Canal Fill Ratio in Hemiarthroplasty Compared to Total Hip Arthroplasty: A Case Control Study

Overview

Journal Iowa Orthop J

Date 2025 Jan 15

PMID 39811163

Authors

Justin A Magnuson

Nihir Parikh

Sundeep Kahlon

Jamie Henzes

Andrew J Hughes

Kerri-Anne Ciesielka

Arjun Saxena

Andrew M Star

Affiliations

Soon will be listed here.

Abstract

Background: Cementless stems are commonly used in hemiarthroplasty (HA) for femoral neck fractures. Recent studies have reported increased risk of periprosthetic fracture with cementless stems compared to cemented HA. In elective total hip arthroplasty (THA), lower proximal canal fill ratios (CFR) of cementless stems have been associated with worse outcomes. The purpose of this study was to compare CFRs and complications following HA for femoral neck fracture compared to THA for arthritis. We hypothesized that HA would have lower CFRs.

Methods: 130 patients undergoing cementless hemiarthroplasty for femoral neck fracture were identified and matched by age, sex, and BMI to 328 patients undergoing elective cementless THA. Postoperative radiographs were independently evaluated by two investigators to determine Dorr femur type and CFR at four points. Interrater agreement was calculated for CFR and Dorr type. Complication rates were compared between HA and THA groups.

Results: Dorr type and CFR measurements showed strong agreement between investigators. Dorr type was similar between groups. Hemiarthroplasties had significantly lower CFR at each level, with the greatest difference at the lesser trochanter. Dorr C femurs had worse CFR, specifically in the HA group. Complications rates were similar between HA and THA.

Conclusion: Worse CFR in HA compared to THA further suggests that cemented stems should be considered in HA. Suboptimal CFR represents a potential cause of complications including periprosthetic fracture following HA. .

References

Bigart K, Nahhas C, Ruzich G, Culvern C, Salzano M, Della Valle C . Does Femoral Morphology Predict the Risk of Periprosthetic Fracture After Cementless Total Hip Arthroplasty?. J Arthroplasty. 2020; 35(6S):S359-S363. DOI: 10.1016/j.arth.2020.02.048. View

Taylor F, Wright M, Zhu M . Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012; 94(7):577-83. DOI: 10.2106/JBJS.K.00006. View

Miyamoto R, Kaplan K, Levine B, Egol K, Zuckerman J . Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg. 2008; 16(10):596-607. DOI: 10.5435/00124635-200810000-00005. View

Ahn J, Man L, Park S, Sodl J, Esterhai J . Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures. Clin Orthop Relat Res. 2008; 466(10):2513-8. PMC: 2584290. DOI: 10.1007/s11999-008-0368-3. View

Ma H, Chou T, Tsai S, Chen C, Wu P, Chen W . Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis. J Orthop Surg Res. 2019; 14(1):320. PMC: 6787983. DOI: 10.1186/s13018-019-1377-5. View

Kobayashi K, Kidera K, Itose M, Motokawa T, Chiba K, Osaki M . Higher incidence of aseptic loosening caused by a lower canal filling ratio with a modified modular stem in total hip arthroplasty. J Orthop Surg Res. 2020; 15(1):568. PMC: 7706283. DOI: 10.1186/s13018-020-02101-x. View

Wilkerson J, Fernando N . Classifications in Brief: The Dorr Classification of Femoral Bone. Clin Orthop Relat Res. 2020; 478(8):1939-1944. PMC: 7371079. DOI: 10.1097/CORR.0000000000001295. View

Skoldenberg O, Sjoo H, Kelly-Pettersson P, Boden H, Eisler T, Stark A . Good stability but high periprosthetic bone mineral loss and late-occurring periprosthetic fractures with use of uncemented tapered femoral stems in patients with a femoral neck fracture. Acta Orthop. 2014; 85(4):396-402. PMC: 4105771. DOI: 10.3109/17453674.2014.931195. View

Kristensen T, Dybvik E, Kristoffersen M, Dale H, Engesaeter L, Furnes O . Cemented or Uncemented Hemiarthroplasty for Femoral Neck Fracture? Data from the Norwegian Hip Fracture Register. Clin Orthop Relat Res. 2019; 478(1):90-100. PMC: 7000039. DOI: 10.1097/CORR.0000000000000826. View

10.

Cui S, Wang D, Wang X, Li Z, Guo W . The choice of screw internal fixation and hemiarthroplasty in the treatment of femoral neck fractures in the elderly: a meta-analysis. J Orthop Surg Res. 2020; 15(1):433. PMC: 7507610. DOI: 10.1186/s13018-020-01958-2. View

11.

Spaans E, Koenraadt K, Wagenmakers R, Elmans L, Van den Hout J, Eygendaal D . Does surgeon volume influence the outcome after hip hemiarthroplasty for displaced femoral neck fractures; early outcome, complications, and survival of 752 cases. Arch Orthop Trauma Surg. 2018; 139(2):255-261. DOI: 10.1007/s00402-018-3076-9. View

12.

Khanuja H, Vakil J, Goddard M, Mont M . Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011; 93(5):500-9. DOI: 10.2106/JBJS.J.00774. View

13.

Kostuj T, Smektala R, Schulze-Raestrup U, Muller-Mai C . [The influence of timing of surgery on mortality and early complications in femoral neck fractures, by surgical procedure: an analysis of 22,566 cases from the German External Quality Assurance Program]. Unfallchirurg. 2011; 116(2):131-7. DOI: 10.1007/s00113-011-2071-1. View

14.

Lo I, Tzeng Y, Wang C, Yang T, Lin C, Chiang C . Initial femoral stem position in cementless bipolar hemiarthroplasty for femoral neck fracture in elderly patients is associated with early implant subsidence: A radiographic analysis. Injury. 2021; 52(7):1801-1806. DOI: 10.1016/j.injury.2021.05.006. View

15.

Lin J, Liang W . Outcomes after fixation for undisplaced femoral neck fracture compared to hemiarthroplasty for displaced femoral neck fracture among the elderly. BMC Musculoskelet Disord. 2015; 16:199. PMC: 4543452. DOI: 10.1186/s12891-015-0671-6. View

16.

Kim J, Shon H, Song S, Lee Y, Koo K, Ha Y . Reoperation rate, mortality and ambulatory ability after internal fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a study on Korean Hip Fracture Registry. Arch Orthop Trauma Surg. 2020; 140(11):1611-1618. DOI: 10.1007/s00402-020-03345-2. View

17.

Veronese N, Maggi S . Epidemiology and social costs of hip fracture. Injury. 2018; 49(8):1458-1460. DOI: 10.1016/j.injury.2018.04.015. View

18.

Langslet E, Frihagen F, Opland V, Madsen J, Nordsletten L, Figved W . Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res. 2013; 472(4):1291-9. PMC: 3940758. DOI: 10.1007/s11999-013-3308-9. View

19.

Guyen O . Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures?. Orthop Traumatol Surg Res. 2018; 105(1S):S95-S101. DOI: 10.1016/j.otsr.2018.04.034. View

20.

Nantha Kumar N, Kunutsor S, Fernandez M, Dominguez E, Parsons N, Costa M . Effectiveness and safety of cemented and uncemented hemiarthroplasty in the treatment of intracapsular hip fractures. Bone Joint J. 2020; 102-B(9):1113-1121. DOI: 10.1302/0301-620X.102B9.BJJ-2020-0282.R1. View