RESUMO
BACKGROUND: The incidence of osteoporosis is a prime concern, especially in parts of the world where the population is aging, such as Europe or the US. Many new therapy strategies have been described to enhance bone healing. Lumbar interbody fusion (LIF) is a surgical procedure that aims to stabilize the lumbar spine by fusing two or more vertebrae using an interbody cage. LIF is a standard treatment for various spinal conditions, such as degenerative disc disease, spinal stenosis, and spondylolisthesis. However, successful fusion is challenging for patients with osteoporosis due to their reduced bone mineral density (BMD) and increased risk of cage subsidence, which can lead to implant failure and poor clinical outcomes. METHODS: A comprehensive literature search yielded 220 articles, with 16 ultimately included. Keywords included BMD, cage subsidence, osteoporosis, teriparatide, and lumbar interbody fusion. RESULTS: This review examines the relationship between BMD and LIF success, emphasizing the importance of adequate bone quality for successful fusion. Preoperative assessment methods for BMD and the impact of low BMD on fusion rates and patient outcomes are discussed. Additionally, techniques to improve fusion success in patients with weakened bone density, such as biological enhancement and BMD-matched interbody cages, are explored. However, consensus on the exact BMD threshold for a successful outcome remains elusive. CONCLUSION: While an apparent correlation between BMD and fusion rate in LIF procedures is acknowledged, conclusive evidence regarding the precise BMD threshold indicative of an increased risk of unfavorable outcomes remains elusive. Surgeons are advised to exercise caution in surgical planning and follow-up for patients with lower BMD. Furthermore, future research initiatives, particularly longitudinal studies, are encouraged to prioritize the examination of BMD as a fundamental risk factor, addressing gaps in the literature.
RESUMO
Femoral neck fracture (FNF) is a common and devastating injury in the elderly population. The incidence of FNF is expected to increase in the future, particularly in the aging population. The displaced intracapsular FNF is replaced with a reconstruction prosthesis. These treatment options typically include hemiarthroplasty (HA) or total hip arthroplasty (THA). Dislocation after THA can be a significant complication, leading to increased hospital costs and patient dissatisfaction. This narrative review aims to investigate the potential risk factors for dislocation following THA after FNF. A systematic literature search was conducted, and 21 studies met the inclusion criteria. The studies included a total of 1703 patients who underwent THA after FNF. The majority of the patients were women, and the average age of participants was 76.2 years. The studies were primarily conducted by the orthopedic and traumatology departments. The surgical approach used for THA varied, with the anterior approach being associated with lower dislocation rates compared to the posterior approach. The analysis of surgical volume revealed that high-volume hospitals had lower dislocation rates compared to low-volume hospitals. Eight studies reported postoperative Harris Hip Scores (HHS), with higher HHS scores correlating with lower dislocation rates. Body mass index (BMI) was mentioned in 11 studies, and a normal BMI range was associated with lower dislocation rates compared to the overweight group. Rehabilitation protocols, particularly early initiation of physiotherapy, showed promising results in reducing dislocation rates. Additionally, the type of prosthesis used in the acetabulum was found to influence dislocation rates, with dual mobility cups demonstrating lower rates compared to single cups. In conclusion, several factors may contribute to the risk of dislocation following THA after FNF. These include the surgical approach, surgical volume, postoperative HHS scores, BMI, rehabilitation protocols, and the type of acetabular cup used. Further research is needed to better understand these risk factors and develop strategies to minimize dislocation rates and improve patient outcomes.
