Cement augmentation of the Proximal Femur Nail Antirotation (PFNA) is associated with enhanced weight-bearing in older adults

Keppler, Alexander Martin; Pfeufer, Daniel; Kau, Fabian; Linhart, Christoph; Zeckey, Christian; Neuerburg, Carl; Böcker, Wolfgang; Kammerlander, Christian

doi:10.1016/j.injury.2021.01.037

Cited by 14 publications

(13 citation statements)

References 24 publications

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“…According to this study, the injection allows earlier patient mobilization and the subsequent daily activities with a satisfaction almost comparable with the life of the patient prior to trauma [35]. A recent study comparing post-surgical weight bearing while walking highlighted early mobilization and higher weight bearing in augmented patients for femoral fracture [36]. A study by Sermon et al compared augmented PFNA in cadaveric femoral head, mimicking an intertrochanteric fracture showing increased rates of resistance to compressive cyclic loading compared to non-augmented fractures [37].…”

Section: Hip Fracturesmentioning

confidence: 76%

Augmentation in fragility fractures, bone of contention: a systematic review

Piccirilli

Cariati

Primavera

et al. 2022

BMC Musculoskelet Disord

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Background Osteoporosis is a complex multifactorial disease characterized by reduced bone mass and microarchitectural deterioration of bone tissue linked to an increase of fracture risk. Fragility fractures occur in osteoporotic subjects due to low-energy trauma. Osteoporotic patients are a challenge regarding the correct surgical planning, as it can include fixation augmentation techniques to reach a more stable anchorage of the implant, possibly lowering re-intervention rate and in-hospital stay. Methods The PubMed database and the Google Scholar search engine were used to identify articles on all augmentation techniques and their association with fragility fractures until January 2022. In total, we selected 40 articles that included studies focusing on humerus, hip, spine, and tibia. Results Literature review showed a quantity of materials that can be used for reconstruction of bone defects in fragility fractures in different anatomic locations, with good results over the stability and strength of the implant anchorage, when compared to non-augmented fractures. Conclusion Nowadays there are no recommendations and no consensus about the use of augmentation techniques in osteoporotic fractures. Our literature review points at implementing the use of bone augmentation techniques with a specific indication for elderly patients with comminuted fractures and poor bone quality.

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Section: Hip Fracturesmentioning

confidence: 76%

Augmentation in fragility fractures, bone of contention: a systematic review

Piccirilli

Cariati

Primavera

et al. 2022

BMC Musculoskelet Disord

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“…Between January 2000 and March 2023, of 659 articles screened, 22 met the inclusion criteria and formed the basis of this study. 7,16–36…”

Section: Resultsmentioning

confidence: 99%

“…Other studies show that cement augmentation might facilitate improved functional outcome in the postoperative period including gait and weight-bearing abilities. 22,52 It is the authors' opinion that further research is necessary to provide the clinical indication regarding the type of fractures and the bone quality assessments that will show in which cases cement augmentation should be considered and could be beneficial to patients.…”

Section: Discussionmentioning

confidence: 99%

Failure of Fixation in Trochanteric Hip Fractures: Does Nail Design Matter?

Davidson,

Giannoudis

2023

Journal of Orthopaedic Trauma

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Objective: The objective of this study was to compare clinical outcomes of patients with trochanteric hip fractures treated with specific different cephalomedullary nail (CMN) designs. Methods: A scoping review of the English literature was performed. Inclusion criteria were studies comparing perioperative and postoperative outcomes of trochanteric hip fractures fixated by CMNs for one of the following CMN designs: short versus long nails, blade versus screw fixation, dual versus single lag screw fixation, and application of cement augmentation. Inclusion criteria consisted of human comparative clinical trials (randomized and observational). Exclusion criteria included noncomparative studies, studies comparing CMN with non-CMN devices or with arthroplasty, studies with less than 3 months follow-up, studies that did not provide relevant clinical outcome measures, biomechanical, finite element analyses, animal, or in vitro publications. Data regarding reoperations, peri-implant fractures, mechanical failure, nonunion, infection rates, and functional outcomes were reviewed. Results: Twenty-two studies met the inclusion criteria and formed the basis of this study. Failure of fixation rates and reoperation rates for each of the nail designs selected for evaluation is presented, in addition to specific outcome measures relevant to that nail design which was explored: peri-implant fracture—short versus long nails, and specific mechanism of failure—blade versus plate. Conclusions: Decreased failure of fixation and reoperations rates were found for integrated dual lag screw fixation. Similar fixation failure and reoperation rates were found for the long versus short nails and for blade versus screw fixation. Level of Evidence: Diagnostic, Level IV.

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“…No other events or complications (including reoperations for reasons unrelated to the implant) were considered in the model because they were assumed to be balanced between groups on the basis of the results of the RCT 25 . Cement-related complications, such as leakage, toxicity, and pulmonary embolism, were not simulated because they were assumed to be immaterial to the differences in costs or utilities 25 for the following reasons: (1) they are very rare following the fixation of trochanteric fractures 18,[22][23][24][25]27 and are much rarer following that procedure than they are following other procedures, such as arthroplasty 28 and vertebroplasty 29,30 ; (2) a leakage test was routinely done before the augmentation, thereby lowering the risk of leakage; and (3) we were not aware of any reports of disutility associated with cement-related complications in fracture care.…”

Section: Overview and Model Structurementioning

confidence: 99%

“…Cement augmentation has been associated with improved anchorage of the head element of the nail in the femoral head and greater cut-out resistance [18][19][20][21] . Several studies have shown that the increased implant stability with a PFNA with TRAUMACEM V1 Injectable Bone Cement (DePuy Synthes) may allow early mobilization 22 and promote functional recovery [22][23][24][25] .…”

mentioning

confidence: 99%

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures

Joeris

Kabiri

Galvain

et al. 2022

Journal of Bone and Joint Surgery

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Background:A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer’s perspective.Methods:The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient’s lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses.Results:The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%.Conclusions:Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available.Level of Evidence:Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

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Cement augmentation of the Proximal Femur Nail Antirotation (PFNA) is associated with enhanced weight-bearing in older adults

Cited by 14 publications

References 24 publications

Augmentation in fragility fractures, bone of contention: a systematic review

Augmentation in fragility fractures, bone of contention: a systematic review

Failure of Fixation in Trochanteric Hip Fractures: Does Nail Design Matter?

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures

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