Hemiprosthesis for Femoral Neck Fractures in the Elderly: A Retrospective Study of 319 Patients

A larger sized cup accelerates cartilage erosion of acetabulum after bipolar hemiarthroplasty in elderly with femur neck fracture

Bipolar hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up.We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65-96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A - bipolar cup size > actual head size, Group B - cup size < head size, Group C - cup size = head size. The degree of both superior and medial acetabular cartilage erosion was identified and calculated on postoperative radiographs using line of acetabular margin and Kohler line.The mean superior and medial acetabular erosion were 1.62 ± 1.6 mm (range, 0-4.4) and 4.15 ± 2.7 mm (range, 0-8.2) in Group A, 1.30 ± 1.3 mm (range, 0-3.8) and 4.11 ± 2.7 mm (range, 0-7.8) in Group B, and 0.90 ± 1.1 mm (range, 0-2.6) and 3.16 ± 2.9 mm (range, 0-7.9) in Group C (P = .039 and P = .187, respectively). The superior acetabular erosion showed significant difference between the 3 groups. During mean follow-up period of 12.3 years, 5 patients (5/117, 4.3%) underwent conversion to total hip arthroplasty due to superior acetabular erosion. All of 3 patient underwent BHA with a larger bipolar cup than the actual femoral head.A lager sized cup accelerated superior cartilage erosion of acetabulum after BHA. An optimal cup size should be considered when undergoing BHA in elderly patients.

Femoral Stem Subsidence and its Associated Factors after Cementless Bipolar Hemiarthroplasty in Geriatric Patients

Introduction

Early femoral stem subsidence has been a concern as a predictor of the beginning of implant loosening, especially on cementless hip arthroplasty implants. This study aimed to determine the factors that affect femoral stem subsidence and outcome following hemiarthroplasty in the geriatric population.

Materials and Methods

This is a retrospective study of 179 patients who underwent cementless bipolar hemiarthroplasty during the 2011-2019 period at an orthopaedic and traumatology hospital. Data on the patient's demography, pre-operative American Society Anaesthesiologist (ASA) score, body mass index (BMI), canal flare index (CFI), Dorr classification, and stem alignment were obtained. The primary outcomes were post-operative femoral stem subsidence, post-operative pain, and functional outcome using Harris Hip Score (HHS). Statistical analysis was conducted to identify risk factors associated with the primary outcome.

Results

The mean femoral stem subsidence was 2.16 ±3.4 mm. The mean post-operative Visual Analog Score (VAS) on follow-up was 1.38 ± 1. Mean HHS on follow-up was 85.28±10.3. American Society Anaesthesiologist score 3 (p = 0.011, OR = 2.77) and varus alignment (p=0.039, OR = 6.963) were related to worse stem subsidence. Otherwise, neutral alignment (p = 0.045 and OR = 0.405) gave protection against femoral stem subsidence. The female gender (p = 0.014, OR 2.53) was associated with postoperative pain onset. Neutral alignment had significant relationship with functional outcomes (p = 0.01; OR 0.33).

Conclusion

A higher ASA score and varus stem alignment were related to a higher risk of femoral stem subsidence. Meanwhile, neutral stem alignment had a protective effect on the femoral stem subsidence and outcome.

Change in the cause of inpatient mortality after arthroplasty: a retrospective study

Background

Although arthroplasty has been proved to be a safe and effective procedure, data regarding inpatient mortality rates associated with arthroplasty in China is unclear. We aimed to investigate the inpatient mortality rate after arthroplasty and the determinants of mortality at our center to ensure improved perioperative management.

Methods

This retrospective study included all patients who underwent arthroplasty at our center. Clinical data of mortality patients were collected. The incidence and the causes of inpatient mortality after arthroplasty were analyzed.

Results

A total of 4176 total knee arthroplasties, 2164 total hip arthroplasties, and 1031 femoral head replacements were performed. A rapid growth in surgery volume was observed, and more than 50% of the surgeries were performed in the last 5 years. The overall inpatient mortality rate is 0.3%; however, the mortality rate even decreased in the last 5 years. The cause of death changed over time. Pneumonia has become the leading cause of death in the past 5 years instead of cardiovascular complications.

Conclusions

Arthroplasty is a safe and effective procedure associated with a relatively low inpatient mortality in China. And inpatient mortality does not increase as the growing surgery volume due to improvement of perioperative management. However, patients presenting with risk factors and those undergoing non-elective procedures demonstrated a relatively high incidence of postoperative complications, particularly pneumonia.