Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem / 대한고관절학회지

PURPOSE: To compare and analyze clinical and radiologic outcomes of cemented versus cementless bipolar hemiarthroplasty for treatment of femur neck fractures. MATERIALS AND METHODS: A total of 180 patients aged 65 years and over older who underwent bipolar hemiarthroplasty for treatment of displaced femur neck fractures (Garden stage III, IV) from March 2009 to February 2014 were included in this study. Among the 180 patients, 115 were treated with cemented stems and 65 patients with cementless stems. Clinical outcomes assessed were: i) postoperative ambulatory status, ii) inguinal and thigh pain, and iii) complications. The radiologic outcome was femoral stem subsidence measured using postoperative simple X-ray. RESULTS: The cemented group had significantly lower occurrence of complications (postoperative infection, P=0.04) compared to the cementless group. There was no significant difference in postoperative ambulatory status, inguinal and thigh pain, and femoral stem subsidence. CONCLUSION: For patients undergoing bipolar hemiarthroplasty, other than complications, there was no statistically significant difference in clinical or radiologic outcomes in our study. Selective use of cemented stem in bipolar hemiarthroplasty may be a desirable treatment method for patients with poor bone quality and higher risk of infections.

Estudio densitométrico de diez años de remodelación femoral tras la implantación de un vástago anatómico / Étude densitométrique de dix ans d'un remodelage fémoral après implantation d'une tige anatomique / A Ten-Year sensitometric study of femoral remodeling after implantation of an anatomical stem

Introducción: la absorciometría dual con rayos X es comúnmente utilizada para cuantificar la remodelación ósea periprotésico, normalmente en seguimientos a corto plazo. Objetivo: determinar los patrones de remodelado producidos por vástago anatómico, mediante la cuantificación de cambios en la densidad mineral ósea en las 7 zonas de Gruen, durante el seguimiento, así como analizar la influencia de otros factores en el remodelado óseo. Métodos: se realizó un estudio prospectivo (10 años de seguimiento) a un grupo de 39 pacientes a los que se implantó una prótesis total de cadera no cementada. Se utilizó la cadera sana contralateral como control. Para cuantificar la remodelación femoral periprotésica se utilizó la absorciometría dual con rayos X en las 7 zonas de Gruen. Las mediciones de masa ósea se realizaron a los 15 días, 1, 3 y 10 años tras la intervención en la cadera no operada y a los 15 días, 1, 3, 5 y 10 años de la operación en la cadera protetizada. Se analizó también la influencia de otros factores en el remodelado óseo (sexo, índice de masa corporal y masa ósea preoperatoria). Resultados: se halló un descenso de la densidad mineral ósea del 7 por ciento en la zona 1 de Gruen y del 24,1 por ciento en la zona 7 de Gruen al final del décimo año. El sexo, el índice de masa corporal y la masa ósea preoperatoria no fueron estadísticamente relevantes en su influencia sobre el remodelado óseo. Conclusión: la remodelación ósea periprotésica depende en su mayor parte del implante, no se halló correlación con sexo, índice de masa corporal o masa ósea preoperatoria(AU)

Introduction: Dual X-ray absorptiometry is commonly used to quantify periprosthetic bone remodeling, usually for short-term follow up. Objective: determine patterns of remodeling caused by anatomical stem, by quantifying changes in bone mineral density in the 7 Gruen zones during follow up and analyze the influence of other factors in bone remodeling. Methods: a prospective study (10 year follow-up) was performed to a group of 39 patients undergoing uncemented total hip prosthesis. The healthy hip was used as control. Dual X-ray absorptiometry in Gruen zones 7 was used to quantify the femoral periprosthetic remodeling. Bone mass measurements were performed at 15 days, 1, 3 and 10 years after surgery on the non-operated hip, and at 15 days, 1, 3, 5 and 10 years of operation in the prosthetic hip. The influence of other factors in bone remodeling (sex, body mass index, and preoperative bone mass) was also analyzed. Results: 7 percent of decrease in bone mineral density was found in Gruen zone 1 and 24.1 percent was found in Gruen zone 7 at the end of the tenth year of follow up. Sex, body mass index and preoperative bone density were not statistically significant in its influence on bone remodeling. Conclusions: periprosthetic bone remodeling depends mainly on the implant. No correlation has been found with sex, body mass index and preoperative preoperative bone density(AU)

Introduction: l'absorptiométrie biphotonique à rayons X est fréquemment utilisée pour évaluer le remodelage osseux péri-prothétique, notamment par des suivis à court terme. Objectif: le but de cette étude est de déterminer les standards du remodelage osseux péri-prothétique produits par une tige anatomique, et d'analyser également l'influence d'autres facteurs sur le remodelage osseux. Méthodes: une étude prospective (suivi de 10 ans) d'un groupe de 39 patients, ayant subi une implantation de prothèse de hanche sans ciment, a été réalisée. Afin d'évaluer le remodelage fémoral périprothétique, on a effectué une absorptiométrie biphotonique à rayons X dans les 7 zones de Gruen. On a mesuré la DMO de la hanche non-opérée aux 15 jours et 1, 3, et 10 ans après la chirurgie, ainsi que la DMO de la hanche opérée aux 15 jours et 1, 3, 5, et 10 ans après la chirurgie. On a également analysé le retentissement d'autres facteurs (sexe, indice de masse corporelle, densité osseuse préopératoire) sur le remodelage osseux. Résultats: à la fin de la dixième année, on a trouvé une perte de la DMO de 7 pourcent dans la zone 1, et de 24.1 pourcent dans la zone 7. Le sexe, l'indice de masse corporelle et la masse osseuse préopératoire n'ont pas statistiquement influé sur le remodelage osseux. Conclusions: le remodelage osseux péri-prothétique dépend notamment de l'implant ; on n'a pas trouvé de corrélation avec le sexe, l'indice de masse corporelle ou la densité osseuse préopératoire(AU)

Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture / 대한고관절학회지

PURPOSE: In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem. MATERIALS AND METHODS: A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups. RESULTS: Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition, there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2. CONCLUSION: Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.

Usefulness of the Cementless Stem for the Treatment of Hip Fracture in Elderly Patients with Osteoporosis: Comparative Analysis between Cementless Stem and Cemented Stem

PURPOSE: We evaluated the usefulness of the cementless stem in treating hip fracture patients older than 70. MATERIALS AND METHODS: We studied elderly osteoporotic hip fractures in the neck and intertrochanter area who had received hip arthroplasty with over 2 years of follow up period. Among those, we analyzed the clinical and radiological results of hip arthroplasty with cemented stem (group 1) and hip arthroplasty with cementless stem (group 2). Each group was consists of fifty hips. RESULTS: The mean age at surgery was 75 years and mean follow-up period was 40 months (minimum 24 months). The admission period was 28.68+/-8.8 days for group 1 and 28.05+/-8.7 days for group 2 (p>0.05) and the average operation time was 87+/-21.2 minutes, and 80+/-17 minutes (p>0.05) and the total blood loss was 611+/-141.3 cc and 557+/-120.5 cc (p>0.05) respectively. There was no statistically significant difference in all aspects. One case of pulmonary embolism occurred in group 1. Stem loosening was not observed in both groups at the last follow-up radiologic study. CONCLUSION: The hip arthroplasty with cementless stem for the osteoporotic hip fractures showed a competent results clinically and radiologically in short term follow up as compared with the cemented stem.

Cemented Bipolar Hemiarthroplasty for Intertrochanter Fracture in Elderly Patients: Minimum 2-Years Follow-up Results

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cemented femoral stem for treating femoral trochanteric region hip fractures in elderly patients. MATERIALS AND METHODS: This study includes 47 hips were available to be follow up for over 2 years, between December 1995 and December 2002. Clinical evaluation was done using Koval's classification before the fracture and at last follow-up, and Harris's hip score at the last follow up. Radiological evaluation was done via the plain radiographs. RESULTS: The Koval classification was as follows: recovery to the condition before fracture in 15 cases (31.9%), degradation by 1 class in 31 cases (66.0%) and degradation by 2 classes in 1 case (2.1%). The Harris hip score was 84.6 points at the last follow-up. All the cases showed stable fixation of the femoral stem. Postoperative complications were reported as 1 case of pneumonia, 1 case of deep vein thrombosis, 1 case of pulmonary thromboembolism, 1 case of pulmonary edema, 3 cases of stress ulcer, 1 case of superficial infection and 1 case of deep infection. Superficial pressure sore occurred in 1 case, postoperative delirium occurred in 9 cases and partial rupture of the bladder in 1 case. CONCLUSION: Bipolar hemiarthroplasty using a cemented femoral stem was effective and satisfactory for the treatment of elderly patients with intertrochanter fractures. But further studies that will focus on complications are required.

Results of Revision Hip Arthroplasty using Cemented Femoral Stem

PURPOSE: To analyze clinical and radiological follow-up results of patients who underwent revision hip arthroplasty with a cemented stem. MATERIALS AND METHODS: This study reviewed the records of 31 patients (34 hips), who underwent revision hip arthroplasty with a cemented stem between February, 1993 and May, 2004 after an average follow-up of eight years. There were 14 segmental type hips according to the femoral bone defect using the AAOS classification. According to the Paprosky classification, there were 7 and 5 type IIC and type III hips indicating a severe bone defect. Immediate postoperative cement mantle grades were grades A and B(26 hips) and grade C, D(8 hips). RESULTS: The Kaplan Meier survival rate of the cemented stem was 80.7% at 8 years. Re-revision hip arthroplasty was performed in 5 hips, in whom aseptic loosening occurred 4 hips, and infection occurred 1 hip, which was cured by re-surgery. Immediately after the operation, 4 out of the 5 re-revision cases were classified as C & D in the Barrack classification of the cement mantle. Overall, an inadequate cement mantle led to a poorer survival rate. CONCLUSION: The results of revision hip arthroplasty using a cemented stem were not so good. However, the cemented stem might be used in cases considered unsuitable for a cementless stem if a good cement mantle could be achieved using a skillful cement technique.