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Bacaksiz T, Akan I. The Fate of Reoperation After Proximal Femur Fracture Surgery in Elderly Population. Cureus 2023; 15:e39856. [PMID: 37404442 PMCID: PMC10314995 DOI: 10.7759/cureus.39856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION The overall complication rate after proximal femur fracture surgery is high. This study aims to define the reoperation reasons and outcomes of reoperations after proximal femur fracture surgery in elderly patients. METHODS This retrospective cohort study included patients over 75 years of age who underwent surgery for an intertrochanteric femur fracture and femoral neck fracture between 2014 and 2021. The minimum follow-up was 12 months, or until the patient was deceased. The primary outcome measure was the success of reoperation with regard to fracture type and implant. Results: A total of 89 patients required reoperation for an overall rate of 9.3% during follow-up. Infection was the leading reason for reoperation. Hemiarthroplasty (HA) for intertrochanteric fracture is associated with a high rate of infection compared with HA for femoral neck fracture. The success rate of reoperation due to postoperative infection was poor (46.3%) whereas the success rate for other implant-related complications was favorable (91.6%). Conclusion: The risk of postoperative infection after HA is significantly higher for intertrochanteric femur fractures compared to neck fractures in the elderly population. The limited success after postoperative infection should be taken into consideration in decision-making.
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Affiliation(s)
- Tayfun Bacaksiz
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University, Izmir, TUR
| | - Ihsan Akan
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
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Chen WH, Guo WX, Gao SH, Wei QS, Li ZQ, He W. Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: A systematic review and meta-analysis. World J Clin Cases 2021; 9:9878-9888. [PMID: 34877326 PMCID: PMC8610898 DOI: 10.12998/wjcc.v9.i32.9878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/27/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Proximal femoral nails (PFNs) are the most common method for the treatment of unstable intertrochanteric femoral fractures (IFFs), but postoperative bed rest is required. There is a large amount of blood loss during the operation. Osteoporosis in elderly patients may cause nonunion of fractures and other complications. Arthroplasty can give patients early weight bearing and reduce financial burden, but whether it can replace PFNs remains controversial.
AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.
METHODS A search was conducted in the PubMed, Embase, and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN. The search time was limited from January 1, 2005 to November 1, 2020. Two investigators independently screened studies, extracted data and evaluated the quality according to the inclusion and exclusion criteria. According to the research results, the fixed effect model or random effect model were selected for analysis. The following outcomes were analyzed: Harris Hip score, mortality, complications, operation time, blood loos, hospital stay, weight-bearing time, fracture classification and type of anesthesia.
RESULTS We analyzed four randomized controlled trials that met the requirements. A total of 298 patients were included in these studies. According to the AO/OTA classification, there are 20 A1 types, 136 A2 types, 42 A3 types and 100 unrecorded types. Primary outcome: The Harris Hip Score at the final follow-up of the PFN group was higher [mean difference (MD): 9.01, 95% confidence interval (CI): 16.57 to 1.45), P = 0.02]. There was no significant difference between the two groups in the rate of overall mortality [risk ratio (RR): 1.44, P = 0.44] or the number of complications (RR: 0.77, P = 0.05). Secondary outcomes: blood loss of the arthroplasty group was higher (MD: 241.01, 95% CI: 43.06–438.96, P = 0.02); the operation time of the PFN group was shorter (MD: 23.12, 95%CI: 10.46–35.77, P = 0.0003); and the length of hospital stay of the arthroplasty group was shorter [MD: 0.97, 95% CI: 1.29 to 0.66), P < 0.00001]. There was no difference between the two groups in the type of anesthesia (RR: 0.99). There were only two studies recording the weight-bearing time, and the time of full weight bearing in the arthroplasty group was significantly earlier.
CONCLUSION Compared with PFN, arthroplasty can achieve weight bearing earlier and shorten hospital stay, but it cannot achieve a better clinical outcome. Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.
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Affiliation(s)
- Wen-Huan Chen
- The Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Wen-Xuan Guo
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Shi-Hua Gao
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Qiu-Shi Wei
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Zi-Qi Li
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Wei He
- Department of Joint Surgery, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
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Liu L, Sun Y, Wang L, Gao Q, Li A, Wang J, Gao Y. Total hip arthroplasty for intertrochanteric fracture fixation failure. Eur J Med Res 2019; 24:39. [PMID: 31882018 PMCID: PMC6935170 DOI: 10.1186/s40001-019-0398-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022] Open
Abstract
Background Intertrochanteric fracture is a common fracture suffered by elderly patients. Total hip arthroplasty (THA) is regarded as a salvage operation to restore hip joint function after fixation failure, which remains somewhat controversial due to some clinical potential issues. Methods 18 elderly patients (average age 70.3 years) each with intertrochanteric fracture fixation failure treated with THA between September 2013 and October 2016 were retrospectively analyzed. Internal fixation treatments involved 5 patients who had received proximal femoral nail anti-rotation, 7 who received locking proximal femur plates and 6 who received dynamic hip screws. All patients were treated with THA using biological acetabular prosthesis and hip arthroplasty (HA) coating skillet femoral prosthesis, with the greater trochanter fixed using wire or steel when necessary. Patients’ Harris scores pre- and post-treatment, SF-36 Health Questionnaire score and digital radiology (DR) were used for joint prostheses initial stability and survival evaluation. Results 15 patients completed follow-up periods ranging between 19 and 54 months (mean 26.2 months; 1 patient died from a pulmonary embolism, 1 patient died from pulmonary heart disease 1 year after surgery and 1 patient withdrew for personal reasons). There were no joint infections, periprosthetic fractures or dislocations. The average Harris score increased significantly, from 32.68 ± 12.04 points before surgery to 91.08 ± 5.9 points at 24 months post-treatment. SF-36 scores were significantly increased. Conclusion THA as salvage treatment for failed internal fixation of intertrochanteric femoral fractures in elderly patients significantly reduced hip pain and restored joint function, and early clinical outcomes were satisfactory.
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Affiliation(s)
- Liyun Liu
- School of Medicine, Henan University, Kaifeng, 475004, Henan, People's Republic of China.,Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, 45000, Henan, People's Republic of China
| | - Yongqiang Sun
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, 45000, Henan, People's Republic of China
| | - Linlin Wang
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, 45000, Henan, People's Republic of China
| | - Qiankun Gao
- Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, 45000, Henan, People's Republic of China
| | - Ang Li
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Jialin Wang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Yanzheng Gao
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China.
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Kang JS, Ko SH, Na Y, Youn YH. Clinical and Radiological Outcomes of Rectangular Tapered Cementless Stem According to Proximal Femoral Geometry in Elderly Asian Patients. Hip Pelvis 2019; 31:224-231. [PMID: 31824877 PMCID: PMC6892905 DOI: 10.5371/hp.2019.31.4.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose A retrospective analysis of mid- to long-term clinical and radiological outcomes of Korean patients over 60 years of age who underwent hip arthroplasty using a cementless rectangular tapered stem according to Dorr proximal femur geography. Materials and Methods From January 2007 to December 2013, 107 patients (112 hips) underwent hip arthroplasty using the C2 stem. The mean age of patients was 77.4 years (range, 60–91 years) and the mean follow-up duration was 91.1 months (range, 60–116 months). All patients were evaluated clinically and radiologically with special attention to Dorr femoral bone classification, implant fixation, radiolucent line (RLL), and thigh pain. Results All implants demonstrated radiographic evidence of stable fixation by bone ingrowth without any change in position. The mean Harris hip score improved from 65.5±16.0 (preoperative) to 90.5±15.9 (final follow-up) (P<0.001). Incidence of RLLs, stress shielding, and thigh pain was highest in patients with Dorr type A (RLL, P=0.021; stress shielding, P=0.030; thigh pain, P<0.001). One stem revision was performed due to deep infection. The Kaplan–Meier survival rate of the femoral stem was 97.6%. Conclusion The overall survival rate of the C2 stems was greater than 97%; there were no significant differences in survival of the C2 stem according to the Dorr classification. The incidences of RLL of thigh pain and RLL were significantly different among Dorr classifications and (highest in patients with Dorr type A).
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Affiliation(s)
- Joon Soon Kang
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Sang Hyun Ko
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yeop Na
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yung Hun Youn
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
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Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2019; 44:623-633. [PMID: 31201487 DOI: 10.1007/s00264-019-04351-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/21/2019] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Unstable intertrochanteric femoral fractures in the elderly require either fixation or joint sacrificing surgery; proximal femoral nail (PFN) and bipolar hemiarthroplasties (BPH) are the most common interventions. PFN is considered to be the ideal construct for these fractures; however, the usage of hemiarthroplasties to facilitate earlier mobilization has been on a rise. Currently there is no consensus on the superiority of one of these two techniques over the other and the present review was done to determine this. RESEARCH QUESTION Is PFN a better alternative to BPH for unstable intertrochanteric femur fractures in the elderly? OBJECTIVE The present systematic review and meta-analysis was conducted to determine the superiority of PFN over BPH by comparing the primary outcomes like mortality, Harris Hip scores (HHS), complications, and re-operations. Additionally, secondary outcomes like blood loss, duration of surgery, and period of hospital stays were also compared. METHODOLOGY Three databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles that directly compared PFN and BPH in unstable intertrochanteric femur fractures in the elderly. RESULTS We analyzed a total of seven studies published between the years 2005 to 2017. There were four retrospective and three prospective randomized controlled studies. The number of patients in these studies ranged from 53 to 303. PRIMARY OUTCOMES There was a significant difference in HHS between two groups with standard mean difference of - 0.51 (range - 0.67 to -0.36), favouring the PFN group. The rate of mortality was higher in the BPH group with odds ratio of 2.07 (range 1.40-3.08). Implant-related complications like fractures and subsidence were more in BPH group but this was not significant. SECONDARY OUTCOMES Mean surgical time (standard mean difference 2.19) and blood loss (3.75) were significantly less in the PFN group. The duration of hospital stay was also found to be significantly less in the PFN group (2.66). CONCLUSION Proximal femoral nails are superior to bipolar hemiarthroplasties for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally it is faster surgery, with lesser blood loss contributing to better results.
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Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Siddhartha Sharma
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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Yoo JI, Cha YH, Kim KJ, Kim HY, Choy WS, Hwang SC. Comparison between Cementless and Cemented Bipolar Hemiarthroplasty for Treatment of Unstable Intertrochanteric Fractures: Systematic Review and Meta-analysis. Hip Pelvis 2018; 30:241-253. [PMID: 30534543 PMCID: PMC6284077 DOI: 10.5371/hp.2018.30.4.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose This study was conducted to compare cemented and cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures via meta-analysis and systematic review of relevant studies. Materials and Methods Systematic review and meta-analysis were performed on 31 available clinical studies; 19 of these studies used cemented stems, 12 used cementless stems, one used both types of stems, and two studies involved a comparative analysis of both stem types. Results There were statistically significant differences in rates of leg length discrepancy (LLD) greater than 1 cm between the cemented (event rate, 0.089) and cementless groups (event rate, 0.015 and 0.047; P=0.03). Conclusion Cemented bipolar hemiarthroplasty and cementless bipolar hemiarthroplasty performed on elderly patients with unstable intertrochanteric fracture revealed similar mortality and complication rates; however, the rate of LLD greater than 1 cm was significantly higher in the cemented group compared with the cementless group.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Kap-Jung Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Ha-Yong Kim
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
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Functional outcomes of internal fixation and arthroplasty in the treatment of intertrochanteric femoral fractures: a systematic review. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nie B, Wu D, Yang Z, Liu Q. Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly: A meta-analysis. Medicine (Baltimore) 2017; 96:e7446. [PMID: 28682912 PMCID: PMC5502185 DOI: 10.1097/md.0000000000007446] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND More and more studies conduct to compare intramedullary fixation (IMF) with arthroplasty in treating intertrochanteric hip fractures, but it remains controversy. The aim of this meta-analysis was to find out whether IMF or arthroplasty was more appropriate for treating intertrochanteric hip fractures in elderly patients. METHODS Relevant studies were searched in the electronic databases of PubMed, Embase, and The Cochrane Central Register of Controlled Trials from January 1980 to September 2016 with English language restriction. Surgical information and postoperative outcomes were analyzed using RevMan 5.3 version. RESULTS A total of 1239 patients from 11 studies which satisfied the eligibility criteria were included. Compared with IMF, the use of arthroplasty reduced implant-related complications (odds ratio [OR]: 2.05, P = .02) and reoperation rate (OR: 7.06, P < .001), and had similar length of hospital stay (weighted mean difference [WMD]: -0.41, P = .63). However, IMF reduced blood loss (WMD: -375.01, P = .001) and transfusion requirement (OR: 0.07, P < .001), shorter operation time (WMD: -18.92, P = .010), higher Harris hip score (WMD: 4.19, P < .001), and lower rate of 1-year mortality (OR: 0.67, P = .02) compared with arthroplasty. CONCLUSION The main treatment of intertrochanteric hip fractures is internal fixation using IMF. In the absence of concrete evidence, arthroplasty should be undertaken with caution in carefully selected patient and surgeon should be aware of the increased complexity of doing the arthroplasty in these elderly patients. Further high-quality randomized controlled trials (RCTs) are needed to provide robust evidence and evaluate the treatment options.
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Affiliation(s)
- Boyuan Nie
- Department of Orthopedics, Dayi Hospital of Shanxi Medical University Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
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Park BJ, Cho HM, Min WB. A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients. Hip Pelvis 2015; 27:152-63. [PMID: 27536619 PMCID: PMC4972720 DOI: 10.5371/hp.2015.27.3.152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/07/2015] [Accepted: 07/28/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. Materials and Methods From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). Results Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. Conclusion In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.
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Affiliation(s)
- Bong-Ju Park
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hong-Man Cho
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
| | - Woong-Bae Min
- Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea
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