The Outcomes of Cemented Femoral Revisions for Periprosthetic Femoral Fractures in the Elderly: Comparison with Cementless Stems

Abstract

Introduction:The present study compares the outcome of the long cemented stem and the revision uncemented stem used in periprosthetic femoral fractures. We propose that the revision with a long stem cemented prosthesis does not compromise fracture healing. Patients and Methods: A consecutive series of 37 patients, operated between 2010 and 2017, were enrolled in a retrospective analysis. A long cemented stem was implanted in 21 patients (study group; age at operation: 63 to 89 years). A distally tapered fluted uncemented stem was used in 16 patients (control group; age at operation: 35 to 77 years). The clinical outcome was evaluated with Merle d'Aubigné and Postel scoring system. Standard radiographs were taken before surgery, at 3, 6, and 12 months postoperatively, and last follow-up. Any and all complications during the follow-up period were recorded. Results: Although a significant difference (P = 0.006) was observed in the post-operative Merle d´Aubigné score over the 12-month follow-up period, no significant difference (P = 0.066) was found in the post-operative pain score between the study and control groups. Periodic radiographic assessments showed the disappearance of radiolucent lines and the diaphyseal part of the fracture was healed in all 34 followed-up cases during the first annual follow-up. Early surgical complications were seen in both groups, the medical complications were observed only in the study group. Conclusion: Based on our results, periprosthetic fractures of the femur after a total hip arthroplasty were associated with significant morbidity and increased mortality in elderly patients. Revision with a long-stem cemented prosthesis provided early pain-free weightbearing without compromising the healing of femoral fractures in elderly patients with osteoporotic bone, altered mobility, poor balance, and reduced cognitive capacity.

Similar revision rate after cemented and cementless femoral revisions for periprosthetic femoral fractures in total hip arthroplasty: analysis of 1,879 revision hip arthroplasties in the Dutch Arthroplasty Register

“…The available literature regarding optimal fixation comparing long cemented femoral stems and distally tapered uncemented stems in PPFs is very scarce. Most of these studies are limited by (retrospective) design and number of inclusions ( 10 - 11 , 14 - 15 ). One registry-based study with data from the Swedish Hip Arthroplasty Register compared the outcomes of cemented and cementless fixation for Vancouver B2 and B3 periprosthetic fractures ( 16 ).…”

“…They reported no differences in risk of revision among cemented, cementless monoblock, and cementless modular revision components for the treatment of type B2 and B3 fractures, which is in line with our results. A recent study compared the outcome of long cemented stems and uncemented revision stems used in PPFs ( 10 ). Although early surgical complications were reported in both groups, an increased morbidity and complication rate was seen in the long-stemmed cemented group.…”

“…In the past, long cemented revision stems have been advocated based on various studies (8)(9). However, other studies suggest favorable outcomes in terms of implant survival for uncemented revision stems (10)(11)(12). Most of these studies are limited by design and number of patients.…”

Periprosthetic Fracture around a Cemented Stem in Total Hip Arthroplasty

“…The numerical increment of primary THAs also results in the increment of revision operations in elderly patients due to trauma. Sponer et al 12) reported on the outcomes of revision arthroplasties in a comparison of cemented stems and cementless stems. According to the authors, use of a long stem cemented stem implant would provide a greater possibility of pain-free weight-bearing without compromising the process for healing fractures of osteoporotic bones associated with old age 12) .…”