Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture

Abstract

Purpose:In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem. Materials and Methods: A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups. Results: Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition, there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2. Conclusion: Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.

Comparative Study of Bipolar Hemiarthroplasty for Femur Neck Fractures Treated with Cemented versus Cementless Stem

“…Previous studies reported a longer operation time in patients with cemented stems202227), comparable to our study, or revealed no difference in outcome after cemented versus cementless BHA728).…”

“…The result showing no difference in intraoperative blood loss between two groups can be interpreted that cement manipulation had insignificant influence in surgical procedure to bring changes in intraoperative blood loss under condition that patients in two groups have the same bleeding tendency, and this may also differ depending on surgeon's surgical skills. Postoperative blood loss volume was significantly greater in the uncemented group, and this outcome was comparable to the finding of Park et al28). On the other hand, Ng and Krishna22) and Figved et al27) reported a higher intraoperative bleeding volume in the cemented group.…”

Hemiarthroplasty through Direct Anterior Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: Analysis of Early Cases

“…None of the patients required a blood transfusion after surgery. Blood loss was reduced significantly from approximately 700 mL in the previous study reported by Park et al 20) in which the conventional PL approach was used for treatment of unstable intertrochanteric fractures in elderly patients. The mean visible blood loss in unstable intertrochanteric fractures treated using intramedullary nails was a 200 mL 21) .…”

Cemented versus cementless bipolar hemiarthroplasty for femoral neck fractures in the elderly

“…7 , 8 , 16 Figved et al 8 and Ng and Krishna 12 reported a higher intraoperative bleeding volume in the cemented group. On the other hand, Park et al 28 reported that the postoperative blood loss volume was significantly higher in the uncemented group. A haemostatic effect of cement insertion to the femoral canal is suggested, but further investigation is needed to clarify its exact mechanism.…”