Intraoperative periprosthetic femur fracture during bipolar hemiarthroplasty for displaced femoral neck fractures

Hong, Choon Chiet; Nashi, Nazrul; Tan, Jiong Hao; Manohara, Ruben; Lee, Wei Ting; Murphy, Diarmuid

doi:10.1007/s00402-018-2952-7

Cited by 18 publications

(25 citation statements)

References 35 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%

“…Intraoperative periprosthetic fracture with press-fit implants is an inherent risk when operating on patients with a fragility fracture. There is some evidence that this risk may be elevated with MIS approaches for elective THA [40] , [41] as well as for femoral neck fractures [29] , [42] , [43] , [46] . In our series, there are 4 of 37 cases (10.1%) with intraoperative nondisplaced calcar fracture managed successfully with cerclage cabling.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…The chi-square test, Fisher’s exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. Odds ratios (OR) with 95% confidence intervals (CI) were presented for predetermined possible predictors of intraoperative fractures [21, 29]. The data analysis was performed using SPSS (SPSS Inc., Chicago, IL, version 25).…”

Section: Methodsmentioning

confidence: 99%

“…Specific risk factors have been outlined for the occurrence of these types of fractures. The type of fixation (cemented vs. uncemented) and Dorr canal type are known to be significant risk factors [20, 21]. Female sex has been shown to be a significant risk factor with total hip arthroplasty [22].…”

Section: Introductionmentioning

confidence: 99%

Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Bellova¹,

Baecker²,

Lotzien³

et al. 2019

J Orthop Surg Res

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Background: Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. Methods: We retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients' demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon's experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher's exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS. Results: Of 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872-6.079), stovepipe femur (OR 1.749, 95% CI .823-3.713), junior surgeon (OR 1.204, 95% CI .596-2.432), and on-call-duty surgery (OR 1.471, 95% CI .711-3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41). Conclusions: IPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process.

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“…With the increase of the elderly population in China, the number of displaced femoral neck fractures is also increasing. [ 1 – 3 ] They can be challenging to treat, as the femoral neck lacks periosteum and therefore relies on direct bone healing, resulting in the rates of osteonecrosis and nonunion of femoral head is high. Although the incidence of injury is high, in the elderly patients, the surgical treatment of displaced femoral neck fractures is still uncertain.…”

Section: Introductionmentioning

confidence: 99%

Retrospective cohort trial protocol of screw fixation compared with hemiarthroplasty for displaced femoral neck fractures in elderly patients

et al. 2020

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Background: There is limited evidence for the evaluation of the efficacy and safety of the hemiarthroplasty versus screw fixation in elderly patients with the displaced femoral neck fractures. Our current investigation aimed at assessing the complications, functional outcome, and revision rate of the patients (over 65 years old) who received internal fixation or hemiarthroplasty via a same senior surgeon. Methods: A retrospective study was conducted on elderly patients with displaced femoral neck fractures from May 2014 to February 2018. The current study was carried out at our hospital and it was approved through our institutional review committee of West China Hospital. Inclusion criteria were as follows: the patients were 65 years or older, this is the anesthesia grade. The higher grade of the patients,the greater risk of surgery. level I–III, and the patients with displaced intracapsular fractures of the femoral neck, with the radiographic and clinical follow-up of 12 months or more. The major outcome was the revision rate between the 2 groups. And the secondary outcomes contained the life quality and functional outcome detected via utilizing the interview-administered and self-administered questionnaires, length of hospital stay, surgery time, and hip-related complications (such as hip dislocation, loosening or breakage of implant, wound problems, infection, osteolysis, neurovascular injury, and bone nonunion). Results: It was assumed that hemiarthroplasty would result in fewer revisions or complications and better functional scores in comparison with internal fixation technique.

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Intraoperative periprosthetic femur fracture during bipolar hemiarthroplasty for displaced femoral neck fractures

Cited by 18 publications

References 35 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

Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Retrospective cohort trial protocol of screw fixation compared with hemiarthroplasty for displaced femoral neck fractures in elderly patients

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