Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study

Background and purposeRecent studies have demonstrated a high incidence of postoperative periprosthetic femoral fracture (PPF) in elderly patients treated with 2 commonly used cemented, polished tapered stems. We compared the prevalence and incidence rate of PPF in a consecutive cohort of octagenerians with femoral neck fractures (FNFs) treated with either a collarless, polished tapered (CPT) stem or an anatomic matte stem (Lubinus SP2).Patients and methodsIn a multicenter, prospective cohort study, we included 979 hips in patients aged 80 years and above (72% females, median age 86 (80–102) years) with a femoral neck fracture as indication for surgery. 69% of the patients were classified as ASA class 3 or 4. Hip-related complications and repeat surgery were assessed at a median follow-up of 20 (0–24) months postoperatively.Results22 hips (2.2%) sustained a PPF at a median of 7 (0–22) months postoperatively; 14 (64%) were Vancouver B2 fractures. 7 of the 22 surgically treated fractures required revision surgery, mainly due to deep infection. The cumulative incidence of PPFs was 3.8% in the CPT group, as compared with 0.2% in the SP2 group (p < 0.001). The risk ratio (RR) was 16 (95% CI: 2–120) using the SP2 group as denominator.InterpretationThe CPT stem was associated with a higher risk of PPF than the SP2 stem. We suggest that the tapered CPT stem should not be used for the treatment of femoral neck fractures in patients over 80 years.

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“… 2014 , Ginsel et al. 2015 ). These suggestions remain to be investigated further regarding specific stems.…”

Section: Discussionmentioning

confidence: 99%

Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

et al. 2016

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“…No studies, to our knowledge, have compared the TS and CB principles. One study by Ginsel et al 54 compared TS-designed Exeter stems with identical length and offset, but with different cross-section size (202), and found large stems to be more resistant to torque forces for fracture. The wedge polished TS design facilitates a thicker cement mantle around the tip of the stem than the straight and anatomic CB-designed stems.…”

Section: Mechanical Studies Comparing the Taper-slip And Composite-bementioning

confidence: 99%

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

Dybvik

Furnes

et al. 2018

The Bone & Joint Journal

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Sammendrag på norskDet forekommer ca. 9000 hoftebrudd hos eldre i Norge årlig. Dette er den hyppigste årsaken til akutt innleggelse i kirurgiske avdelinger i norske sykehus. Det er sannsynligvis den mest alvorlige bruddtypen som ortopeder behandler. Hoftebrudd pasienter blir innlagt hele døgnet, blir operert av både ferske og erfarne leger og representerer en høyrisiko pasient-gruppe med mange tilleggs sykdommer og gjennomsnitts alder rundt 80 år. En av fire pasienter dør innen ett år, og flesteparten oppnår ikke funksjonsnivået som de hadde før bruddet. Det er også et stort behov for rehabilitering og hjemmesykepleie etter behandling og derav høye kostnader for samfunnet. Pasienter som får komplikasjoner etter kirurgi har enda dårligere prognose og høyere dødelighet. Hoftebrudd involverer flere typer hoftenaere brudd. Denne avhandlingen konsentrerer seg om lårhalsbrudd, og spesielt de 3500 pasientene som hvert år blir operert med en delprotese etter lårhalsbrudd. I Norge registrerer kirurgen hver hoftebruddoperasjon på et skjema som sendes til Nasjonalt Hoftebruddregister (NHBR). Dersom pasienten får en komplikasjon og må gjennomgå ny operasjon blir denne registrert på et tilsvarende skjema og koblet til den første operasjonen ved hjelp av pasientens personnummer. Hoftebruddpasientene får også tilsendt spørreskjema etter operasjonen for å svare på hvordan de har det. Dødsfall registrert i Norge kan også kobles til hofteoperasjonen. En delprotese operasjon involverer å erstatte lårhals og lårhode med en protese. Det er i dag ikke enighet om hvilken operasjonstilgang som er best når man opererer halvproteser. Det er heller ikke enighet om man skal bruke en protese som festes med bensement eller en protese som gror fast i benet. Hvis man velger å feste protesen med bensement finnes det forskjellige design på de protesene som er på markedet i dag. Man vet ikke hvilke protesedesign som gir best resultat hos pasientene. I denne doktoravhandlingen har vi brukt NHBR til å gi svar på problemstillingene over. Den består av tre publiserte artikler. 4 I første artikkel viser vi at de som er operert med en bakre kirurgisk tilgang til hoften (og svart på spørreskjema etter operasjon) har tendens til mindre smerte, mer tilfredshet, bedre livskvalitet og mindre rapporterte gangproblemer enn en kirurgisk tilgang rett fra siden. Når man skal velge kirurgisk tilgang ved halvprotese må våre resultater sees i sammenheng med andre studier som viser at den bakre tilgangen har større risiko for en fryktet komplikasjon hvor protesen går ut av ledd. I andre artikkel finner vi at halvproteser som er festet med bensement har mindre risiko for en ny operasjon enn halvproteser som skal gro fast. Vi finner ikke forskjell i risiko for dødsfall det første året mellom metodene. Vi finner heller ikke forskjell i smerte eller livskvalitet mellom metodene for de som har svart på spørreskjema. Vi anbefaler bruk av bensement når man skal feste halvprotese etter lårhalsbrudd for å redusere fare for ny operasjon. I tredje artikkel ser vi på forskjellig...

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“…Mechanically, it has been shown that larger stems can improve primary stability of both cemented (Ginsel et al. 2015) and cementless (Fottner et al. 2017) stems due to a better bone load.…”

Section: Discussionmentioning

confidence: 99%

“…Ginsel et al. (2015) found that an Exeter stem (Stryker Orthopaedics, Mahwah, NJ, USA) with a larger cross-section tolerates more torque until failure, Morishima et al. (2014) found that an Exeter stem (Stryker) with increased length tolerates more torque and energy until failure.…”

mentioning

confidence: 99%

Cementing of the hip arthroplasty stem increases load-to-failure force: a cadaveric study

Klasan¹,

Bäumlein²,

Bliemel³

et al. 2019

Acta Orthopaedica

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Background and purpose — To date, there is not a single clinical or mechanical study directly comparing a cemented and a cementless version of the same stem. We investigated the load-to-failure force of a cementless and a cemented version of a double tapered stem.Material and methods — 10 femurs from 5 human cadaveric specimens, mean age 74 years (68–79) were extracted. Bone mineral density (BMD) was measured using peripheral quantitative computed tomography. None of the specimens had a compromised quality (average T value 0.0, –1.0 to 1.4). Each specimen from a pair randomly received a cemented or a cementless version of the same stem. A material testing machine was used for lateral load-to-failure test of up to a maximal load of 5.0 kN.Results — Average load-to-failure of the cemented stem was 2.8 kN (2.3–3.2) and 2.2 kN (1.8–2.8) for the cementless stem (p = 0.002). The cemented version of the stem sustained a higher load than its cementless counterpart in all cases. Failure force was not statistically significantly correlated to BMD (p = 0.07).Interpretation — Implanting a cemented version of the stem increases the load-to-failure force by 25%.

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Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study

Abstract: The use of large body polished tapered cemented stems for neck of femur fractures increases the torque to failure in a biomechanical model and therefore is likely to reduce late periprosthetic fracture risk in this vulnerable cohort.

Cited by 18 publications

References 24 publications

Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

Cementing of the hip arthroplasty stem increases load-to-failure force: a cadaveric study

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Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study

Abstract: The use of large body polished tapered cemented stems for neck of femur fractures increases the torque to failure in a biomechanical model and therefore is likely to reduce late periprosthetic fracture risk in this vulnerable cohort.

Cited by 18 publications

References 24 publications

Substantially higher prevalence of postoperative peri­prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

Substantially higher prevalence of postoperative peri­prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

Cementing of the hip arthroplasty stem increases load-to-failure force: a cadaveric study

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Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

Substantially higher prevalence of postoperative periprosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem