Cemented Vs Cementless Femoral Fixation for Total Hip Arthroplasty After Displaced Femoral Neck Fracture: A Nationwide Analysis of Short-Term Complications and Readmission Rates

Heckmann, Nathanael; Chen, Xiao T.; Ballatori, Alexander; Ton, Andy; Shahrestani, Shane; Chung, Brian; Christ, Alexander B.

doi:10.1016/j.arth.2021.06.029

Cited by 19 publications

(19 citation statements)

References 30 publications

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“…The most common complication in the present study was periprosthetic fracture (PPF), which occurred once (1%) in the Original stem group (1 intra-operative), and twice (2%) in the ProxCoat group (1 intra-operative and 1 postoperative). PPF is one of the most common complications in uncemented stems [40,41]; the rate of PPF reported in other series varied between 0.5 and 12% [40,[42][43][44], which is comparable to the present study.…”

Section: Discussionsupporting

confidence: 89%

Effect of femoral stem surface coating on clinical and radiographic outcomes of cementless primary total hip arthroplasty: a patient-matched retrospective study

Viamont-Guerra

Ramos-Pascual

Saffarini

et al. 2022

International Orthopaedics (SICOT)

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Purpose This study aims to determine whether changing the stem coating grants superior outcomes at a minimum followup of five years. Methods Retrospective review of a consecutive series of primary total hip arthroplasties (THAs) operated by direct anterior approach between 01/01/2013 and 31/12/2014. Two stems were compared, which were identical except for their surface coating; "the Original stem" was fully coated with hydroxyapatite (HA), while "the ProxCoat stem" was proximally coated with plasma-sprayed titanium and HA. Matching was performed. Clinical assessment included modified Harris hip score (mHHS), Oxford hip score (OHS), and forgotten joint score (FJS). Radiographic assessment evaluated alignment, subsidence, pedestal formation, heterotopic ossification, radiolucent lines ≥ 2 mm, spot welds, cortical hypertrophy, and osteolysis. Results 232 hips received the Original stem and 167 the ProxCoat stem, from which respectively five hips (2.2%) and no hips (0%) underwent revision. Matching identified two groups of 91 patients, with comparable patient demographics. At > five years follow-up, there were no differences in OHS (16 ± 6 vs 15 ± 5; p = 0.075) nor FJS (81 ± 26 vs 84 ± 22; p = 0.521), but there were differences in mHHS (89 ± 15 vs 92 ± 12; p = 0.042). There were no differences in alignment, subsidence, pedestal formation, heterotopic ossification, cortical hypertrophy, and osteolysis. There were differences in prevalence of proximal radiolucent lines (12% vs 0%; p < 0.001) and distal spot welds (24% vs 54%; p < 0.001). Conclusion At a minimum follow-up of five years, this study on matched patients undergoing primary THA found that ProxCoat stems results in significantly fewer radiolucent lines, more spot welds, and less revisions than Original stems, thus suggesting better bone ingrowth.

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Section: Discussionsupporting

confidence: 89%

Effect of femoral stem surface coating on clinical and radiographic outcomes of cementless primary total hip arthroplasty: a patient-matched retrospective study

Viamont-Guerra

Ramos-Pascual

Saffarini

et al. 2022

International Orthopaedics (SICOT)

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“…Parker et al [29] reported a clear advantage of cemented arthroplasties with regard to faster mobilization and reduction of postoperative pain in a systematic review [29]. Furthermore, the rate of aseptic revisions was significantly reduced among cemented hemiarthroplasties and total hip arthroplasties [27,[30][31][32]. For cemented hemiarthroplasties within the first 2 days after surgery, Fenelon et al [33] reported an increased mortality compared to uncemented stems.…”

Section: Discussionmentioning

confidence: 99%

“…Data from the NHS demonstrated significantly lower mortality in cemented hemiarthroplasties after 30 days post-surgery and later [ 34 ]. While a feared complication of cemented procedures is the increased risk of cardiovascular events, another benefit is the association with a lower number of perioperative fractures [ 30 , 35 ]. Periprosthetic fractures are the major reason of revision surgery and show a 7% five-year incidence [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and treatment of intracapsular femoral neck fractures in Germany

Szymski

Walter

Lang

et al. 2022

Arch Orthop Trauma Surg

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Introduction Intracapsular femoral neck fractures are one of the most common fractures in Germany. Nevertheless, the epidemiology and treatment modalities are not described comprehensively. For this reason, this study highlights the epidemiology of femoral neck fractures in different age groups and summarizes treatment strategies within the period from 2009 to 2019 based on nationwide data. Materials and methods In this retrospective cohort study all cases of intracapsular femoral neck fractures (ICD-10: S72.0) between 2009 and 2019 in Germany were analyzed with regard to epidemiology, incidence and treatment. Operation and procedure classification system (OPS)- codes in combination with intracapsular femoral neck fracture as main diagnosis were taken to investigation. Data was provided by the Federal Statistical Office of Germany (Destatis). Results A total of 807,834 intracapsular femoral neck fractures with a mean incidence of 110.0 per 100,000 inhabitants annually was detected within eleven years. In 68.8% of all fractures patients were female. Most patients were older than 70 years (82.4%), and 56.7% were older than 80 years. The overall increase of fracture numbers between 2009 and 2019 was 23.2%. Joint replacement has been most often performed (80.4%). Hemiarthroplasty (56.8%) and total hip arthroplasty (22.8%) were the most common procedures with an increase of 27.1 and 38.6%, respectively. The proportion of cemented hemiarthroplasties was 86.2% while 51.3% of all total hip arthroplasties were totally or partially cemented. Osteosyntheses were mainly conducted using dynamic compression screws (34.0%), conventional screws (31.3%) and nails (22.2%). Conclusion The incidence of intracapsular femoral neck fractures in Germany has been increasing continuously within the last decade. In particular, patients over 80 years suffered predominantly from this type of fracture. The majority was treated with a joint replacement procedure, mainly cemented hemiarthroplasty.

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“…Proximal femoral nail fixation is a minimally invasive intramedullary fixation procedure based on biomechanical principles using an anti-rotation helical blade to fix the femoral neck. Because the helical blade is very close to the bone, it can prevent fracture rotation and varus deformity, and enhance fracture stability ( 22 – 25 ). As a minimally invasive operation, small surgical incision, small trauma, short operation time, and avoiding periosteum and soft tissue dissection are the inherent advantages of proximal femoral nailing ( 26 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Hip Arthroplasty and Closed Reduction Proximal Femur Nail in the Treatment of Elderly Patients with Hip Fractures

Zhou

Shen

2022

Front. Surg.

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ObjectiveTo compare the clinical effect of hip arthroplasty and closed reduction intramedullary nailing of proximal femur in the treatment of elderly hip fracture patients.MethodsThere are 90 elderly hip fracture patients being recruited in the present study. Fifty patients in Group A received closed reduction intramedullary nailing of proximal femur, and 40 patients in Group B received hip arthroplasty. All patients were followed up for 12 months after surgery, clinical outcomes included surgical indicators, visual analog scale (VAS) score, Harris score, quality of life, mental status, and complications.ResultsThe surgery time, bleeding volume, infusion volume of patients in Group A are all significantly lower than those in Group B (p < 0.05), while the weight-bearing activity time and first workout time of Group A are all significantly higher than those in Group B (p < 0.05). The VAS score in patients of Group A at 1 week postoperative is significantly lower than that in patients of Group B (p < 0.05). The Harris score in patients of Group A at 3, 6, and 12 months postoperative are all significantly higher than those in patients of Group B (p < 0.05), and the excellent and good rate of hip function recovery at 12 months postoperative in patient of Group A is significantly lower than that in patients of Group B (80% vs. 95%, p < 0.05). Furthermore, The score of SF-36 standardized physical component, SF-36 standardized mental component and Barthel in patients of Group A at 6 months postoperative are significantly lower than those in patients of Group B (p < 0.05), and the score of mini-mental state examination is significantly higher (p < 0.05), while there are not significantly different at 12 months postoperative (p > 0.05). The incidence of postoperative complications in Group A was significantly lower than that in Group B (10% vs. 27.5%, p < 0.05).ConclusionElderly hip fracture patients treated with closed reduction intramedullary nailing of proximal femur has less surgical trauma and lower complication rates, but slower postoperative recovery compared with hip arthroplasty.

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Cemented Vs Cementless Femoral Fixation for Total Hip Arthroplasty After Displaced Femoral Neck Fracture: A Nationwide Analysis of Short-Term Complications and Readmission Rates

Cited by 19 publications

References 30 publications

Effect of femoral stem surface coating on clinical and radiographic outcomes of cementless primary total hip arthroplasty: a patient-matched retrospective study

Effect of femoral stem surface coating on clinical and radiographic outcomes of cementless primary total hip arthroplasty: a patient-matched retrospective study

Incidence and treatment of intracapsular femoral neck fractures in Germany

A Comparative Study of Hip Arthroplasty and Closed Reduction Proximal Femur Nail in the Treatment of Elderly Patients with Hip Fractures

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