Radiographic Characteristics of the Femoral Nutrient Artery Canals in Total Hip Arthroplasty using Cementless Femoral Stem

@#Introduction: Accurate diagnosis of undisplaced periprosthetic femoral fracture (PFF) after hip arthroplasty is crucial, as overlooked PFF may affect its treatment and prognosis. The undisplaced PFF is often difficult to distinguish from radiolucent lines of nutrient artery canal (NAC) of the femur present on post-operative radiographs. We aimed to identify the radiographic features of NAC to distinguish them from PFFs. Materials and methods: In this retrospective radiological study, a total of 242 cases in 215 patients with hip arthroplasty were analysed using pre-operative and postoperative anteroposterior (AP) and translateral (TL) radiographs. Interobserver agreement of the measurements was assessed by two independent experienced orthopaedic surgeons. The kappa value ranged from 0.83 to 0.87, indicating strong agreement according to the Landis and Koch criteria. Results: The NACs were found pre-operatively in 94 (39.8%) cases on AP views and in 122 cases (50.4%) on TL views. The radiolucent lines were observed post-operatively in 42 (17.4%) on AP views and 122 (50.4%) on the TL views. three cases (1.2%) had a fracture around the stem that were detected on radiographs. One case with PFF presented simultaneously with NAC on the immediate post-operative radiographs. All patients were treated by conservative measures, and the radiolucent lines did not appear on followup radiographs. Conclusion: It is not easy to differentiate undisplaced PFFs that can occur after hip arthroplasty operation from NACs. However, accurate diagnosis is possible through careful observation and comparison of pre-operative and postoperative radiologic images

Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring / 대한고관절학회지

PURPOSE: Bipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture. MATERIALS AND METHODS: We reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem. RESULTS: Sixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive. CONCLUSION: Cerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.

Tratamiento de las fracturas periprotesicas de cadera de tipos B2 y B3 con tallos no cementados de fijacion distal / Treatment of type B2 and B3 periprosthetic hip fractures with distal fixation cementless stem

Introducción: La fractura periprotésica es la tercera causa más frecuente de revisión de cadera por detrás del aflojamiento aséptico y la infección. Aquellas que se presentan asociadas a un tallo flojo (B2) o a un déficit de capital óseo (B3) deben ser tratadas con la revisión femoral. Materiales y Métodos: Se estudiaron retrospectivamente 38 pacientes con fracturas periprotésicas de fémur de tipos B2 y B3 tratadas con tallos no cementados de fijación distal sin injerto óseo ni placas de osteosíntesis. El tiempo de seguimiento promedio fue de 2.5 años (rango 1.5-10). Resultados: El puntaje promedio en el Harris Hip Score fue 69 (rango 57-91). En todos los casos, se logró la consolidación ósea. La supervivencia libre de revisión fue del 94,8%. Las complicaciones fueron: un (2,6%) hundimiento del tallo >5 mm, una (2,6%) luxación, dos (5,2%) infecciones y un (2,6%) hematoma de la herida. Conclusión: La técnica de revisión con tallos no cementados de fijación distal sin el aporte de injerto óseo ha demostrado ser un método eficaz para tratar las fracturas periprotésicas de cadera de tipos B2 y B3.

Introduction: Periprosthetic hip fracture is the third most common cause of hip revision, behind aseptic loosening and infection. Fractures presenting in combination with a loose stem (B2) or poor bone stock (B3) should be revised. Methods: We retrospectively evaluated 38 patients with type B2 and B3 periprosthetic hip fractures that had been treated with distal fixation cementless stem without bone graft or a plate. Follow-up averaged 2.5 years (range 1.5-10). Results: The mean postoperative Harris Hip Score was 69 points (range 57-91). Fracture consolidation was achieved in all patients. Implant survival at last follow-up was 94.8%. Complications were: one (2.6%) stem subsidence, one (2.6%) dislocation, two (5.2%) infections and one (2.6%) hematoma. Conclusion: Hip revision in the set of type B2 and B3 periprosthetic fracture with distal fixation cementless stem without bone graft is an effective technique.

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.

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.

Cementless Bipolar Hemiarthroplasty for Hip Fracture in Patients More than Seventy Years Old with Osteoporosis

Purpose: This study evaluated the effectiveness of bipolar hemiarthroplasty with a cementless femoral stem for hip fractures in patients older than 70 years with osteoporosis. Materials and Methods: This study examined 84 hips with osteoporosis that are available to follow up of more than 2 years, between July 1997 and May 2006. The clinical evaluation was carried out using the Koval classification before the fracture and at the last follow-up, and the Harris hip score at the last follow up. The radiological evaluation was carried out using the plain radiographs. Results: The average follow up period was 31.4 months. The Koval classification was as follows: recovery to the condition before the fracture in 25 cases (30.1%), degradation by 1 class in 56 cases (67.5%) and degradation by 2 classes in 2 cases (2.4%). The Harris hip score was 82.7 points at the last follow-up. One case (1.2%) showed cortical hypertrophy and all cases showed stable insertion of the femoral stem. Conclusion: Bipolar hemiarthroplasty with a cementless femoral stem is effective and satisfactory, both clinically and radiologically, for the treatment of elderly patients with fractures around the hip.

Cementless Total Hip Arthroplasty Using a Tapered Femoral Component / 대한정형외과학회잡지

PURPOSE: We investigated the results of cementless total hip arthroplasty using a tapered titanium-alloy stem. MATERIALS AND METHODS: We followed 72 hips in 60 patients who underwent total hip arthroplasty and received the using Mallory-Head femoral component for a mean of 9.1 years. The most common disease was avascular necrosis (56 hips; 77.7%). Their mean age was 50.1 years at the time operation. We analysed the clinical results by the Merle d'Aubigne and Postel scoring system and the radiographic outcome according to Engh's criteria. RESULTS: The mean hip score was 16.4 at the last followup. An excellent or good clinical result was obtained in 62 hips (86.1%). Thigh pain was present in 3 hips (4.1%), and femoral osteolysis was observed in 8 hips (11.1%), which did not progress to the distal part. Two femoral components were revised for loosening and for periprosthetic fracture. Thus, 69 stems survived at the last follow up. Sixty-six hips (91.7%) had fixation by bone ingrowth, and three (4.1%) showed stable fibrous fixation. CONCLUSION: These results shows that excellent fixation can be obtained by using a tapered titanium alloy femoral component by medium-term followup.