The Corail® stem for the treatment of displaced femoral neck fractures - a viable alternative?

Abstract

Cementless hemiarthroplasty in hip fracture surgery has been associated with poorer outcomes and more pain than cemented hemiarthroplasty. The aim was to investigate clinical and radiographic outcomes for a cementless tapered titanium fully hydroyxapatite-coated (Corail® System) stem in this consecutive cohort of hip fracture patients. We retrospectively evaluated the results of 68 consecutive elderly patients with displaced intracapsular hip fractures, treated with this implant. Mean clinical follow-up was 4.3 years (2-6 years). One-year mortality was 24%. 95% of patients had no/occasional/mild mid-thigh pain, with moderate pain in 5%. 39% achieved independent or walking-stick mobility. 36 patients had follow-up radiography. Osseointegration was noted in 34, with a mixed bony/fibrous in-growth in 2. One patient had revision for subsidence of an undersized implant, with no conversions to total hip arthroplasty. The Corail® stem can be used effectively for the treatment of femoral neck fractures in the elderly.

Outcome of An Uncemented Hydroxyapatite Coated Hemiarthroplasty for Displaced Femoral Neck Fractures: A Clinical and Radiographic 2-Year Follow-Up Study

“…Overall, the findings are comparable with the findings of Cawley et al (21). reporting osseousintegration in the majority of radiographs at minimum two year follow-up.…”

“…This is comparable to what is previously reported (20). Even though roughly half the patients reported varying degrees of localised pain the VAS scores were lower than in previous reports (2) and comparable with other studies specifically reporting the outcome of the Corail stem (20,21). The patients reported high levels of satisfaction and self assessed quality of life at the two year follow-up and the EQ-5D questionnaire primarily reported no or few problems with only a very few patients reporting extreme problems.…”

“…Twenty-nine of 37 radiographs showed press fit and collectively these findings demonstrates a high rate of bony in growth and thus stem fixation according to the Engh criteria (29). The overall complication rate is comparable to that previously reported, whereas the mortality rate of 48% is higher than previously reported at two year follow-up (20,21). This may be attributed to our cohort being unselected and thus inclusive of patients with severe co-morbidities.…”

“…It remains to be seen if these benefits in patients with osteoarthritis also apply to elderly patients with DFNF and osteoporosis. Few studies have explored the clinical and radiographic outcome of modern hydroxyapatite coated hemiarthroplasties for treatment of DFNF (6,16,20,21). Prospectively collected clinical and radiographic data using validated outcome measures with a minimum 2 year follow-up reports are scarce (20).…”

Corail uncemented hemiarthroplasty with a Cathcart head for intracapsular hip fractures

“…5 There is evidence that its use in the elderly, who are likely to have osteoporotic bone, is acceptable, with good osseo-integration and little subsidence. 6,7 A radiostereometric analysis 8 has demonstrated a mean subsidence of 2.7 mm when the Corail stem is used to treat intracapsular fractures. There are collared and collarless versions, with the collar designed to prevent excess subsidence.…”