Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture

Overview

Journal Hip Pelvis

Date 2016 Aug 19

PMID 27536631

Authors

Jeong Hoon Kang

Sang Hong Lee

Sung Jung

Affiliations

Soon will be listed here.

Abstract

Purpose: The current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry.

Materials And Methods: Seventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis.

Results: At the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C.

Conclusion: Bipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture.

References

Gruen T, McNeice G, Amstutz H . "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; (141):17-27. View

HINCHEY J, DAY P . PRIMARY PROSTHETIC REPLACEMENT IN FRESH FEMORAL-NECK FRACTURES. A REVIEW OF 294 CONSECUTIVE CASES. J Bone Joint Surg Am. 1964; 46:223-40. View

Bezwada H, Shah A, Harding S, Baker J, Johanson N, Mont M . Cementless bipolar hemiarthroplasty for displaced femoral neck fractures in the elderly. J Arthroplasty. 2004; 19(7 Suppl 2):73-7. DOI: 10.1016/j.arth.2004.06.018. View

Cohen C, Smith T . The intraoperative hazard of acrylic bone cement: report of a case. Anesthesiology. 1971; 35(5):547-9. DOI: 10.1097/00000542-197111000-00020. View

Zicat B, Engh C, Gokcen E . Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995; 77(3):432-9. DOI: 10.2106/00004623-199503000-00013. View

Khan R, MacDowell A, Crossman P, Datta A, Jallali N, Arch B . Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures. Int Orthop. 2002; 26(4):229-32. PMC: 3620946. DOI: 10.1007/s00264-002-0356-2. View

Wagner H, Wagner M . Cone prosthesis for the hip joint. Arch Orthop Trauma Surg. 2000; 120(1-2):88-95. DOI: 10.1007/pl00021223. View

Engh C, Bobyn J . Principles, techniques, results, and complications with a porous-coated sintered metal system. Instr Course Lect. 1986; 35:169-83. View

Kienapfel H, Sprey C, Wilke A, Griss P . Implant fixation by bone ingrowth. J Arthroplasty. 1999; 14(3):355-68. DOI: 10.1016/s0883-5403(99)90063-3. View

10.

Brooker A, Bowerman J, Robinson R, RILEY Jr L . Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973; 55(8):1629-32. View

11.

Dorr L, Faugere M, Mackel A, Gruen T, Bognar B, Malluche H . Structural and cellular assessment of bone quality of proximal femur. Bone. 1993; 14(3):231-42. DOI: 10.1016/8756-3282(93)90146-2. View

12.

Girard J, Roche O, Wavreille G, Canovas F, Le Beguec P . Stem subsidence after total hip revision: 183 cases at 5.9 years follow-up. Orthop Traumatol Surg Res. 2011; 97(2):121-6. DOI: 10.1016/j.otsr.2010.10.006. View

13.

Zhang J, Michalenko M, Kuhl E, Ovaert T . Characterization of indentation response and stiffness reduction of bone using a continuum damage model. J Mech Behav Biomed Mater. 2010; 3(2):189-202. PMC: 2818081. DOI: 10.1016/j.jmbbm.2009.08.001. View

14.

Engh C, Bobyn J, Glassman A . Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987; 69(1):45-55. DOI: 10.1302/0301-620X.69B1.3818732. View

15.

Rothman R, Hozack W, Ranawat A, Moriarty L . Hydroxyapatite-coated femoral stems. A matched-pair analysis of coated and uncoated implants. J Bone Joint Surg Am. 1996; 78(3):319-24. DOI: 10.2106/00004623-199603000-00001. View

16.

Middleton R, Uzoigwe C, Young P, Smith R, Gosal H, Holt G . Peri-operative mortality after hemiarthroplasty for fracture of the hip: does cement make a difference?. Bone Joint J. 2014; 96-B(9):1185-91. DOI: 10.1302/0301-620X.96B9.33935. View

17.

Carlsson A, NILSSON B . The relationship of bone mass and loosening of the femoral component in total hip replacement. Acta Orthop Scand. 1980; 51(2):285-8. DOI: 10.3109/17453678008990800. View

18.

Campbell A, Rorabeck C, Bourne R, Chess D, Nott L . Thigh pain after cementless hip arthroplasty. Annoyance or ill omen. J Bone Joint Surg Br. 1992; 74(1):63-6. DOI: 10.1302/0301-620X.74B1.1732268. View

19.

Engh C, McGovern T, Bobyn J, Harris W . A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg Am. 1992; 74(7):1009-20. View

20.

Callaghan J, Dysart S, Savory C . The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am. 1988; 70(3):337-46. View