Association of Intra-Operative Metaphyseal Fractures with Prosthesis Size during Hemiarthroplasty of the Hip

Barlas, K J; Ajmi, Q S; Bagga, T K; Howell, F R; Roberts, J A; Eltayeb, M

doi:10.1177/230949900801600108

Cited by 16 publications

(7 citation statements)

References 16 publications

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“…The 7% incidence of IOF using a contemporary uncemented prosthesis design is comparable to that of others. 2 11 12 13 16) In comparison to previous studies using the JRI uncemented hydroxyapatite-coated prosthesis, 11 17 18) our IOF rate compares favourably. We attribute this to the longstanding experience and training in implanting the uncemented JRI HA prosthesis at our institution.…”

Section: Discussioncontrasting

confidence: 51%

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Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures

et al. 2018

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BackgroundThe 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.MethodsWe 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.ResultsThere 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).ConclusionsOur 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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Section: Discussioncontrasting

confidence: 51%

“…Most of the fractures in our cohort were around the femoral metaphysis (Vancouver A). Barlas et al, 17) in their cohort of 273 hip fractures treated using the JRI furlong H-A.C. prosthesis, demonstrated an IOF rate of 10.3%. Similarly, they also showed that Vancouver A was the only type of IOF sustained.…”

Section: Discussionmentioning

confidence: 95%

Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures

et al. 2018

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“…Further complications of bipolar hemiarthroplasty include intra-operative metaphyseal fractures reported in 10% of cases in a series of 273 patients with displaced femoral neck fractures, depending on extension of fracture dislocation [51]. The dislocation rate was reported to be 1.5% in a large series of 1934 hips [52], half of which redislocate after reduction.…”

Section: Resultsmentioning

confidence: 99%

Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement?

et al. 2010

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BackgroundFemoral 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.MethodsThe 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.ResultsTHA 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.ConclusionsTHA 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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“…16 In our study, the rate of intra-operative fracture in cementless bipolar hemiarthroplasty was 8.6%, which is comparable to 5.2% to 10% reported in other studies. 17,18 Greater trochanteric fractures occurred more commonly during proximal broaching or trial insertion. Surgeons should avoid excessive lateralisation of implants during broaching, reaming, and removal of the trial implant.…”

Section: Figurementioning

confidence: 99%

Intra-Operative Fractures in Cementless Bipolar Hemiarthroplasty

Kuo

Tan

Lee

2015

J Orthop Surg (Hong Kong)

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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 Intra-operative fractures in cementless bipolar hemiarthroplasty

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Association of Intra-Operative Metaphyseal Fractures with Prosthesis Size during Hemiarthroplasty of the Hip

Abstract: In elderly women with compromised bone quality, extra care is needed to achieve better fitting so as to avoid iatrogenic metaphyseal fractures. Under-sizing or cementing of the prosthesis is recommended when encountering difficulties.

Cited by 16 publications

References 16 publications

Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures

Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures

Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement?

Intra-Operative Fractures in Cementless Bipolar Hemiarthroplasty

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