Is there a role for cementless primary stem in hip arthroplasty for early or late fixation failures of intertrochanteric fractures?

Abstract

Background The choice of femur stems during the hip arthroplasty procedures for patients with treatment failure of intertrochanteric fractures (ITF) remains controversial. We aimed to compare the surgical complication and reoperation rates between cementless primary and revision stems in the early (≤3 months) and late (> 3 months) fixation failures of ITF. Methods This was a retrospective, cohort study conducted in a single, tertiary referral hospital of Taipei, Taiwan. We included hip arthroplasty procedures for failed ITF using cementless primary or revision stems. There were 40 and 35 patients who had early and late fixation failure of ITF, respectively. The patient demographics, time to fixation failure, surgical complications and medical complications were recorded for analysis. Results We included 75 patients that underwent hip arthroplasty procedure for failed ITF using cementless primary (n = 38) or revision (n = 37) stems. The mean age was 79.3 years and 56% of the patients were female. In the early fixation failure group, the complication rate was similar between the primary and revision stems (44% vs. 29%, p = 0.343). However, there was a trend toward a higher reoperation rate (31% vs. 8%, p = 0.061) of using the primary stem, compared with the revision stem. In the late fixation failure group, the rate of complication and reoperation was similar between the two stem types. Conclusion For early fixation failures of ITFs, we caution against the use of cementless primary stems due to a trend towards an increased risk of reoperations compared to the use of cementless revision stems. However, in late fixation failures of ITFs, there is a role for cementless primary stems. Level of evidence III, retrospective cohort study.

Cementless primary or revision stem in revision hip arthroplasty for aseptic stem loosening with Paprosky type I/II femoral defect?

“…3 When using a cementless femoral stem, primary stability is of paramount importance but can be challenging, owing to varying degrees of bone loss. 4,5 One advantage of using a primary stem during the revision procedure is easier implantation, sparing the diaphysis invasion while preserving the native bone stock. 6,7 In contrast, the benefits of using a longer, revision stem include an increased contact area for osteointegration, which allows bypass of the metaphysis and achieves a more reliable fixation in the diaphysis.…”

Conversion Hip Arthroplasty Using Standard and Long Stems after Failed Internal Fixation of Intertrochanteric Fractures

“…Previous studies have reported different types of the femoral prosthesis in CHA for FIF-ITF patients, as well as cemented [13][14][15] , cementless [16][17][18][19] , standard 14,17,20 , calcar-replacement 5 , modular [21][22][23] , nonmodular 24 , revision stem 25,26 , etc. Few studies have paid attention to the length of the femoral prosthesis, this study retrospectively included and analyzed the results, technical problems, and complications of CHA following FIF-ITF patients in multi-centers, and the clinical e ciency of standard and long stems were compared.…”