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Feng Y, Wan J, Deng H, Chen L, Xiao Y, Li T, He J, Wang P, Chong W, Hai Y, Jia L, Zhang Y. Effect of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly: A meta-analysis of randomized clinical trials. Medicine (Baltimore) 2024; 103:e39562. [PMID: 39287288 PMCID: PMC11404976 DOI: 10.1097/md.0000000000039562] [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: 10/18/2023] [Revised: 05/07/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024] Open
Abstract
PURPOSE In patients undergoing hemiarthroplasty in the elderly, the choice of the cemented method remains controversial. This meta-analysis was undertaken to compare the impact of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly. METHODS This study included randomized controlled trials comparing the postoperative effects of cemented vs uncemented in patients with hemiarthroplasty. With no language restrictions, we searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Cochrane Collaboration), Clinical Trials.gov, the ISRCTN registry, as well as gray literature with no language restrictions from January 1966 to April 2023. Data were quantitatively summarized using a random-effects model. The primary outcome was 1-year mortality. RESULTS This study included 13 randomized controlled trials with 3485 patients. The primary outcomes of the meta-analysis showed that cemented fixation in elderly patients undergoing hemiarthroplasty was superior to noncemented in 1-year mortality (risk ratio [RR] = 0.87, 95% confidence interval [CI]: 0.77, 0.97). Moreover, cemented was associated with a reduced risk of intraoperative periprosthetic fracture (RR = 0.19, 95% CI: 0.07, 0.50), postoperative periprosthetic fracture (RR = 0.34, 95% CI: 0.16,0.72), and loosening (RR = 0.33, 95% CI: 0.11, 0.97). CONCLUSIONS Cemented hemiarthroplasty is superior to noncemented in terms of survival. Moreover, cementation reduces the incidence of some implant-related complications. More extensive trials are needed to provide adequate guidance for choosing the proper cemented method.
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Affiliation(s)
- Yuning Feng
- Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Jun Wan
- Chengdu University School of Medicine, Chengdu, China
| | - Haidong Deng
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Tiangui Li
- Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- Department of Anesthesia, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jialing He
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Yu Zhang
- Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
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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; 20:e59-e72. [PMID: 38466141 DOI: 10.1097/pts.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Hughes T, Richard B. An Argument for Cemented Hemiarthroplasty in Geriatric Hip Fractures. J Orthop Trauma 2023; 37:e382-e383. [PMID: 37587568 DOI: 10.1097/bot.0000000000002647] [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: 08/18/2023]
Affiliation(s)
- Travis Hughes
- University of Arizona College of Medicine, Tucson, AZ
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Binkley N, Nickel B, Anderson PA. Periprosthetic fractures: an unrecognized osteoporosis crisis. Osteoporos Int 2023; 34:1055-1064. [PMID: 36939852 DOI: 10.1007/s00198-023-06695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/02/2023] [Indexed: 03/21/2023]
Abstract
Total joint replacement is common and increasing. Many of these patients have low bone mineral density preoperatively, and arthroplasty leads to bone loss. As falls are common before and after arthroplasty, it is unsurprising that periprosthetic fractures, defined as those associated with an orthopedic device, whether a joint replacement or other internal fixation devices, are not rare. These fractures engender morbidity and mortality comparable to osteoporosis-related hip fractures but remain largely unrecognized and untreated by osteoporosis/metabolic bone disease clinicians. Indeed, recent osteoporosis guidelines are silent regarding periprosthetic fractures. The purposes of this clinical review are to briefly describe the epidemiology of arthroplasty procedures and periprosthetic fractures, raise awareness that these fractures are osteoporosis-related, and suggest approaches likely to reduce their occurrence. Notably, bone health evaluation is essential following the occurrence of a periprosthetic fracture to reduce subsequent fracture risk. Importantly, in addition to such secondary fracture prevention, primary prevention, i.e., bone health assessment and optimization prior to elective orthopedic procedures, is appropriate.
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Affiliation(s)
- Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA.
| | - Brian Nickel
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
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Reddy AK, Scott JT, Norris GR, Moore C, Checketts JX, Hughes GK, Small T, Calder MM, Norris BL. Cemented vs Uncemented hemiarthroplasties for femoral neck fractures: An overlapping systematic review and evidence appraisal. PLoS One 2023; 18:e0281090. [PMID: 36827316 PMCID: PMC9955942 DOI: 10.1371/journal.pone.0281090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The purpose of our study is to assess the methodology of overlapping systematic reviews related to cemented vs uncemented hip hemiarthroplasties for the treatment of femoral neck fractures to find the study with the best evidence. Also, we assess the gaps in methodology and information to help with direction of future studies. METHODS A systematic search was conducted in September 2022 using Pubmed, Embase, and Cochrane Library. Clinical outcome data and characteristics of each study were extracted to see which treatment had better favorability. The outcomes and characteristics extracted from each study includes, first author, search date, publication journal and date, number of studies included, databases, level of evidence, software used, subgroup analyses that were conducted, and heterogeneity with the use of I2 statistics Methodological quality information was extracted from each study using four different methodologic scores (Oxford Levels of Evidence; Assessment of Multiple Systematic Reviews (AMSTAR); Quality of reporting of meta-analyses (QUROM); Oxman and Guyatt. After that, the Jadad decision algorithm was used to identify which studies in our sample contained the best available evidence. Finally, overlap of each systematic review was assessed using Corrected Covered Area (CCA) to look at redundancy and research waste among the systematic reviews published on the topic. RESULTS After screening, 12 studies were included in our sample. For the Oxford Levels of Evidence, we found that all the studies were Level I evidence. For the QUORUM assessment, we had 1 study with the highest score of 18. Additionally, we did the Oxman and Guyatt assessment, where we found 4 studies with a maximum score of 6. Finally, we did an AMSTAR assessment and found 2 studies with a score of 9. After conducting the methodological scores; the authors determined that Li. L et al 2021 had the highest quality. In addition, it was found that the CCA found among the primary studies in each systematic review calculated to .22. Any CCA above .15 is considered "very high overlap". CONCLUSIONS The best available evidence suggests that Cemented HAs are better at preventing Prosthesis-related complications. Conversely, the best evidence also suggests that Cemented HA also results in longer operative time and increased intraoperative blood loss. When conducting future systematic reviews related to the topic, we ask that authors restrict conducting another systematic review until new evidence emerges so as not to confuse the clinical decision-making of physicians.
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Affiliation(s)
- Arjun K. Reddy
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Jared T. Scott
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Grayson R. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Chip Moore
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Griffin K. Hughes
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Travis Small
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Mark M. Calder
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Orthopaedic & Trauma Service of Oklahoma, Tulsa, Oklahoma
- Department of Orthopaedic Trauma, The University of Oklahoma at Tulsa School of Community Medicine, Tulsa, Oklahoma
| | - Brent L. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
- Orthopaedic & Trauma Service of Oklahoma, Tulsa, Oklahoma
- Department of Orthopaedic Trauma, The University of Oklahoma at Tulsa School of Community Medicine, Tulsa, Oklahoma
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Bökeler U, Bühler A, Eschbach D, Ilies C, Liener U, Knauf T. The Influence of a Modified 3rd Generation Cementation Technique and Vaccum Mixing of Bone Cement on the Bone Cement Implantation Syndrome (BCIS) in Geriatric Patients with Cemented Hemiarthroplasty for Femoral Neck Fractures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1587. [PMID: 36363544 PMCID: PMC9696240 DOI: 10.3390/medicina58111587] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 10/14/2023]
Abstract
Background and Objectives: Cemented hemi arthroplasty is a common and effective procedure performed to treat femoral neck fractures in elderly patients. The bone cement implantation syndrome (BCIS) is a severe and potentially fatal complication which can be associated with the implantation of a hip prosthesis. The aim of this study was to investigate the influence of a modified cementing technique on the incidence of BCIS. Material and Methods: The clinical data of patients which were treated with a cemented hip arthroplasty after the introduction of the modified 3rd generation cementing technique were compared with a matched group of patients who were treated with a 2nd generation cementing technique. The anesthesia charts for all patients were reviewed for the relevant parameters before, during and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1,2, or 3 depending on the severity of hypotension, hypoxia loss of consciousness. Results: A total of 92 patients with complete data sets could be included in the study. The mean age was 83 years. 43 patients (Group A) were treated with a 2nd and 49 patients (Group B) with a 3rd generation cementing technique. The incidence of BCIS grade 1,2, and 3 was significantly higher (p = 0,036) in group A (n = 25; 58%) compared to group B (n = 17; 35%). Early mortality was higher in group A (n = 4) compared to group B (n = 0). Conclusions: BCIS is a potentially severe complication with a significant impact on early mortality following cemented hemiarthroplasty of the hip for the treatment of proximal femur fracture. Using a modified 3rd generation cementing technique, it is possible to significantly reduce the incidence of BCIS and its associated mortality.
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Affiliation(s)
- Ulf Bökeler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Alissa Bühler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
| | - Christoph Ilies
- Department for Anesthesia and Intensive Care, Marienhospital Stuttgart, 70199 Stuttgart, Germany
| | - Ulrich Liener
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
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Zelle BA, Salazar LM, Howard SL, Parikh K, Pape HC. Surgical treatment options for femoral neck fractures in the elderly. INTERNATIONAL ORTHOPAEDICS 2022; 46:1111-1122. [DOI: 10.1007/s00264-022-05314-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022]
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Demirel E, Şahin A. Predictive Value of Blood Parameters and Comorbidities on Three-Month Mortality in Elderly Patients With Hip Fracture. Cureus 2021; 13:e18634. [PMID: 34765379 PMCID: PMC8576146 DOI: 10.7759/cureus.18634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/05/2022] Open
Abstract
Background Knowing the factors that increase the risk of death in patients with hip fractures will help us to take precautions and intervene when necessary in the pre- and postoperative periods. Therefore, it is important to have inexpensive and practical biomarkers that can predict postoperative complications and mortality. The present study aimed to identify the factors that contribute to early mortality in elderly patients with hip fractures in the first three months after trauma, as well as the parameters that may be determinants of mortality. Methods The data of 1,015 patients over 65 years of age with femoral neck and intertrochanteric fractures admitted between January 2009 and January 2020 were retrospectively reviewed. A total of 763 patients who met the inclusion criteria were included in the study. Our study was designed to include 110 (14.4%) patients in Group 1 who were determined to have died within three months after the diagnosis of hip fracture and 653 (85.6%) patients in Group 2 who were determined not to have died within one year after the trauma. Age, gender, comorbid diseases, American Society of Anesthesiologists (ASA) score, type of anesthesia, operation time, type of implant used, time until surgery, and some biochemical blood values were compared between the two groups. Our data were analyzed statistically using the IBM Statistical Product and Service Solutions (SPSS) software for Windows, v. 25.0 (IBM SPSS Statistics for Windows, Armonk, NY). Results Of all of the patients, 370 (48.5%) were female and 393 (51.5%) were male. The patients who survived had an average age of 76.08, while the patients who died had an average age of 80.57. The mean age among the groups is significantly higher in patients who died. High creatinine, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and low albumin values were found to be associated with mortality. Conclusion It has been determined that advanced age, delayed operation time, high ASA score, and the number of comorbid diseases are associated with mortality in elderly patients with hip fractures, and biomarkers, such as creatinine, ALT, and LDH, can be used as markers for early mortality. With the increase of studies of similar nature, it will be possible to calculate a systematic risk map for mortality in elderly patients with a proximal femur fracture.
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Affiliation(s)
- Esra Demirel
- Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, TUR
| | - Ali Şahin
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, TUR
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