Cementless Bipolar Hemiarthroplasty of Hip Fracture in Patients on Hemodialysis / 대한고관절학회지

PURPOSE: This study analyzed the clinical and radiologic results and complications in patients with chronic renal failure who underwent cementless bipolar hemiarthroplasty for treatment of hip fractures. MATERIALS AND METHODS: Between January 2003 and February 2010, we performed 36 consecutive cementless bipolar hemiarthroplasty procedures in 35 patients with hip fracture who were on hemodialysis for chronic renal failure. Clinically, postoperative Harris hip score, inguinal and thigh pain, and orthopaedic and medical complications were investigated. Radiologically, we examined bone ingrowth, osteolysis, loosening, and nonunion. RESULTS: According to the Harris hip score grading system, the average postoperative score was 85.7 and the function before the injury was restored in 29 cases. Postoperatively, four patients experienced mild inguinal pain and four patients experienced mild thigh pain. One patient experienced severe thigh pain. Orthopaedic complications(6 cases, 16.7%) included mild hematoma(3 cases), superficial wound infection(2 cases), and dislocation(1 case). Medical complications(10 cases, 27.8%) included sepsis(5 cases), multiple organ failure due to aggravation of underlying diseases(2 cases), ulcer perforation(2 cases), and aspiration pneumonia(1 case). Five patients had died within one year (mortality, 13.9%). Except for loosening of the femoral stem in one case, bone ingrowth was observed in all cases. None of the patients had osteolysis and nonunion. CONCLUSION: Although cementless bipolar hemiarthroplasty was considered as an effective treatment in patients with hip fractureon hemodialysis due to favorable results at midterm follow-up, close attention for the postoperative medical complications due to poor general condition is needed.

Cementless Bipolar Hemiarthroplasty for Treating Intertrochanteric Fracture in Elderly Patients

PURPOSE: To evaluate clinicoradiological outcomes after cementless bipoloar hemiarthroplasty in elderly patients with femoral intertrochanteric fractures. MATERIALS AND METHODS: From March 2006 to February 2008, 28 patients-all in patients greater than 80 years of age, classified unstable intertrochanteric fractures in Evans classification-were followed for more than 1 year. 24 patients were women and 4 patients were men. The mean age of the patients was 84.6 years, the mean follow-up period was 16.3 months. Harris hip score, postoperative inguinal and thigh pain, Parker and Palmer mobility score were analyzed clinically. The radiological results were assessed using various radiological indicies including bone-union, fit and alignment change of femoral stem and vertical subsidence. RESULTS: The average Harris hip score was 82.9, Parker and Palmer mobility score preoperative 8.0 changed to 5.2 postoperatively. More than moderate pain was presented in 1 case. There were no cases of varus deformity or osteolysis. All stems were stable without significant alignment change or subsidence except 1 case of periprosthetic fracture. There were no dislocation, thromboembolism, death during operation or hospital days. CONCLUSION: In elderly patients, cementless bipolar hemiarthroplasty is good treatment method of unstable intertrochanteric fracture and short-term clinicoradiological outcomes proved to be satisfactory.

Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

BACKGROUND: Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. METHODS: Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat(R) AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices. RESULTS: At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence. CONCLUSIONS: The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

The Effect of Prophylactic Cable Fixation for Prevention of Femoral Fractures in Hemiarthroplasties

PURPOSE: The purpose of this study was to assess the effect of a prophylactic cable fixation for prevention of femoral fractures in cementless bipolar hemiarthoplasties. MATERIALS AND METHODS: Forty-eight cementless bipolar hemiarthroplasties with prophylactic cable fixations on the femur were performed in patients >65 years of age between January 2004 and August 2008 (group 1). The control group which did not undergo prophylactic cable fixation included 48 cases (group 2). The mean age was 75.4 years (group 1) and 73.6 years (group 2). The patients were followed up for an average of 19.1 (group 1) and 18.3 months (group 2). The intra-operative fracture rates were compared. Additionally, operative time, estimated blood loss (EBL), and length of hospital stay were compared. Radiologic assessment for stem stability was performed. Clinical assessment was evaluated by the thigh pain and Jensen's functional score, and Parker & Palmer's mobility score. RESULTS: There was no fractures in the cabled group (1), and 4 fractures (8.3%) in the control group (2; p=0.041). The mean operative time was 172 minutes (1) and 162 minutes (2), the EBL was 866 cc (1) and 855 cc (2), and the duration of admission was 36 (1) and 35 days (2), respectively. Radiologically, subsidence was 1.59 mm (1) and 1.67 mm (2). Clinically, one (1) and two (2) thigh pains were recorded and the functional score of Jensen was 2 (1) and 2.2 points (2), and the mobility score of Parker and Palmer was 5.2 (1) and 5.3 points (2), respectively. CONCLUSION: Prophylactic cable fixation is effective for reducing intra-operative femoral fractures.

Cementless Bipolar Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate clinicoradiological outcomes after cementless bipolar hemiarthroplasty in elderly patients with femoral neck fractures. MATERIALS AND METHODS: Eighty hips-all in patients greater than 70 years of age-were followed for more than 2 years after undergoing cementless bipolar hemiarthroplasty with a tapered cementless stem (Lima SPH-C2(R)). The mean age was 76 years, and the mean follow-up period was 37 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices. RESULTS: At last follow-up, the mean Harris hip score was 80.2 points. There was one case of significant hip pain. Fifty-five cases (68.7%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 47 cases (58.7%) of bone ingrowth and 33 cases (41.3%) of stable fibrous fixation. There were no cases of osteolysis, and 30 cases (37.5%) exhibited new bone formation around the stem. All stems were stable without significant alignment change or progressive subsidence. CONCLUSION: Short-term outcomes proved to be satisfactory in elderly patients undergoing cementless bipolar hemiarthroplasty for femoral neck fractures.

Cementless Bipolar Hemiarthroplasty for Femoral Neck Fracture in Patients More than Eighty Years Old / 대한정형외과학회잡지

PURPOSE: This study evaluated the minimum 3 year follow-up results of cementless bipolar hemiarthroplasty in elderly patients more than 80 years of age with a femoral neck fracture. MATERIALS AND METHODS: 57 cementless bipolar hemiarthroplasties for femoral neck fractures were performed in elderly patients more than 80 years of age between January 1996 and December 2000. The clinical, radiological results and bone mineral density of 38 hips in 35 patients who could be followed up for at least 3 years were analyzed. The mean age of the patients was 82.5 years (80 to 100 years). 29 patients were women and 6 were men. For all cases, an identical prosthesis (VerSys(R) fiber metal midcoat collarless stem, Zimmer, Warsaw, Indiana, USA) was implanted. RESULTS: The average follow-up period was 41 months (36 to 62 months). The average Harris Hip Score was 76.4+/-14.1 points at the time of the most recent follow-up. An excellent score (90-100 points) was recorded in 2 hips (5%), good (80-89 points) in 10 hips (26%), fair (70-79 points) in 21 hips (55%) and poor (60-69) in 5 hips (13%). The radiological assessment showed that all stems were biological stable, with 20 stems (53%) showing bony ingrowth and 18 stems (47%) having stable fibrous fixation. No cup migration, osteolysis, vertical subsidence, pedestal reaction and varus deposition of the stem etc. were observed. The mean T value of the bone mineral density (BMD) was -3.75+/-0.75 and was not related to the clinical and radiological results. CONCLUSION: Cementless bipolar hemiarthroplasty for elderly patients more than 80 years of age with a femoral neck fracture showed satisfactory short-term results with no relationship to the severity of osteoporosis.