Early Complications Following Cemented Modular Hip Hemiarthroplasty

Abstract

Introduction : Hemiarthroplasty is the recommended treatment for displaced, intracapsular, femoral neck fractures. This study aimed to evaluate the early complications following insertion of the JRI Furlong cemented hemiarthroplasty, a contemporary, modular, double tapered, polished prosthesis.Method : A series of 459 consecutive patients (May 2006 - June 2009) treated with a JRI hemiarthroplasty with a minimum of one-year (1-4years) follow-up were evaluated. Data collected retrospectively from clinical records and hospital databases included patient demographics, mortality, deep infection, dislocation, periprosthetic fracture, and any requirement for revision or complications related to the prosthesis.Results : Full data were available for 429 of 459 (93%), partial data for 30 (7%). Average age was 83 years (52-100), 76% were female. One-year mortality was 24%. Intraoperative fractures occurred in 17 patients (3.7%). There were two intraoperative deaths. There were nine early deep wound infections (2%). There were two revisions to total hip replacement (THR), four patients required conversion to THR and one underwent an excision arthroplasty procedure.Discussion : Early surgical outcomes for the JRI hemiarthroplasty prosthesis are equivalent or superior to other major hemiarthroplasty prostheses previously reported however, there was a high intraoperative fracture rate of 3.7%. We recommend using a stem one size smaller than the final broach in fragile, osteoporotic bone. No patients re-presented with aseptic loosening or stem failure.

Complications following 250 cemented modular hip hemiarthroplasties

“…The anatomical stem design of the Lubinus sp II stem is reported to have less periprosthetic fractures than wedge-type stems when using cemented hemiendoprosthesis in femoral neck fracture patients (34). The present rate of intraoperative fractures of 0.8% resembled the rates reported in previous studies (range, 0.8–3.7%) (13, 15, 35). Some of these studies performed both cemented and uncemented hemiarthroplasties, which may in part explain the higher rate of iatrogenic fractures.…”

“…In this study, we report the complications associated with the use of cemented, modular, unipolar HA (Lubinus sp II) and the posterior approach for femoral neck fractures over 8-year follow-up. Given the challenges presented by the patient material, our level of complications is comparable with previous studies (8–10, 13–15, 19).…”

“…This may be due to the fragility of these patients and due to the fact that minor complications like superficial infections are treated in primary healthcare centers, with only major complications being referred to specialized care. The number of deep (prosthetic) infections was acceptable (13,15,19). However, it is possible that late infections are underestimated because the most fragile patients may have been determined unfit for reoperation by a general practitioner and treated with suppression antibiotics in the healthcare centers without orthopedic consultation.…”

“…The literature (8–10) on complications using a modern, modular, cemented, unipolar hemiendoprosthesis via a posterior approach is sparse. Most of the literature (11–15) on complications with modern hemiendoprosthesis uses the Hardinge approach or does not differentiate between approaches.…”

Prospective study of functional outcome in surgical management of intracapsular femur neck fracture treated using modular bipolar prosthesis in elderly

“…There were no major postoperative complications like wound infection and other. Sullivan et al [17] found 3.7% periprosthetic fracture Following Modular Hip Hemiarthroplasty out of 429 patients. Balan et al [10] found no periprosthetic fracture out of 30 patient treated with modular bipolar prosthesis.…”