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Purudappa PP, Berliner Z, Venishetty N, Aggarwal V, Serbin P, Mounasamy V, Sambandam SN. Uncemented Hemiarthroplasty in Displaced Femoral Neck Fractures is associated with Higher Perioperative Surgical Complications but Lower Medical Complications: Analysis from the National Inpatient Database. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:582-587. [PMID: 37868136 PMCID: PMC10585485 DOI: 10.22038/abjs.2023.70498.3307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/20/2023] [Indexed: 10/24/2023]
Abstract
Objectives This study aimed to analyze and compare the perioperative outcomes of cemented and uncemented hemiarthroplasty in elderly patients with displaced femoral neck fractures by utilizing the data from the National Inpatient Sample database. Methods Data from the National Inpatient Sample Database was analyzed to identify patients who underwent hemiarthroplasty following a displaced femoral neck fracture (cemented and uncemented. Demographic data, comorbidities, length of stay, total charges, and perioperative complications were analyzed. Results 27390 patients were identified in the cemented group and 29406 in the uncemented group. The patients who underwent uncemented hemiarthroplasty demonstrated a higher incidence of prosthetic dislocation (Odds Ratio (OR) 3.348, p < 0.001), periprosthetic mechanical complications (OR 2.597, p < 0.001), wound dehiscence (OR 2.883, p < 0.001), superficial surgical site infection (OR 2.396, p = 0.043), deep surgical site infection (OR 1.686, p < 0.001), and periprosthetic fractures (OR 2.292, p < 0.001) as compared with patients who underwent cemented hemiarthroplasty. However, patients with uncemented fixation demonstrated a lower incidence of death (OR 0.567, p < 0.001), pulmonary embolism (OR 0.565, p < 0.001), deep vein thrombosis (DVT) (OR 0.746, p < 0.001), myocardial infarction (OR 0.772, p = 0.025) and blood loss anemia (OR 0.869, p < 0.001) as compared with cemented fixation. Conclusion Our study on displaced femoral neck fractures utilizing the National Inpatient database found that uncemented hemiarthroplasty was associated with a higher incidence of perioperative surgical complications. Cemented hemiarthroplasty, however, was associated with a statistically significant higher rate of death, pulmonary embolism, deep vein thrombosis, and myocardial infarction.
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Affiliation(s)
| | | | - Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech Health Sciences Center, El Paso, Texas, USA
| | | | - Philip Serbin
- University of Texas Southwestern, Dallas, Texas, USA
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Hoskins W, Corfield S, Lorimer M, Peng Y, Bingham R, Graves SE, Vince KG. Is the Revision Rate for Femoral Neck Fracture Lower for Total Hip Arthroplasty Than for Hemiarthroplasty?: A Comparison of Registry Data for Contemporary Surgical Options. J Bone Joint Surg Am 2022; 104:1530-1541. [PMID: 35920553 DOI: 10.2106/jbjs.21.01256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND When arthroplasty is indicated for a femoral neck fracture (FNF), it is unclear whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is best. This study compares data from the Australian Orthopaedic Association National Joint Replacement Registry using contemporary surgical options. METHODS Patients from 60 to 85 years old who were treated with arthroplasty for FNF, between September 1999 and December 2019, were included if the femoral stems were cemented. Only THAs with femoral heads of ≥36 mm or dual-mobility articulations were included. Patients who had monoblock HA were excluded. Rates of revision for all aseptic failures and dislocation were compared. Competing risks of revision and death were considered using the cumulative incidence function. Subdistribution hazard ratios (HRs) for revision or death from a Fine-Gray regression model were used to compare THA and HA. Interactions of procedure with age group and sex were considered. Secondary analysis adjusting for body mass index (BMI) and American Society of Anesthesiologists (ASA) classification was also considered. RESULTS There were 4,551 THA and 29,714 HA procedures included. The rate of revision for THA was lower for women from 60 to 69 years old (HR = 0.58 [95% confidence interval (CI), 0.39 to 0.85]) and from 70 to 74 years old (HR = 0.65 [95% CI, 0.43 to 0.98]) compared with HA. However, women from 80 to 85 years old (HR = 1.56 [95% CI, 1.03 to 2.35]) and men from 75 to 79 years old (HR = 1.61 [95% CI, 1.05 to 2.46]) and 80 to 85 years old (HR = 2.73 [95% CI, 1.89 to 3.95]) had an increased rate of revision when THA was undertaken compared with HA. There was no difference in the rate of revision for dislocation between THA and HA for either sex or age categories. CONCLUSIONS When contemporary surgical options for FNF are used, there is a benefit with respect to revision outcomes for THA in women who are <75 years old and a benefit for HA in women who are ≥80 years old and men who are ≥75 years old. There is no difference in dislocation rates. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Traumaplasty Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, Northland District Health Board, Whangarei, Northland, New Zealand
| | - Sophia Corfield
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Yi Peng
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Roger Bingham
- Traumaplasty Melbourne, Melbourne, Victoria, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Kelly G Vince
- Department of Orthopaedics, Northland District Health Board, Whangarei, Northland, New Zealand
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Stratos I, Eidmann A, Eisert M, Horas K, Rudert M. The Endoprosthetic Treatment of Femoral Neck Fractures in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:564-565. [PMID: 36422872 PMCID: PMC9743214 DOI: 10.3238/arztebl.m2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/16/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Ioannis Stratos
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Annette Eidmann
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Marius Eisert
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Konstantin Horas
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
| | - Maximilian Rudert
- Orthopedic Department, König-Ludwig-Haus; Julius-Maximilians-Universität Würzburg ()
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Hammouche SA, Phillips J, Massoumi A, Scammell BE, Moran CG. Implant and patient survival rates using Exeter Trauma Stem hemiarthroplasty in fracture neck of femur patients: The largest study to date. Injury 2022; 53:2199-2206. [PMID: 35393097 DOI: 10.1016/j.injury.2022.03.019] [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: 10/01/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Exeter Trauma Stems (ETS) femoral hemiarthroplasties are based on Exeter THR stems with a few design changes. Little has been published on ETS survival rates to justify their high cost compared to other cheaper implants. This is the largest prospective study to assess ETS implant failure-free survival rates in fracture neck of femur patients (NOF). This non-developing-centre study examined whether these design differences have altered implant survival (compared with Exeter THR's published survival data). METHODS Data were prospectively collected by independent audit officers. Dislocation, periprosthetic fracture, re-admission with severe hip pain, deep infection and revision surgery were considered events of interest in implant failure-free survival. RESULTS This study assessed 1,123 ETS stems (36 patients received bilateral ETS) in NOF patients. The mean patient age at the time of operation was 83 years (range; 49 - 102 years). The mean observation period was 2.5 years (range; 0 days - 8 years). Only 29 implants failed. All failure events were reported within the first year. Stem failure-free survival was 97.2% at eight years (CI 95.9% - 98%). Dislocation occurred in 10 patients (1%), periprosthetic femoral fracture in 4 (0.4%), and deep infection in 11 patients (1.2%). Patient survival rates were 75% and 48% at one and five years respectively. CONCLUSION ETS has high implant failure-free survival rates when used in hip fractures. ETS design changes have not altered ETS survival when used in hip fractures compared with the published literature of Exeter THR stem when used as a treatment for OA. Exeter Trauma Stems in NOF patients might last these elderly patients their entire short lifetime.
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Affiliation(s)
- Salah A Hammouche
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom.
| | - Jonathan Phillips
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
| | - Abaris Massoumi
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
| | - Brigitte E Scammell
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
| | - Chris G Moran
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
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5
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Raja BS, Gowda AK, Singh S, Ansari S, Kalia RB, Paul S. Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis. J Clin Orthop Trauma 2022; 29:101876. [PMID: 35515344 PMCID: PMC9062326 DOI: 10.1016/j.jcot.2022.101876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. MATERIAL AND METHODS The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. RESULTS A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. CONCLUSION Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya K.S. Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India,Corresponding author.
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Wang K, Kenanidis E, Gamie Z, Suleman K, Miodownik M, Avadi M, Horne D, Thompson J, Tsiridis E, Moazen M. The impact of stem fixation method on Vancouver Type B1 periprosthetic femoral fracture management. SICOT J 2022; 8:1. [PMID: 34989673 PMCID: PMC8734436 DOI: 10.1051/sicotj/2021064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/06/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Our understanding of the impact of the stem fixation method in total hip arthroplasty (THA) on the subsequent management of periprosthetic femoral fractures (PFF) is still limited. This study aimed to investigate and quantify the effect of the stem fixation method, i.e., cemented vs. uncemented THA, on the management of Vancouver Type B1 periprosthetic femoral fractures with the same plate. METHODS Eight laboratory models of synthetic femora were divided into two groups and implanted with either a cemented or uncemented hip prosthesis. The overall stiffness and strain distribution were measured under an anatomical one-legged stance. All eight specimens underwent an osteotomy to simulate Vancouver type B1 PFF's. Fractures were then fixed using the same extramedullary plate and screws. The same measurements and fracture movement were taken under the same loading conditions. RESULTS Highlighted that the uncemented THA and PFF fixation constructs had a lower overall stiffness. Subsequently, the mechanical strain on the fracture plate for the uncemented construct was higher compared to the cemented constructs. CONCLUSION PFF fixation of a Vancouver type B1 fracture using a plate may have a higher risk of failure in uncemented THAs.
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Affiliation(s)
- Katherine Wang
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Eustathios Kenanidis
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK - Academic Orthopaedics Department, Papageorgiou General Hospital & CORE Lab at CIRI AUTH, Aristotle University Medical School, University Campus 54 124, Thessaloniki, Greece
| | - Zakareya Gamie
- Northern Institute for Cancer Research, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Khurram Suleman
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Mark Miodownik
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Mahsa Avadi
- DePuy Synthes, St. Anthony's Road, Leeds LS11 8DT, UK
| | - David Horne
- DePuy Synthes, St. Anthony's Road, Leeds LS11 8DT, UK
| | | | - Eleftherios Tsiridis
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK - Academic Orthopaedics Department, Papageorgiou General Hospital & CORE Lab at CIRI AUTH, Aristotle University Medical School, University Campus 54 124, Thessaloniki, Greece
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
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Murphy EP, Fenelon C, Cassar-Gheiti A, O'Loughlin P, Curtin W, Murphy CG. Does Proximal Femoral Morphology Impact Morbidity and Mortality? A Cohort Study of Uncemented Hemiarthroplasties in the Treatment of Femoral Neck Fractures. Arthroplast Today 2021; 10:57-62. [PMID: 34307812 PMCID: PMC8283011 DOI: 10.1016/j.artd.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background To assess outcomes after uncemented hemiarthroplasty stems in the treatment of intracapsular femoral neck fractures over an 11-year period. Mortality rates were assessed, and whether proximal femoral geometry and stem alignment were factors in intraoperative or postoperative periprosthetic fracture (PPF) needs to be identified. Materials and Methods A retrospective single-center observational study was conducted of all patients who underwent intracapsular femoral neck fracture treatment using an uncemented prosthesis between January 2008 and December 2018. Primary endpoints included mortality rate, Dorr classification, prosthesis alignment, intraoperative fracture, and reoperation rate for any reason. Subanalysis on collared and uncollared implants was also conducted. Multivariate logistic regression was performed based on Dorr classification for stem alignment, fracture incidence, reoperation rate, implant sizing, and patient mortality. Results A total of 536 patients received an uncemented hemiarthroplasty in the study period. The mean patients age was 80.4 years, of which 71% were female. The 30-day mortality rate was 5.2%, with no deaths on day zero or day one. Twenty patients (3.7%) sustained an intraoperative calcar fracture, and 14 patients a PPF (2.6%) at a mean of 1.3 years from surgery. Dorr C type femurs were more likely to develop a PPF (P = .001), while valgus stem alignment was associated with PPF (P = .049). Conclusions This implant has low reoperation rates, low early postoperative mortality, and low 30-day mortality. This large single-center study provides up-to-date information using a contemporary stem in patients with multiple comorbidities. Dorr C femoral morphology and valgus stem malalignment were risk factors for postoperative fractures.
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Affiliation(s)
- Evelyn P Murphy
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | - Christopher Fenelon
- Department of Science and Engineering, University of Limerick, Limerick, Co, Limerick, Ireland
| | - Adrian Cassar-Gheiti
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | | | - William Curtin
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | - Colin G Murphy
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
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Dual-Mobility Articulations in Femoral Neck Fractures: A Systematic Review of the Literature and Meta-analysis of the Outcomes. J Am Acad Orthop Surg 2021; 29:e618-e627. [PMID: 32925381 DOI: 10.5435/jaaos-d-20-00407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/24/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Femoral neck fractures have been traditionally managed with hemiarthroplasty (HA) or conventional total hip arthroplasty (CTHA). There has been recent interest in using dual-mobility components (DMC) in total hip arthroplasty for patients with femoral neck fractures to provide increased stability and decrease the need for future revision. METHODS We conducted a systematic review of the literature reporting on the use of DMC in the management of femoral neck fractures in geriatric patients. We included studies in which DMC were used alone and studies that included a comparison to total hip arthroplasty or HA. The outcomes of interest were postoperative dislocation, revision, and revision surgery rates. Two separate subgroup analyses were conducted. For the comparative studies, we analyzed the differences in outcomes using a random-effects model of relative risks. For the noncomparative studies, we estimated the cumulative incidence of the different outcomes. RESULTS Eighteen studies met the inclusion criteria and were included in our analysis. Eleven noncomparative studies showed a cumulative incidence of dislocation to be 1.2% (95% confidence interval = 0.3% to 2.7%) when DMC were used alone. Subgroup analyses of the seven comparative studies yielded a relative risk of dislocation using DMC was 59% less than HA and 83% less than CTHA. DMC also compared favorably in terms of revision surgery and revision rates to HA. There was insufficient quality evidence to comment on revision surgery and revision rates when compared with CTHA in comparative studies, but among the noncomparative studies, there was a low rate of revision and revision surgery. CONCLUSIONS Our study revealed overall lower risk of dislocation using DMC compared with both CTHA and HA. There were also lower revision and revision surgery rates when DMC were used compared with HA. Further studies are required to elucidate cost-effectiveness and long-term outcomes of DMC in these scenarios. LEVEL OF EVIDENCE Level III-meta-analysis.
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Vluggen TPMJ, van Vugt R, Boonen B, Keulen MHF. Management of two-level proximal femoral fractures. BMJ Case Rep 2021; 14:14/5/e240684. [PMID: 34059536 DOI: 10.1136/bcr-2020-240684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of an 82-year-old female, who experienced a ground-level fall on the trochanter of the right femur. X-rays showed a proximal femoral fracture (PFF) with an unclear and unusual fracture pattern. Three-dimensional CT images were obtained and showed a displaced femoral neck fracture and ipsilateral fracture of the greater trochanter. Our patient underwent unipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate and cable grip. At 11 months, functional outcomes, patient satisfaction and quality of life were excellent. Primary osteoporosis was diagnosed and treatment with bisphosphonates was initiated.Two-level PFFs are rare and complex. Due to ageing and a subsequent increase in osteoporosis, numbers of PFFs with complex fracture patterns might increase in the future. Adequate treatment and early prevention of osteoporosis are key to reduce this risk and lower the overall burden. Surgical treatment should be patient-tailored and focus on minimising the risk of complications and reinterventions.
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Affiliation(s)
| | - Raoul van Vugt
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.,The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Bert Boonen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Mark Hendrik Franciscus Keulen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.,The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
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Mufarrih SH, Qureshi NQ, Masri B, Noordin S. Outcomes of total hip arthroplasty using dual-mobility cups for femoral neck fractures: a systematic review and meta-analysis. Hip Int 2021; 31:12-23. [PMID: 32513027 DOI: 10.1177/1120700020926652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Femoral neck fractures (FNFs), with up to 15% mortality, are prominent orthopaedic emergencies. After treating FNFs, dislocation is another challenge increasing morbidity, mortality and treatment costs substantially. The emerging dual-mobility cup (DMC) may decrease dislocation rates following total hip arthroplasty (THA) for FNFs. We performed a systematic review of literature reporting dislocation and mortality rates with DMC-THA for the treatment of FNFs. METHODS 2 authors independently searched PubMed (MEDLINE), Google Scholar and Cochrane library for studies reporting dislocation and mortality rates for FNFs treated with DMC-THA since inception up to January 2019. Data on outcomes of interest was extracted from all studies and assessed for eligibility for a meta-analysis. RESULTS Out of 522 search results, 18 studies were included in the systematic review and 4 in the meta-analysis. The mean rate of dislocation following DMC-THA for FNFs was found to be 1.87% ± 2.11, with a 1-year mortality rate of 14.0% ± 10.55. Results of meta-analysis showed that dislocation and 1-year postoperative mortality rates were significantly lower for DMC-THA with a risk ratio 0.31 (95% CI, 0.16-0.59; I2 = 0%, p = 0.0003) and 0.55 (0.40, 0.77; I2 = 0%, p = 0.003) respectively when compared to biploar hemiathroplasty (BHA). CONCLUSIONS The mean dislocation and mortality rates in DMC-THA are lower than previously reported rates for THA with single cup and comparable to unipolar and bipolar hemiarthroplasty. Further research involving randomised control trials to assess differences in outcomes, longevity and cost-effectiveness needs to be conducted to make recommendations for the use of DMC in treating FNFs.
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Affiliation(s)
- Syed H Mufarrih
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Nada Q Qureshi
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Bassam Masri
- Department of Orthopaedics at the University of British Columbia, BC, Canada.,Department of Orthopaedics at Vancouver Acute (Vancouver General and University Hospitals), Vancouver, BC, Canada
| | - Shahryar Noordin
- Orthopaedic Surgery, Aga Khan University Hospital, Karachi, Pakistan
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11
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Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: A randomised controlled trial of 50 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:587-594. [PMID: 33068165 PMCID: PMC7981295 DOI: 10.1007/s00590-020-02808-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/25/2022]
Abstract
Background The primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups. Methods A prospective double-blind randomised control trial was conducted. Fifty patients with an intracapsular hip fracture meeting the inclusion criteria were randomised to either an uncemented (n = 25) or cemented (n = 25) THA. There were no differences (p > 0.45) in age, gender, health status or preinjury hip function between the groups. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. These were assessed at 4, 12 and 72 months after surgery, apart from the TUG which as only assessed as 6 months. Results The study was terminated early due to the significantly (n = 8, p = 0.004) higher rate of intraoperative complications in the uncemented group: three fractures of the proximal femur and five conversions to a cemented acetabular component. There were no significant (p ≥ 0.09) differences in the functional measures (OHS, HSS, EQ5D, TUG and pain) or patient satisfaction between the groups. There was no difference in operative time (p = 0.75) or blood loss (p = 0.66) between the groups. There were two early revisions prior to 3 months post-operatively in the uncemented group and none in the cemented group, but this was not significant (log rank p = 0.16). Conclusion There was a high rate of intraoperative complications, which may be due to poor bone quality in this patient group. There were no ergonomic or functional advantages demonstrated between uncemented and cemented THA. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure.
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12
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Dogger MN, Fransen BL, Sierevelt IN, Nolte PA. Implant survival in uncemented total hip arthroplasty for displaced intracapsular femoral neck fractures: outcomes of 115 patients in a single center. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:885-893. [PMID: 32146516 DOI: 10.1007/s00590-020-02652-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/03/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There remains disagreement about the use of cemented or uncemented total hip arthroplasty (THA) for patients with a displaced intracapsular femoral neck fracture (FNF). The aim of this study was to assess implant survival, mortality, and postoperative complication rates of uncemented THA for a displaced intracapsular FNF in a single center. PATIENTS AND METHODS A cohort of 115 patients who received uncemented THAs for a displaced intracapsular FNF was retrospectively examined for implant survival in terms of revision and any reoperation, mortality, and postoperative complications. RESULTS The one- and five-year implant survival was 99.1% (95% confidence interval (CI) 97.3-100.9) and 97.8% (95% CI 94.7-100.9) for revision and 93.6% (95% CI 88.9-98.3) and 90.0% (95% CI 83.3-96.7) for any reoperation, respectively. Impaired mobility was significantly associated with lower implant survival (p = 0.01). The one, three, and 12 month mortality rates were 2.8% (95% CI 0-5.9), 3.7% (95% CI 0.2-7.2), and 5.6% (95% CI 1.3-9.9), respectively. Postoperative complication rate was 10% with 5% intra-operative fractures. CONCLUSIONS Contrary to earlier reports of results of uncemented THA for displaced FNF, the results of this study were comparable with those reported in the literature for cemented THA in displaced FNF with respect to implant survival, mortality, and complication rates. This indicates that uncemented THA could be a viable option for these patients. In future, the additional literature with a prospective design is needed to support and reinforce our conclusion.
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Affiliation(s)
- Melissa N Dogger
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - Bas L Fransen
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
- Department of Orthopaedic Surgery, CORAL - Center for Orthopaedic Research Alkmaar, Noordwest Ziekenhuisgroep Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Risk Factors for Periprosthetic Femur Fracture and Influence of Femoral Fixation Using the Mini-Anterolateral Approach in Primary Total Hip Arthroplasty. J Arthroplasty 2020; 35:774-778. [PMID: 31685395 DOI: 10.1016/j.arth.2019.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The mini-anterolateral (AL) approach for total hip arthroplasty (THA) has gained popularity. In contrast to other approaches, risk factors for periprosthetic femur fractures have not been well established for the AL approach. METHODS Six hundred eighty-four primary THAs performed using the AL approach were retrospectively reviewed for risk factors associated with perioperative periprosthetic femur fractures within 3 months of surgery. Risk factors evaluated were gender, age, body mass index, laterality, and Dorr ratio of the proximal femur. Cemented stems and collared uncemented stems were compared to uncemented tapered-wedge and meta-diaphyseal stems. A Student's t-test was used for continuous variables, and a chi-squared test was used for categorical variables. RESULTS Of 684 primary THAs performed, 57 (8.3%) resulted in fracture. Twenty-eight (4.1%) occurred intraoperatively and 29 (4.2%) occurred postoperatively within 90 days. All intraoperative fractures were fixed at the time of surgery and healed uneventfully. Of the postoperative fractures, 15 (2.2%) were amenable to nonoperative management and healed. Fourteen (2.0%) required revision arthroplasty. There was a significantly lower rate of fracture in patients receiving cemented or collared stems (0%, n = 101) than in those receiving tapered-wedge or meta-diaphyseal fitting stems (9.8%, n = 583; P = .0009). Odds of fracture increased with female gender (P = .0063) and increasing Dorr ratio (P = .0003). Analysis showed a trend toward increased risk with older age, but did not achieve statistical significance. Body mass index and laterality showed no statistically significant effect. CONCLUSION Performing primary THA via the AL approach, 2.0% of patients had a postoperative fracture requiring revision within the first 3 months. With cemented and collared stems, the fracture rate was significantly lower. Surgeons should consider using cemented or collared stems in high-risk patients.
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Barışhan FC, Akesen B, Atıcı T, Durak K, Bilgen MS. Comparison of hemiarthroplasty and total hip arthroplasty in elderly patients with displaced femoral neck fractures. J Int Med Res 2018; 46:2717-2730. [PMID: 29708038 PMCID: PMC6124276 DOI: 10.1177/0300060518770354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective This study was performed to compare the clinical and radiological outcomes of displaced femoral neck fractures (FNFs) treated with either hemiarthroplasty or total hip arthroplasty (THA) in elderly patients. Morbidity and mortality were also evaluated. Methods Twenty-two patients who underwent hemiarthroplasty and 16 patients who underwent THA for treatment of Garden type 3-4 FNFs from 2012 to 2015 were enrolled in this study. All patients were >65 years of age. Cox regression analysis was performed for mortality evaluation. Results The postoperative blood loss volume, decrease in the hemoglobin level, and transfusion rate were significantly higher in the THA group. The univariate mortality risk was higher in patients with a Charlson comorbidity score of >4, American Society of Anesthesiologists score of >2, Singh index of <3, and postoperative hospitalization of >1 week. Conclusion This study revealed no significant difference in the short-term clinical and radiological results between cementless hemiarthroplasty and THA in elderly patients with displaced FNFs. However, morbidity and mortality were associated with the presence of additional systemic diseases. THA is the preferred surgical technique in patients with displaced FNFs and low comorbidities.
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Affiliation(s)
- Fatih Canşah Barışhan
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Burak Akesen
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Teoman Atıcı
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Kemal Durak
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
| | - Muhammed Sadık Bilgen
- Bursa Uludag University, Department of Orthopaedics and Traumatology, Uludağ University Medical Faculty Campus of Görükle, Bursa 16059, Turkey
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Prashanth YS, Niranjan M. Comparative Study of Surgical Management of Fracture Neck of Femur with Cemented Versus Uncemented Bipolar Hemiarthroplasty. J Clin Diagn Res 2017; 11:RC17-RC21. [PMID: 28384949 PMCID: PMC5376863 DOI: 10.7860/jcdr/2017/22598.9454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is evidence for use of cemented hemiarthroplasty resulting in greater anchoring and lesser peri prosthetic fracture. However, this procedure results in more haemodynamic instability and cardiopulmonary complications termed as 'cement reaction' or bone cement implantation syndrome. There has been a heightened interest among surgeons to compare cemented and uncemented hemiarthroplasty for fracture neck of femur. AIM To compare cemented and uncemented hemiarthroplasty in terms of blood loss during the procedure, post-operative complications, mortality, functional recovery and long term clinical outcome. MATERIALS AND METHODS In a prospective study spanning 8 years from January 2006 to January 2014 in a tertiary care hospital, 52 cases of fracture of neck were selected. Twenty four patients underwent cemented and 28 patients underwent uncemented hemiarthroplasty. Mean follow up duration was 59.3 months. Harris Hip Score evaluation was done at each follow up. Radiological evaluation was done at each follow up for calcar length and periprosthetic fractures. RESULTS Mean age of patients was 70 years. Harris Hip scores at 3, 6 and 12 months did not show statistically significant differences. Periprosthetic osteolysis or loosening was not seen in the present study. No complications noted in uncemented hemiarthroplasty. Four patients who had cemented hemiarthroplasty had infections. No mortality occurred during admission and within 12 months after surgery. CONCLUSION No significant difference was noted between the cemented and uncemented hemiarthroplasty procedures on long term follow up in terms of functionality. No re-operations and no mortality reported. Cemented hemiarthroplasty had more blood loss and minimal post-operative complications.
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Affiliation(s)
- YS Prashanth
- Assistant Professor, Department of Orthopaedics, Azeezia Institute of Medical Sciences, Kollam, Kerala, India
| | - M Niranjan
- Professor and Head, Department of Orthopaedics, Bangalore Baptist Hospital, Bangalore, Karnataka, India
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