Arthroplasties (with and without bone cement) for proximal femoral fractures in adults

Parker, Martyn J.; Gurusamy, Kurinchi Selvan; Azegami, Shin

doi:10.1002/14651858.cd001706.pub4

Cited by 197 publications

(144 citation statements)

References 34 publications

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“…The Cochrane Review published in 2010 concluded that patients with cemented HA experienced less pain at one year or later and had improved post-operative mobility compared with patients having uncemented HA, while mortality and surgical complications were not significantly different between these groups [26]. A recent systematic review concluded that cemented HA reduces the risk of residual pain and provides better functional outcomes [27].…”

Section: Discussionmentioning

confidence: 99%

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Hongisto

Pihlajamäki

Niemi³

et al. 2014

International Orthopaedics (SICOT)

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Purpose For femoral neck fractures, recent scientific evidence supports cemented hemiarthroplasty (HA) over uncemented HA and suggests that total hip arthroplasty (THA) should be performed more frequently. We report the current surgical trends in treating femoral neck fractures in Finland. Methods The study was conducted using the Finnish National Hospital Discharge Register and included all Finns at least 50 years of age who underwent surgery for femoral neck fractures from 1998 through 2011. Age-and sex-specific incidence rates and annual proportion of each treatment method were calculated. Results During 1998-2011, a total of 49,514 operations for femoral neck fracture were performed in Finland. The proportion of uncemented HA increased from 8.1 % in 2005 to 22.2 % in 2011. During the same time, the proportion of cemented HA decreased from 63.9 to 52.5 %, internal fixation decreased from 23.2 to 16.1 % and THA increased from 4.9 to 9.2 %. Conclusions Between 2005 and 2011, the proportion of uncemented HA for femoral neck fractures increased markedly in Finland, while cemented HA and internal fixation declined. During this time, the use of THA nearly doubled. The current evidence-based guidelines for treatment of femoral neck fractures were mainly followed, but the increase in uncemented HA procedures contradicts recent scientific evidence.

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Section: Discussionmentioning

confidence: 99%

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Hongisto

Pihlajamäki

Niemi³

et al. 2014

International Orthopaedics (SICOT)

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“…Others, such as Calder et al [1] in a study on 250 patients, Cornell et al [2] in a study including 48 patients, Davison et al [3] reporting on 187 patients and finally Raia et al [4] in a study including 115 patients, also failed to present differences in clinical outcome or surgical complications when comparing uni-and bipolar HAs in randomised studies. Subsequently, a Cochrane review from 2010 based on the seven studies published so far concluded that there is currently not enough evidence to support the use of either unipolar or bipolar prosthesis when performing an HA [12].…”

Section: Discussionmentioning

confidence: 99%

Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures

Enocson

Hedbeck

Törnkvist

et al. 2011

International Orthopaedics (SICOT)

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Background Hip replacement using a hemiarthroplasty (HA) is a common surgical procedure in elderly patients with fractures of the femoral neck. Data from the Swedish Hip Arthroplasty Register suggest that there is a higher risk for revision surgery with the bipolar HA compared with the unipolar HA. Purpose In this study we analysed the reoperation and the dislocation rates for Exeter HAs in patients with a displaced femoral neck fracture, comparing the unipolar and bipolar prosthetic designs. Additionally, we compared the outcome for HAs performed as a primary intervention with those performed secondary to failed internal fixation. Methods We studied 830 consecutive Exeter HAs (427 unipolar and 403 bipolar) performed either as a primary operation for a displaced fracture of the femoral neck or as a secondary procedure after failed internal fixation of a fracture of the femoral neck. Cox regression analyses were performed to evaluate factors associated with reoperation and prosthetic dislocation. Age, gender, the surgeon's experience, indication for surgery (primary or secondary) and type of HA (unipolar or bipolar) were tested as independent variables in the model. Results The prosthetic design (uni-or bipolar) had no influence on the risk for reoperation or dislocation, nor had the age, gender or the surgeon's experience. The secondary HAs were associated with a significantly increased risk for reoperation (HR 2.6, CI 1.5-4.5) or dislocation (HR 3.3,3) compared to the primary HAs. We found no difference in the risk for reoperation or dislocation when comparing Exeter unipolar and bipolar HAs, but special attention is called for to reduce the risk of prosthesis dislocation and reoperation after a secondary HA.

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“…In bipolar hemiarthroplasty for displaced femoral-neck fractures in elderly patients, the evidence suggests that both traditional and modern cemented prostheses provide more favorable clinical outcomes than do uncemented implants [4,5,7]. Cemented hemiarthroplasty has a significantly lower rate of intraoperative and postoperative implant-related complications [6].…”

Section: Discussionmentioning

confidence: 99%

“…Hemiarthroplasty has a better functional outcome and fewer complications than internal fixation for the treatment of displaced femoral-neck fractures in elderly patients [2][3][4]. There are many different prostheses available for hemiarthroplasty, but the optimal technique remains controversial [4]. For example, it is unclear whether cemented or uncemented implants are preferable in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…For example, it is unclear whether cemented or uncemented implants are preferable in this patient population. Several clinical trials and systematic reviews have indicated favorable clinical outcomes with cemented implants: reduced hip pain, faster recovery from disability, and shorter hospital stays [4][5][6][7]. Taylor et al [6] reported that cemented hemiarthroplasty has a significantly lower rate of implant-related complications, in both the intraoperative and postoperative periods.…”

Section: Introductionmentioning

confidence: 99%

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Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

Miyamoto

Nakamura

Iida

et al. 2015

Eur Orthop Traumatol

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Background The purpose of this retrospective cohort study was to investigate the cementing effects on intraoperative blood pressure and the clinical and radiographic outcomes in elderly patients with femoral-neck fracture undergoing bipolar hemiarthroplasty using a polished, tapered stem. Methods This retrospective cohort study included 38 patients with acute displaced femoral-neck fractures (mean age, 76.2 years; mean follow-up, 21.4 months (68 % follow-up rate)). Results Intraoperative systolic blood pressure decreased significantly, both during cementing (109.1 mmHg) and after stem insertion (101.6 mmHg), compared with the level before rasping (122.2 mmHg; p=0.0036 and p=0.0001, respectively). Diastolic blood pressure decreased significantly after stem insertion (57.9 mmHg versus 67.3 mmHg before rasping; p= 0.003). Hypoxia did not occur. Nineteen patients were Donaldson's grade 1, 16 were grade 2, and none were grade 3. Twenty-three patients (74 %) maintained their preoperative activity level; 15 (26 %) worsened after surgery. Stem subsidence significantly increased over time: 0.32 mm at 6 months, 0.53 mm at 1 year, 0.91 mm at 2 years, 1.08 mm at 3 years, and 1.13 mm at 4 years. Conclusions Cemented bipolar hemiarthroplasty for displaced femoral-neck fracture in elderly patients leads to hypotension, unchanged arterial oxygen saturation, favorable clinical outcomes, and acceptable stem subsidence.

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Arthroplasties (with and without bone cement) for proximal femoral fractures in adults

Cited by 197 publications

References 34 publications

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Surgical procedures in femoral neck fractures in Finland: a nationwide study between 1998 and 2011

Unipolar versus bipolar Exeter hip hemiarthroplasty: a prospective cohort study on 830 consecutive hips in patients with femoral neck fractures

Blood-pressure changes and outcomes associated with cemented bipolar hemiarthroplasty for displaced femoral-neck fractures

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