.17%, 33.33% and 36.67% respectively. The factors associated with mortality were determined as increasing age, high ASA score, coronary artery disease, congestive heart failure, Alzheimer’s disease, Parkinson’s disease, malignancycementation and peroperative complications such as hypotension (p<0.05). Mortality was highest in the first month after fracture. Conclusion The results of this study showed higher mortality rates in patients with high ASA scores due to associated co-morbidities such as congestive heart failure, malignancy and Alzheimer’s disease or Parkinson’s disease. The use of cemented prosthesis was also seen to significantly increase mortality whereas no effect was seen from the anesthesia technique used. Treatment of these patients with a multidiciplinary approach in an orthogeriatric ward is essential. There is a need for further studies concerning cemented vs. uncemented implant use and identification of the best anesthesia technique to decrease mortality rates in these patients.
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