Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures

Kabelitz, Method; Fritz, Yannick; Grueninger, Patrick; Meier, Christoph; Fries, Patrick; Dietrich, Michael

doi:10.1177/2151459318765381

Cited by 12 publications

(8 citation statements)

References 54 publications

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“…In our series, there are 4 of 37 cases (10.1%) with intraoperative nondisplaced calcar fracture managed successfully with cerclage cabling. This rate is more common than the 5.4% of intraoperative femoral fracture for uncemented primary THA reported by Berry [44] , but is consistent with the 7%-12% reported for arthroplasty for femoral neck fractures [45] , [46] , [47] . In contrast to other MIS techniques, the SuperPATH approach allows for calcar and subtrochanteric cerclage cable placement through a smaller secondary incision, making the treatment of intraoperative calcar fractures straightforward and without significant compromise of the capsule or short external rotators.…”

Section: Discussionsupporting

confidence: 87%

Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty

et al. 2019

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Background Total hip arthroplasty (THA) is the preferred treatment for displaced femoral neck fractures in select patients, although dislocation remains a concern. In some studies, the supercapsular percutaneously assisted (SuperPATH) approach has demonstrated early mobilization, short hospital stay, and low dislocation rates in primary THA, but there are little data on its use for fractures. This study describes the perioperative outcomes and early dislocation rate of SuperPATH THA for displaced femoral neck fragility fractures. Methods A retrospective review was performed of previous ambulatory patients with a displaced femoral neck fragility fracture treated with THA using the SuperPATH approach. Demographic data, time to ambulation, length of stay, and in-hospital complications during the hospital stay and follow-up period were recorded. Phone interviews were conducted to check for dislocations 1 year after surgery. Results Thirty-seven consecutive patients were included with an average age of 75.0 years. Hospital stay averaged 5.5 days, and patients were discharged on average postoperative day 3.6. About 83.8% of patients were ambulatory by postoperative day 1, and 94.6% ambulatory before discharge. Twenty-seven percent of patients were discharged home, 46% to inpatient rehabilitation, 24% to skilled nursing facility, and 1 patient to hospice. At follow-up, there was no symptomatic heterotopic ossification and no infections. Thirty-two patients were available for telephone interviews at 1 year, with no dislocations reported. Conclusions In this small cohort, the SuperPATH approach for THA appears to be safe and effective for use in femoral neck fragility fractures, resulting in early ambulation and a low dislocation rate.

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Section: Discussionsupporting

confidence: 87%

Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty

et al. 2019

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“…Most of the patients in this study experienced <3mm subsidence in stem (78.2%). The mean of subsidence was 2.16mm (SD 3.4), which was lower than what was found in the previous study of 2.9mm (SD 2.7) 11 and 3.9mm (SD 2) 8 . This result could be affected by the greater cortical thickness and higher volumetric bone mineral density (BMD) in Asia patients than white patients 13 .…”

Section: Discussioncontrasting

confidence: 79%

“…Two previous studies about cementless hemiarthroplasty in femoral neck patients found different results. Kabelitz et al 8 found 12% intra-operative fractures and a low subsidence rate (5%). Furthermore, a study by Choi et al found no subsidence 6 .…”

Section: Introductionmentioning

confidence: 96%

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

2021

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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.

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“…In all cases, we documented bone- or implant-related complications, including i) revision hip surgery for any cause with or without revision arthroplasty, ii) radiographic loosening/subsidence of the stem over 5 mm26), iii) dislocation of the HA head, iv) intraoperative fracture—defined as any fracture in the ipsilateral femoral bone recognized during surgery or on radiography immediately after the surgery, v) postoperative peri-prosthetic fracture, and vi) contralateral hip fracture. We also included surviving patients who were followed-up 10 years after the index surgery in the assessment of their functional states for pain, ambulation (bedridden, wheelchair, walker, cane, or without any aid), and residence (home, nursing facility, or hospital) as outcome measures.…”

Section: Methodsmentioning

confidence: 99%

Cementless Bipolar Hemiarthroplasty for Low-energy Intracapsular Proximal Femoral Fracture in Elderly East-Asian Patients: A Longitudinal 10-year Follow-up Study

et al. 2019

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PurposeShort-term outcomes following cemented and cementless hemiarthroplasties (HAs) are reported to be comparable, however, long-term outcomes of cementless HA—especially among Asian patients—is limited. We aimed to assess long-term outcomes in elderly East-Asian patients with intracapsular proximal femoral fractures treated with cementless HA.Materials and MethodsWe enrolled 135 patients treated with cementless HA who met our inclusion criteria. We documented bone/implant-related complications (e.g., incidences of revision hip surgery, femoral stem subsidence, dislocation, intraoperative and postoperative periprosthetic fractures, contralateral hip fractures). We included those patients who are still alive 10 years after the index surgery in the final functional analysis of the existence of pain, ambulatory status, and residential status.ResultsThe mean age at injury was 78.3 years (range: 60–85 years). At the 10-year follow-up, 26 of the original patients (19.3%) had survived. During follow-up, revision hip surgery was conducted in two patients (1.5%). We recorded the incidence of intraoperative fractures, postoperative periprosthetic fractures, and contralateral fractures in two (1.5%), eight (5.9%), and six patients (4.4%), respectively. Among the 10-year survivors, six patients (23.1% of the survivors) complained of groin pain, but generally reported the pain to be tolerable.ConclusionAmong elderly East-Asian patients, the incidence of revision surgery after cementless HA may be lower than that in their European counterparts, whereas the incidence of periprosthetic fractures can still be considerably higher. For patients undergoing cementless HA, prevention of such secondary fractures is of critical importance.

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Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures

Cited by 12 publications

References 54 publications

Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty

Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty

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

Cementless Bipolar Hemiarthroplasty for Low-energy Intracapsular Proximal Femoral Fracture in Elderly East-Asian Patients: A Longitudinal 10-year Follow-up Study

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