Hemiarthroplasty for Femoral Neck Fractures in the Elderly: A Comparison of Cemented and Uncemented Femoral Stems

Comparative outcomes of cemented versus cementless stems in bipolar hemiarthroplasty for femoral neck fractures

We aimed to compare the clinical and surgical outcomes of cemented vs uncemented bipolar hemiarthroplasty in the treatment of femoral neck fractures in the elderly. Patients (n = 99) without preoperative cardiopulmonary problems undergoing bipolar hemiarthroplasty for femoral neck fracture between August 2015 and February 2019 were randomly divided into cemented (group C) and uncemented (group U) stem fixation groups. Mean operative time, mean intraoperative blood loss, and percentage of intraoperative use of vasopressors, pre- and postoperative activities of daily living (ADL), incidence of postoperative complications, and radiological evaluation of stem alignment were evaluated. A total of 99 patients were included (group C, n = 42; group U, n = 57). Group C had a significantly longer mean operative time (P < .001) and a significantly higher percentage of intraoperative vasopressor use as compared to group U (P < .05). In contrast, the amount of intraoperative blood loss was similar between the 2 groups (P = .30). Likewise, there was no statistically significant difference in pre- and postoperative ADL performance between the groups (P = .70 and .44, respectively). Postoperative computed tomography revealed that stem anteversion was higher in group C than in group U (P < .05). Cemented and uncemented stems were equivalent in terms of blood loss and postoperative complications in patients with femoral neck fractures. Uncemented stem showed advantages in reducing operative time and intraoperative vasopressor administration. Also, fixation method was not investigated in this study.

Treatment of femoral neck fractures using actis stem: complication rate in 188 uncemented hemiarthroplasties

INTRODUCTION

Cemented hemiarthroplasty (HA) is preferred in treating dislocated femoral neck fractures in elderly, osteoporotic patients, since uncemented HA was associated with mechanical complications more frequently. Cementation can conversely cause cardiopulmonary complications, leading to demand on safe, uncemented implants addressing osteoporosis. This study is set up as a retrospective feasibility study on the use of an uncemented, collared wedge implant (Actis®, DePuy Synthes, Warsaw, IN), for HA in elderly patients, focusing on complication rate.

MATERIALS AND METHODS

From 1,194 patients, treated with HA in two study centers between 2017-2022, 188 received Actis® uncemented stem with bipolar head. Complete follow-up were retrospectively collected in all patients.

RESULTS

In 188 patients (f: 64.9%; age: 83.1 ± 7.7a) included, no case of intra-operative mortality was recorded. 2 day mortality was 1.1%, 30 day mortality was 7.4% and 1 year mortality was 28.2%. 2 (1.1%) intra-operative fractures did not receive surgical revision, 3 (1.6%) post-operative periprosthetic fractures caused separate admission and revision. 2 cases (1.1%) of early infection required surgical revision.

CONCLUSION

Our data provide proof of concept, that Actis® Stem allows an alternative, uncemented treatment option for displaced femoral neck fractures with HA. In case of preoperative or intraoperative medial cortical bone defects, stability of this implant is deteriorated.

Reduced mortality associated to cementless total hip arthroplasty in femoral neck fracture

Mortality related to femoral neck fractures remains a challenging health issue, with a high mortality rate at 1 year of follow-up. Three modifiable factors appear to be under control of the surgeon: the choice of the implant, the use of cement and the timing before surgery. The aim of this research project was to study the impact on mortality each of these risk factors play during the management of femoral neck fractures. A large retrospective epidemiological study was performed using a national database of the public healthcare system. The inclusion criteria were patients who underwent joint replacement surgery after femoral neck fracture during the years 2015 to 2017. All data points were available for at least 2 years after the fracture. The primary outcome was mortality within 2 years following the surgery. We evaluated the association between mortality and the type of the implant hemiarthroplasty (HA) versus total hip arthroplasty (THA), cemented versus non cemented femoral stem as well as the timing from fracture to surgical procedure. A multivariate analysis was performed including age, gender, comorbidities/autonomy scores, social category, and obesity. We identified 96,184 patients who matched the inclusion criteria between 2015 and 2017. 64,106 (66%) patients underwent HA and 32,078 (33.4%) underwent THA. After multivariate analysis including age and comorbidities, patients who underwent surgery after 72 h intra-hospital had a higher risk of mortality: Hazard Ratio (HR) = 1.119 (1.056-1.185) p = 0.0001 compared to the group who underwent surgery within 24 h. THA was found to be a protective factor HR = 0.762 (0.731-0.795) p < 0.0001. The use of cement was correlated with higher mortality rate: HR = 1.107 (1.067-1.149) p < 0.0001. Three key points are highlighted by our study in the reduction of mortality related to femoral neck fracture: the use of hemiarthroplasty a surgery performed after 48 h and the use of cement for femoral stem fixation adversely affect mortality risk.

Intraoperative method of femoral head central measurement to prevent leg length discrepancy following hemiarthroplasty

Purpose

This study aimed to introduce and investigate the safety and efficiency of the intraoperative central measurement method of the femoral head (IM-CMFH) to prevent leg length discrepancies (LLD) after hemiarthroplasty.

Methods

Overall, 79 patients aged 75 to 85 years with femoral neck fractures who underwent hemiarthroplasty were divided into two groups: the Control group (n = 46) and the IM-CMFH group (n = 33). The two groups were compared for postoperative LLD and the proportions of patients with greater than 10 mm, 6-10 mm, and within 5 mm, postoperative femoral offset (FO) difference and the proportions of patients within 5 mm, incremental greater than 5 mm and reduction greater than 5 mm. Next, the vertical distance from the center of the femoral head to the tip of the greater trochanter on the anatomical axis of the femur (VD-CFH-TGTAAF), leg length, and FO on the operative and non-operative sides within the IM-CMFH group. Finally, operative time, hemoglobin loss, Harris scores 3 months after surgery, and postoperative complications were analyzed.

Results

Compared with the control group, the postoperative LLD and FO differences were significantly lower in the IM-CMFH group (P = 0.031; P = 0.012), and the proportion of patients with postoperative LLD greater than 10 mm decreased significantly (P = 0.041), while the proportion of patients with FO difference of within 5 mm increased (P = 0.009). In addition, there was no significant difference in the operative time, hemoglobin loss, and Harris score at 3 months postoperatively and postoperative complications between the two groups (P > 0.05). There was no significant difference in FO, leg-length, and VD-CFH-TGTAAF between the operative and non-operative sides within the IM-CMFH group (P > 0.05).

Conclusion

Satisfactory results can be achieved by using the IM-CMFH to prevent LLD following hemiarthroplasty, and there is no increase in operative time, hemoglobin loss, or postoperative complications. This technique is efficient for hemiarthroplasties and is both simple and convenient.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

INTRODUCTION

Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes.

MATERIALS AND METHODS

We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival.

RESULTS

The women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times.

DISCUSSION

Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

INTRODUCTION

Hip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients' survival outcomes.

MATERIALS AND METHODS

We conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients' survival.

RESULTS

The women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times.

DISCUSSION

Our study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.