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Abdelghafour KM, Khaled SA, Abdel-Kader KFM, Azeem HA, Shah NN. Outcomes of a hydroxyapatite ceramic-coated femoral stem in primary total hip arthroplasty: a report of excellent survivorship from a single United Kingdom centre. SICOT J 2024; 10:28. [PMID: 39145666 PMCID: PMC11325862 DOI: 10.1051/sicotj/2024026] [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: 03/27/2024] [Accepted: 07/02/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Hydroxyapatite (HA) coated femoral stems were introduced to enhance the biological fixation at the implant-bone interface, aiming to increase the longevity and survival of the prostheses. We aimed to assess the long-term outcomes of an HA ceramic (HAC) coated stem in primary total hip arthroplasty (THA), assess the stem survival, and clinically evaluate the patients using patient-reported outcome measures (PROMs) and radiological evaluation of stem osseointegration. PATIENTS AND METHODS This was a prospective evaluation of a retrospective cohort of 385 patients (442 hips) who underwent primary THA between June 2008 and December 2018. The mean age was 63.83 years (range, 30-82 years). During the follow-up duration, 23 patients died, and 36 patients (38 hips) were lost to follow-up. Prospective data collected for 326 patients (381 hips) was used to evaluate stem survival with the Kaplan-Meier method using aseptic loosening or any revision as the endpoint. Clinical evaluation was done using the EuroQol five-dimension (EQ-5D) scoring system and PROMs using the Oxford Hip Score (OHS) and Merle D'Aubigne Postel (MDP) score. Radiological assessments were performed using the Engh radiological criteria for stem osteointegration. RESULTS The mean follow-up duration was 9.39 years (range, 4-14.5 years). The survival of the HAC-coated femoral stem was 100% (95% confidence interval [CI], 96.7-100%) at 14 years with aseptic loosening as the endpoint, and 98.9% (CI, 96.7-100%) at 14 years with stem revision for any reason as the endpoint. The mean OHS was 44.5 (range, 30-48), and the mean MDP score was 15.87 (range, 10-18). Radiological evaluations showed full osseointegration of all stems. CONCLUSION This HAC-coated femoral stem has shown excellent survivorship, functional outcomes, and full osseointegration at the final follow-up.
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Affiliation(s)
- Karim M Abdelghafour
- Worthing Hospital, University Hospitals of Sussex, Lyndhurst Road, Worthing BN112DH, UK - Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Sherif A Khaled
- Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Khaled F M Abdel-Kader
- Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Hazem A Azeem
- Kasr Alainy School of Medicine Cairo University, Al-Saray Street, El Manial Cairo 11956, Egypt
| | - Nirav N Shah
- Worthing Hospital, University Hospitals of Sussex, Lyndhurst Road, Worthing BN112DH, UK
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Khanna A, Thompson AL, Cross WW, Tangtiphaiboontana J, Hidden KA, Yuan BJ. Impact of Intraoperative Femoral Fractures During Cemented Hemiarthroplasty for Femoral Neck Fractures. J Arthroplasty 2024:S0883-5403(24)00810-6. [PMID: 39128783 DOI: 10.1016/j.arth.2024.08.006] [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: 03/31/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND There have been several studies on intraoperative femoral fractures (IFFs) during primary total hip arthroplasty, but it is not well understood how this complication affects the patient population undergoing cemented hemiarthroplasty. This study aimed to analyze the impact of IFFs sustained during cemented hemiarthroplasty for the treatment of femoral neck fractures. METHODS A retrospective review was conducted of all patients who were treated for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 31B fractures with cemented hemiarthroplasty between January 1, 2000 and December 31, 2021, at a single academic level 1 trauma center. An initial cohort was constructed of all patients who sustained an IFF during their surgery, yielding 31 patients after excluding those who sustained a pathologic fracture or had incomplete data. These patients were matched 1:2 on age, sex, and body mass index to patients in a control cohort. The primary outcome measure was implant failure. Secondary outcome measures included complications, all-cause mortality, and radiographic outcomes (subsidence, femoral component loosening, acetabular wear, and heterotopic ossification) postoperatively. RESULTS Subsequent implant revision was required in 3.2% (n = 1) of patients who sustained an IFF and 1.6% (n = 1) of patients who did not. After adjusting for comorbidities, there was no observed excess risk of implant failure in the fracture cohort when compared to the control cohort (hazard ratio [HR] = 0.30, P = 0.740). There was no observed excess risk of morbidity (HR = 0.69, P = 0.621) or all-cause mortality (HR = 0.23, P = 0.330). Radiographic outcomes also did not significantly differ between the 2 cohorts (P > 0.05). CONCLUSIONS Intraoperative fractures during cemented hemiarthroplasty do not contribute to an increased risk of secondary surgery, morbidity, or mortality after surgery. They also do not adversely affect radiographic outcomes postoperatively. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
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Affiliation(s)
- Ankur Khanna
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - William W Cross
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Krystin A Hidden
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Esper GW, Meltzer-Bruhn AT, Anil U, Schwarzkopf R, Macaulay W, Konda SR, Ganta A, Egol KA. Periprosthetic fracture following arthroplasty for femoral neck fracture: is a cemented stem protective? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1927-1935. [PMID: 38462554 DOI: 10.1007/s00590-023-03830-5] [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: 11/15/2023] [Accepted: 12/28/2023] [Indexed: 03/12/2024]
Abstract
BACKGROUND Periprosthetic femoral fractures (PFF) carry significant morbidity following arthroplasty for femoral neck fracture (FNF). This study assessed fracture complications following arthroplasty for FNF and the effect of cement fixation of the femoral component on intraoperative and post-operative PFF. METHODS Between February 2014 and September 2021, 740 patients with a FNF who underwent arthroplasty were analyzed for demographics, surgical management, use of cement for fixation of the femoral component, and subsequent PFF. Variables were compared with Mann-Whitney or Chi-square as appropriate. Multivariate logistic regression was used to assess independent risk factors associated with intraoperative or post-operative PFF. RESULTS There were 163 THAs (41% cemented) and 577 HAs (95% cemented). There were 28 PFFs (3.8%): 18 post-operative and 10 intraoperative. Fewer post-operative PFFs occurred with cemented stems (1.63% vs. 6.30%, p = 0.002). Mean time from surgery to presentation with post-operative PFF was 14 months (0-45 months). Mean follow-up time was 10.3 months (range: 0-75.7 months). In multivariate regression, use of cement and THA was independently associated with decreased post-operative PFF (cement: OR 0.112, 95% CI 0.036-0.352, p < 0.001 and THA: OR 0.249, 95% CI 0.064-0.961, p = 0.044). More intraoperative fractures occurred during THA (3.68% vs. 0.69%, p = 0.004) and non-cemented procedures (5.51% vs. 0.49%, p < 0.001). In multivariate regression, use of cement was protective against intraoperative fracture (OR 0.100, CI 0.017-0.571, p = 0.010). CONCLUSIONS In patients with a FNF treated with arthroplasty, cementing the femoral component is associated with a lower risk of intraoperative and post-operative PFF. Choice of procedure may be based on patient factors and surgeon preference.
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Affiliation(s)
- Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ariana T Meltzer-Bruhn
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Utkarsh Anil
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - William Macaulay
- Division of Orthopedic Hip and Knee Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Abhishek Ganta
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, 14th Floor, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY, USA.
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EKEN G. Femur boyun kırığı nedeniyle hemiartroplasti yapılan hastalarda Dorr tipinin klinik sonuçlara ve perioperatif komplikasyonlara etkisi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.925699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Outcomes of cerclage wiring to manage intra-operative femoral fracture occurring during cementless hemiarthroplasty in older patients with femoral neck fractures. INTERNATIONAL ORTHOPAEDICS 2019; 43:2637-2647. [DOI: 10.1007/s00264-019-04327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/28/2019] [Indexed: 01/06/2023]
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Hong CC, Nashi N, Tan JH, Manohara R, Lee WT, Murphy DP. Intraoperative periprosthetic femur fracture during bipolar hemiarthroplasty for displaced femoral neck fractures. Arch Orthop Trauma Surg 2018; 138:1189-1198. [PMID: 29770880 DOI: 10.1007/s00402-018-2952-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to review the incidence and risk factors for the development of intraoperative periprosthetic femur fractures while performing a bipolar hemiarthroplasty for displaced neck of femur fractures. Our secondary aim is to characterize the types of intraoperative periprosthetic fractures, the steps leading to the fractures, and the salvage treatments instituted. MATERIALS AND METHODS 271 patients treated with bipolar hemiarthroplasty after traumatic displaced femoral neck fractures were retrospectively analyzed. Demographic data, co-morbidities, vitamin D level, consumption of steroids, ASA score, surgical approach, surgeon experience, use of cemented or uncemented implants, proximal femur morphology, and types of anaesthesia were analyzed statistically. RESULTS There were 28 patients (10.3%) with intraoperative periprosthetic femur fractures. We found two significant independent risk factors which were the use of uncemented prosthesis (OR 4.15; 95% CI 1.65-10.46; p = 0.003) and Dorr type C proximal femurs (Dorr A OR 3.6; 95% CI 1.47-8.82; p = 0.005). In addition, patients with Dorr type C proximal femurs who underwent uncemented bipolar hemiarthroplasty were more likely to sustain an intraoperative periprosthetic fracture (14(73.7%) out of 19 patients; p = 0.002). There were no significant differences found in other risk factors. The most common location for these fractures was at the greater trochanter at 11 (39.3%) cases. Majority of them, 15 (53.6%), had intraoperative fractures during trial implant insertion and reduction. CONCLUSION The overall incidence of intraoperative periprosthetic femur fractures during hemiarthroplasty for displaced neck of femur fractures was 10.3%. The incidence was significantly higher for uncemented (14.7%) when compared to cemented prosthesis (5.4%) and the greater trochanter was the commonest area for periprosthetic fractures during trial implant insertion and reduction. Uncemented prosthesis and Dorr type C proximal femurs were two significant independent risk factors contributing to intraoperative periprosthetic fractures. By identifying these risk factors, surgeons can take ample precautions to prevent complications.
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Affiliation(s)
- Choon Chiet Hong
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Nazrul Nashi
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jiong Hao Tan
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Ruben Manohara
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Wei Ting Lee
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Diarmuid Paul Murphy
- c/o Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Aslam-Pervez N, Riaz O, Gopal S, Hossain F. Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures. Clin Orthop Surg 2018; 10:14-19. [PMID: 29564042 PMCID: PMC5851849 DOI: 10.4055/cios.2018.10.1.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 01/02/2018] [Indexed: 11/07/2022] Open
Abstract
Background The aim of our study was to determine the rate and preoperative predictors of intraoperative fracture (IOF) during hip hemiarthroplasty (HA) in patients who have sustained a fragility hip fracture injury. Methods We reviewed 626 patients who underwent HA at our institution using the National Hip Fracture Database. Various patient- and surgery-related data including demographic information, cement usage, surgeon grade, time to surgery, and operative duration were collected. The metaphyseal diaphyseal index and modified canal bone ratio were measured on preoperative radiographs. We compared patients with and without IOF with respect to all variables collected. Multivariate regression modeling was used to identify significant preoperative risk factors for IOF. Results There was a 7% incidence of IOF in our cohort exclusively comprising of Vancouver A fractures. The majority of these complications were treated nonoperatively (52%). There was no statistically significant difference with respect to cement usage, surgeon grade, operative duration, time to surgery, and radiographic parameters collected. Increasing age was found to be the most significant preoperative risk factor for predicting IOF (p = 0.024, overall relative risk = 1.06). Conclusions Our identified predictor of increasing age is nonmodifiable and illustrates the importance of meticulous surgical technique in older patients. Furthermore, its independence from fixation methods or prosthesis design as a predictor of IOF may support using an uncemented prosthesis in patients at risk from cement implantation.
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Affiliation(s)
- Nayef Aslam-Pervez
- Department of Orthopaedics and Trauma Surgery, Hull Royal Infirmary, Hull, UK
| | - Osman Riaz
- Department of Orthopaedics and Trauma Surgery, Leeds General Infirmary, Leeds, UK
| | - Shivkumar Gopal
- Department of Orthopaedics and Trauma Surgery, Hull Royal Infirmary, Hull, UK
| | - Fahad Hossain
- Department of Orthopaedics and Trauma Surgery, University College London, London, UK
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Carli AV, Negus JJ, Haddad FS. Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J 2017; 99-B:50-59. [PMID: 28042119 DOI: 10.1302/0301-620x.99b1.bjj-2016-0220.r1] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 11/05/2022]
Abstract
AIMS Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) are devastating complications that are associated with functional limitations and increased overall mortality. Although cementless implants have been associated with an increased risk of PFF, the precise contribution of implant geometry and design on the risk of both intra-operative and post-operative PFF remains poorly investigated. A systematic review was performed to aggregate all of the PFF literature with specific attention to the femoral implant used. PATIENTS AND METHODS A systematic search strategy of several journal databases and recent proceedings from the American Academy of Orthopaedic Surgeons was performed. Clinical articles were included for analysis if sufficient implant description was provided. All articles were reviewed by two reviewers. A review of fundamental investigations of implant load-to-failure was performed, with the intent of identifying similar conclusions from the clinical and fundamental literature. RESULTS In total 596 articles were initially identified, with 34 being eligible for analysis. Aggregate analysis of 1691 PFFs in 342 719 primary THAs revealed a significantly higher number of PFFs with cementless femoral implants (p < 0.001). Single-wedge and double-wedge (fit-and-fill) femoral implants were associated with a threefold increase in PFF rates (p < 0.001) compared with anatomical, fully coated and tapered/rounded stems. Within cemented stems, loaded-taper (Exeter) stems were associated with more PFFs than composite-beam (Charnley) stems (p = 0.004). Review of the fundamental literature revealed very few studies comparing cementless component designs. CONCLUSION Very few studies within the PFF literature provide detailed implant information. Cementless implants, specifically those of single-wedge and double-wedge, have the highest PFF rates in the literature, with most investigations recommending against their use in older patients with osteoporotic bone. This review illustrates the need for registries and future PFF studies to record implant name and information for future analysis. Furthermore, future biomechanical investigations comparing modern implants are needed to clarify the precise contribution of implant design to PFF risk. Cite this article: Bone Joint J 2017;99-B(1 Supple A):50-9.
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Affiliation(s)
- A V Carli
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - J J Negus
- University College London Hospitals, 235 Euston Road, London, NW1 2BU and NIHR University College London Hospitals Biomedical Research Centre, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU and NIHR University College London Hospitals Biomedical Research Centre, UK
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Abstract
PURPOSE To compare patients with or without intra-operative fracture during cementless bipolar hemiarthroplasty. METHODS Records of 76 men and 202 women who underwent cementless bipolar hemiarthroplasty for femoral neck fractures were reviewed. Patients with and without intra-operative fractures and patients with different types of intra-operative fractures were compared. RESULTS Two men and 22 women aged 62 to 93 (mean, 80) years sustained intra-operative fractures at the lesser trochanter (n=18), the greater trochanter (n=5), and the subtrochanter (n=1). All 18 lesser trochanteric fractures and 4 of the greater trochanteric fractures were recognised intra-operatively and managed with cerclage wiring (n=21) or conversion to cemented hemiarthroplasty with cerclage wiring (n=1). The remaining 2 fractures were recognised postoperatively on radiographs and managed conservatively or with revision surgery and cerclage wiring and plating on day 4. Intra-operative fractures correlated with female gender (p=0.03) and operative delay to optimise patients (p=0.02), whereas the fracture site correlated with the time of fracture recognition (p=0.01). Postoperatively, 5 patients were allowed partial weight bearing and 18 were instructed to mobilise with a wheelchair for at least 6 weeks. One patient died from an unrelated cause. At one year, 21 patients reported no hip pain and 2 reported minimal pain. 17 could walk with or without aids and 6 were wheelchair-bound. CONCLUSION Surgeons should be familiar with the size difference in trial and actual implants used in bipolar hemiarthroplasty in order to better estimate the extent of broaching required. In most patients with an intra-operative fracture, the one-year outcome was not compromised, despite the poorer short-term outcome.
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Affiliation(s)
- Chung-Liang Kuo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - Si Heng Sharon Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Haw Chou Lee
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
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Nash W, Harris A. The Dorr type and cortical thickness index of the proximal femur for predicting peri-operative complications during hemiarthroplasty. J Orthop Surg (Hong Kong) 2014; 22:92-5. [PMID: 24781623 DOI: 10.1177/230949901402200123] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess the Dorr proximal femoral types and the cortical thickness index for predicting peri-operative complications during hemiarthroplasty. METHODS Records of 53 male and 147 female elderly who underwent cemented or uncemented monopolar hemiarthroplasty for displaced intracapsular femoral neck fractures were reviewed. Any intra-operative fracture and postoperative dislocation within 30 days was recorded. The cortical thickness index was defined as the ratio of cortical width minus endosteal width to cortical width at a level of 100 mm below the tip of the lesser trochanter. Higher values indicated thicker cortices. The Dorr proximal femur morphology was classified into types A, B, and C. RESULTS 28 patients were excluded. The proximal femurs of the remaining 172 patients (mean age, 85 years) were categorised as Dorr type A (n=29), type B (n=75), and type C (n=68). The respective mean cortical thickness indices were 1.10, 0.79, and 0.65. Lower cortical thickness indices correlated with worse Dorr types (p<0.05). There were 18 intra-operative fractures; 8 and 10 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.046). There were 5 postoperative dislocations; 3 and 2 occurred in Dorr types B and C femurs versus none in Dorr type A femurs (p=0.591). The mean cortical thickness index was significantly lower in those with a fracture (n=18) than those without a fracture (n=154) [0.59 vs. 0.81, p=0.0003]. CONCLUSION Dorr types B and C proximal femurs were at greater risk of intra-operative fracture.
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Affiliation(s)
- William Nash
- SE Thames Rotation, Queen Elizabeth Hospital, London, United Kingdom
| | - Andrew Harris
- Belfast Hospitals NHS Trust, Belfast, Northern Ireland, United Kingdom
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Periprosthetic bone loss following hemiarthroplasty: a comparison between cemented and cementless hip prosthesis. Injury 2013; 44 Suppl 3:S62-6. [PMID: 24060022 DOI: 10.1016/s0020-1383(13)70201-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this prospective randomized clinical study was to evaluate the magnitude of bone mineral changes as well as the clinical results after cemented and cementless haemiarthroplasty (HA) for femoral neck fracture. The study was comprised of 60 patients (mean age 85.2 years); 30 of them underwent cemented HA and 30 cementless HA. All patients underwent osteodensitometry for the purpose of Bone Mineral Density (BMD) evaluation. BMD was measured with dual-energy X-ray absorptiometry test (DEXA scans), which was scheduled at 1 month, 6 months and 1 year after surgery. BMD was evaluated at each of the seven Gruen zones. Harris Hip Score (HHS) at 3 months, 6 months and 12 months was used for evaluation of functional outcome. No difference was found between the two groups of patients in terms hospital stay, morbidity and mortality. The procedure took longer time in group A (cemented HA) compared to group B (cementless HA) (79.03 ± 3.59 vs 68.02 ± 5.97 minutes; p = 0.00). The Harris hip score averaged 76.97 ± 7.49 one year after surgery. At each follow - up examination the HHS was significantly higher in patients with cemented HA. We noted a trend of less intensive BMD reduction in all Gruen zones in group A compared to group B. However, the difference in BMD reduction between these two groups was significant only in zones 2, 3 and 4. Our results support the view that cemented hemiarthroplasty should be used for the management of displaced femoral neck fractures providing better functional outcomes and lower periprosthetic bone loss.
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Lin DJ, Ju CP, Huang SH, Tien YC, Yin HS, Chen WC, Chern Lin JH. Mechanical testing and osteointegration of titanium implant with calcium phosphate bone cement and autograft alternatives. J Mech Behav Biomed Mater 2011; 4:1186-95. [DOI: 10.1016/j.jmbbm.2011.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/30/2011] [Accepted: 04/03/2011] [Indexed: 10/18/2022]
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Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement? Patient Saf Surg 2010; 4:16. [PMID: 20961437 PMCID: PMC2972258 DOI: 10.1186/1754-9493-4-16] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 10/20/2010] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Femoral neck fractures in the elderly are frequent, represent a great health care problem, and have a significant impact on health insurance costs. Reconstruction options using hip arthroplasty include unipolar or bipolar hemiarthroplasty (HA), and total hip arthroplasty (THA). The purpose of this review is to discuss the indications, limitations, and pitfalls of each of these techniques. METHODS The Pubmed database was searched for all articles on femoral neck fracture and for the reconstruction options presented in this review using the search terms "femoral neck fracture", "unipolar hemiarthroplasty", "bipolar hemiarthroplasty", and "total hip arthroplasty". In addition, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were then reviewed with regard to the different techniques, outcome and complications of the distinct reconstruction options. RESULTS THA yields the best functional results in patients with displaced femoral neck fractures with complication rates comparable to HA. THA is beneficially implanted using an anterior approach exploiting the internervous plane between the tensor fasciae latae and the sartorius muscles allowing for immediate full weight-bearing. Based on our findings, bipolar hemiarthroplasty, similar to unipolar hemiarthroplasty, cannot restorate neither anatomical nor biomechanical features of the hip joint. Therefore, it can only be recommended as a second line of defense-procedure for patients with low functional demands and limited live expectancy. CONCLUSIONS THA is the treatment of choice for femoral neck fractures in patients older than 60 years. HA should only be implanted in patients with limited life expectancy.
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Affiliation(s)
- Christian Ossendorf
- Department of Surgery, Division of Trauma Surgery, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
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