Cementless hemiarthroplasty for femoral neck fractures in elderly patients

Öztürkmen, Yusuf; Karamehmetoğlu, Mahmut; Caniklioglu, Mustafa; Ince, Yener; Azboy, İbrahim

doi:10.4103/0019-5413.38582

Cited by 21 publications

(24 citation statements)

References 27 publications

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“…Two patients continue to use walking stick because of physiological weakness. We believe it is better to go for a procedure with prolonged recovery time than to do a procedure with negative effects on cardiopulmonary system in patients with already compromised system Functional evaluation with Harris Hip score at average 54 months (83.5) follow up was comparable with other studies by Yousuf Ozturukman et al, Marya et al and Hutt JRB et al [31][32][33] Many studies have shown good results with cementless total hip arthroplasty for fracture neck femur in elderly using hydroxyapatite or porous coated stems. [35][36][37][38][39][40][41] However due to high risk patients and limited ICU facility in our set up we opted for bipolar hemiarthroplasty and achieved satisfactory results.…”

Section: -21supporting

confidence: 75%

“…19 With porous or hydroxyapatite coated stems osteointegration occurs even in weaker osteoporotic bones as reported by many authors. [31][32][33] In present study we observed that with improved stem designs even in osteoporotic bones tight fit can be achieved though we excluded patients with Dorr type C and D femoral canals. These stems have larger diameters, allow proximal and distal fixation and hydroxyapatite coating allows press fit and good osteointegration.…”

Section: -21mentioning

confidence: 95%

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Cementless bipolar hemiarthroplasty for displaced fracture neck of femur with modular hydroxyapatite coated stem in elderly with cardiopulmonary co-morbidities

Bhat

Ali²,

Gulzar

et al. 2017

Int J Res Med Sci

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Background: Bipolar hemiarthroplasty is one of the common procedures done for fracture neck of femur in elderly. Debate about Cemented or cementless is still on. Cementing increases perioperative mortality by causing significant hemodynamic changes or embolization. Patients with cardiopulmonary complications are at higher risk of cementing complications. We report our series of 31 cases of fracture neck of femur with cardiopulmonary diseases operated over 2 years with modular cementless bipolar hemiarthroplasty.Methods: 31 elderly patients with cardiopulmonary co-morbidities (age=75 to 97 years) with displaced femoral neck fractures were operated between January 2011 to December 2013. Cementless bipolar hemiarthroplasty using hydroxyapatite coated stem was done by single surgeon using same implant in all the patients through anterolateral approach. Clinical and radiological follow-up was done with mean follow up of 54 months (36-72 months).Results: Total 31 cases with cardiopulmonary comorbidities were operated. The average follow up was 54 months. No intraoperative mortality was seen. 3 patients had splitting of femur during canal preparation. 1 patient died due to cardiac arrest in the post-operative period. 1 patient had surgical site infection. 3 patients had hemodynamic abnormalities and 1 patient had significant limb length discripency (1.5 cm). 2 patients died in the follow up because of comorbidities. 27 patients reached to pre-injury status with average harris hip score of 86 at final follow up.Conclusions: Cementless bipolar hemiarthroplasty with hydroxyapatite coated stem is a good option for femoral neck fractures in elderly patients with cardiopulmonary complications without risking the harmful effects of cementing.

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Section: -21supporting

confidence: 75%

Section: -21mentioning

confidence: 95%

Cementless bipolar hemiarthroplasty for displaced fracture neck of femur with modular hydroxyapatite coated stem in elderly with cardiopulmonary co-morbidities

Bhat

Ali²,

Gulzar

et al. 2017

Int J Res Med Sci

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“…However, there was no advantage in functional outcome compared to the arthroplasty group 17. Dislocation has been a major complication with total hip replacement after comminuted intertrochanteric fractures,16 and bipolar arthroplasty has been shown to reduce this risk 61316…”

Section: Discussionmentioning

confidence: 99%

“…Cemented prostheses have been used with high success rates156 but are associated with high perioperative morbidity (hemodynamic instability, cardiopulmonary complications, etc.) and mortality 47.…”

Section: Introductionmentioning

confidence: 99%

Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly

Marya

Thukral

Hasan

et al. 2011

IJOO

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Background:Cemented hip arthroplasty is an established treatment for femoral neck fracture in the mobile elderly. Cement pressurization raises intramedullary pressure and may lead to fat embolization, resulting in fatal bone cement implantation syndrome, particularly in patients with multiple comorbidities. The cementless stem technique may reduce this mortality risk but it is technically demanding and needs precise planning and execution. We report the perioperative mortality and morbidity of cementless bipolar hemiarthroplasty in a series of mobile elderly patients (age >70 years) with femoral neck fractures.Materials and Methods:Twenty-nine elderly patients with mean age of 83 years (range:71-102 years) with femoral neck fractures (23 neck of femur and 6 intertrochanteric) were operated over a 2-year period (Nov 2005–Oct 2007). All were treated with cementless bipolar hemiarthroplasty. Clinical and radiological follow-up was done at 3 months, 6 months, 12 months, and then yearly.Results:The average follow-up was 36 months (range 26-49 months). The average duration of surgery and blood loss was 28 min from skin to skin (range, 20–50 min) and 260 ml (range, 95–535 ml), respectively. Average blood transfusion was 1.4 units (range, 0 to 4 units) Mean duration of hospital stay was 11.9 days (7–26 days). We had no perioperative mortality or serious morbidity.We lost two patients to follow-up after 12 months, while three others died due to medical conditions (10–16 months post surgery). Twenty-four patients were followed to final follow-up (average 36 months; range: 26–49 months). All were ambulatory and had painless hips; the mean Harris hip score was 85 (range: 69–96).Conclusion:Cementless bipolar hemiarthroplasty for femoral neck fractures in the very elderly permits early return to premorbid life and is not associated with any untoward cardiac event in the perioperative period. It can be considered a treatment option in this select group.

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“…Most data on modern uncemented femoral components (not Austin-Moore or Thompson types) in patients with a fracture of the femoral neck are derived from single series studies 54,[61][62][63][64][65] and there are only two trials in which HA-coated components were compared with other types (Table V). 49,66 Livesley et al 66 compared an HA-coated Furlong hemiarthroplasty (JRI) with the conventional uncemented Austin-Moore hemiarthroplasty and found better functional results in the JRI group.…”

Section: Discussionmentioning

confidence: 99%

A new uncemented hydroxyapatite-coated femoral component for the treatment of femoral neck fractures

Sköldenberg

Salemyr

Bodén

et al. 2011

The Journal of Bone and Joint Surgery. British volume

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Our aim in this pilot study was to evaluate the fixation of, the bone remodelling around, and the clinical outcome after surgery of a new, uncemented, fully hydroxyapatite-coated, collared and tapered femoral component, designed specifically for elderly patients with a fracture of the femoral neck. We enrolled 50 patients, of at least 70 years of age, with an acute displaced fracture of the femoral neck in this prospective single-series study. They received a total hip replacement using the new component and were followed up regularly for two years. Fixation was evaluated by radiostereometric analysis and bone remodelling by dual-energy x-ray absorptiometry. Hip function and the health-related quality of life were assessed using the Harris hip score and the EuroQol-5D. Up to six weeks post-operatively there was a mean subsidence of 0.2 mm (-2.1 to +0.5) and a retroversion of a mean of 1.2° (-8.2° to +1.5°). No component migrated after three months. The patients had a continuous loss of peri-prosthetic bone which amounted to a mean of 16% (-49% to +10%) at two years. The mean Harris hip score was 82 (51 to 100) after two years. The two-year results from this pilot study indicate that this new, uncemented femoral component can be used for elderly patients with osteoporotic fractures of the femoral neck.

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Cementless hemiarthroplasty for femoral neck fractures in elderly patients

Cited by 21 publications

References 27 publications

Cementless bipolar hemiarthroplasty for displaced fracture neck of femur with modular hydroxyapatite coated stem in elderly with cardiopulmonary co-morbidities

Cementless bipolar hemiarthroplasty for displaced fracture neck of femur with modular hydroxyapatite coated stem in elderly with cardiopulmonary co-morbidities

Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly

A new uncemented hydroxyapatite-coated femoral component for the treatment of femoral neck fractures

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