Intra-Operative Fractures in Cementless Bipolar Hemiarthroplasty

Kuo, Chung-Liang; Tan, Si Heng Sharon; Lee, Haw Chou

doi:10.1177/230949901502300222

Cited by 10 publications

(4 citation statements)

References 17 publications

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“…In randomized controlled trials, Parker et al [9] and Taylor et al [19] have shown the fracture incidence to be significantly higher with uncemented hemiarthroplasty. The overall fracture rate of 7.1%, as well as the isolated fracture rate of 7.4% for uncemented arthroplasty as determined by this study, was consistent with the current literature [20, 21], especially when considering that 87.5% of procedures were cementless.…”

Section: Discussionsupporting

confidence: 91%

“…This homogenous study population allowed us to retrospectively focus on risk factors in a widely unbiased fashion. To our knowledge, this is a study design, which has been adopted by only two other studies [20, 21]. Both studies used smaller population sizes (278 and 271, respectively) as well as heterogeneity of implant types.…”

Section: Discussionmentioning

confidence: 99%

“…Specific risk factors have been outlined for the occurrence of these types of fractures. The type of fixation (cemented vs. uncemented) and Dorr canal type are known to be significant risk factors [20, 21]. Female sex has been shown to be a significant risk factor with total hip arthroplasty [22].…”

Section: Introductionmentioning

confidence: 99%

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Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Bellova¹,

Baecker²,

Lotzien³

et al. 2019

J Orthop Surg Res

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Background: Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. Methods: We retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients' demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon's experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher's exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS. Results: Of 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872-6.079), stovepipe femur (OR 1.749, 95% CI .823-3.713), junior surgeon (OR 1.204, 95% CI .596-2.432), and on-call-duty surgery (OR 1.471, 95% CI .711-3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41). Conclusions: IPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Bellova¹,

Baecker²,

Lotzien³

et al. 2019

J Orthop Surg Res

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“…The overall incidence of IPF in our study was 8.6% (22 of 257), this finding is consistent with current literature 12 , 19 . Furthermore, the incidence of IPF in the Corail group was 12.2%, while the incidence of IPF in the Austin-Moore group was 4.2%, this difference is statistically significant ( p = 0.025).…”

Section: Discussionsupporting

confidence: 93%

A comparison between Austin-Moore and Corail prosthesis regarding intraoperative periprosthetic femur fractures in hip hemiarthroplasty

Mazzawi

Ghrayeb

Khury

et al. 2022

Sci Rep

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Hip hemiarthroplasty is considered the treatment of choice for displaced femoral neck fractures in elderly less active patients. One important complication of this procedure is an intraoperative periprosthetic femur fracture (IPF), which may lead to poor functional outcome and may increase morbidity and mortality. Our primary aim in this study is to compare between Austin-Moore and Corail prosthesis regarding IPFs. Our secondary aim is to assess patient and surgical technique related risk factors for the development of this complication. Inclusion criteria included patients older than 65 years of age who had a displaced femoral neck fracture and were operated for hip hemiarthroplasty between the years 2014–2018. Patient-specific data was collected retrospectively including age, gender, comorbidities, pre-injury ambulatory status, duration of surgery, surgical approach, use of Austin-Moore or Corail prosthesis, surgeon’s experience and type of anesthesia applied. In addition, radiographs were reviewed for measurement of calcar to canal ratio (CDR) and classification of Dorr canal type. 257 patients with an average age of 83.7 years were enrolled in the study. 118 patients (46%) were treated with an Austin-Moore prosthesis, while 139 (54%) were treated with a Corail prosthesis. A total of 22 patients (8.6%) had intraoperative fractures. Fracture prevalence was significantly higher in the Corail group compared with the Austin-Moore group (12.2% vs. 4.2%, p = 0.025). The majority of patients had a Dorr A type femoral canal, while the rest had Dorr B type canal (70% vs. 30%). There was no difference in fracture prevalence between Dorr A and B canal type patients. We didn’t find any significant risk factor for developing an IPF, neither patient wise (age, gender, and comorbidities) nor surgical technique related (surgical approach, type of anesthesia, and surgeon’s experience). Intraoperative periprosthetic fracture prevalence was significantly higher in the Corail patient group compared with the Austin-Moore group. This may be an important advantage of the Austin-Moore prosthesis over the Corail prosthesis.

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Outcomes of cerclage wiring to manage intra-operative femoral fracture occurring during cementless hemiarthroplasty in older patients with femoral neck fractures

Unnanuntana

Saiyudthong

2019

International Orthopaedics (SICOT)

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Intra-Operative Fractures in Cementless Bipolar Hemiarthroplasty

Cited by 10 publications

References 17 publications

Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

A comparison between Austin-Moore and Corail prosthesis regarding intraoperative periprosthetic femur fractures in hip hemiarthroplasty

Outcomes of cerclage wiring to manage intra-operative femoral fracture occurring during cementless hemiarthroplasty in older patients with femoral neck fractures

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