Factors associated with acetabular degeneration and protrusion in bipolar hip hemiarthroplasty

Year 2022, Volume: 32 Issue: 5, 564 - 570, 29.10.2022

Fahri Emre , Erkan Sabri Ertaş , Murat Bozkurt

https://doi.org/10.54005/geneltip.1152166

Abstract

Purpose
This study aims to investigate the effect of some factors such as the diameter of bipolar prosthetic heads, body mass index (BMI), age, gender, bone mineral density (BMD) and leg length discrepancy (LLD) on the acetabular protrusion in elderly patients who had hip bipolar hemiarthroplasty (BHA) after femoral neck fractures.
Methods
The study included a total of 209 patients with a mean age of 77.4 ± 6.0 years who underwent BHA. The difference between the femoral head diameter of the patients and the diameter of the bipolar prosthetic head was divided into two groups, ranging from 0 to -2 mm (same and 1,2 mm small size) . Acetabular enlargement and cartilage degeneration were followed by standard AP pelvis radiographs and clinical outcomes were evaluated by the Harris Hip Score (HHS) after surgery and during 5 years of follow-up.
Results
During the 5-year follow-up, while HHS values decreased, acetabular diameter increased. Acetabular protrusion developed in 21 (10%) patients, acetabular revision surgery was performed for 36 (17%) patients, the difference between native femoral head diameter and prosthetic head diameter was significantly higher in these groups, as was mean LLD (p = 0.0001). Mean T scores obtained with BMD were lower in these groups (p = 0.0001).
Conclusion
It is safer and more reliable to use a bipolar prosthetic head the same size as the patient’s native femoral head in BHA. When considering the acetabular protrusion and revision surgery rate in this study, small-size bipolar prosthetic head implantation is not recommended and may cause devastating complications.

Keywords

Bipolar hip hemiarthroplasty, Acetabular protrusion, Revision surgery, Femoral neck fracture

Bipolar kalca hemiartroplastisinde asetabuler dejenerasyon ve protruzyon ile iliskili faktorler

Abstract

Amaç
Çalışmanın amacı, femur boyun kırığı sonrasında bipolar kalça hemiartroplastisi uygulanan yaşlı hastalarda bipolar protez başlarının çapı, vücut kitle indeksi, yaş, cinsiyet, kemik mineral yoğunluğu ve bacak uzunluk farkı gibi bazı faktörlerin asetabular protrüzyon üzerine etkisini araştırmaktır.
Gereç ve Yöntem
Çalışmaya bipolar kalça hemiartroplastisi uygulanan toplam 209 hasta dahil edildi. Hastaların ortalama yaşı 77.4 ± 6.0 yıldı. Hastaların femur başı çapı ile bipolar protez başı çapı arasındaki fark 0 ile -2 mm 2 gruba (aynı çap ve 1 veya 2 mm küçük çap) ayrıldı. Asetabular genişleme ve kıkırdak dejenerasyonunu standart AP pelvis radyografileri ile değerlendirildi. Takip süresince klinik sonuçlar Harris Hip Skor’u (HHS) ile değerlendirildi.
Bulgular
Beş yıllık izlemde HHS değerleri düşerken asetabulum çapı arttı. 21 (%10) hastada asetabuler protrüzyon gelişti, 36 (%17) hastaya asetabular revizyon cerrahisi yapıldı. Bu gruplarda doğal femur başı çapı ile protez baş çapı arasındaki fark ve bacak uzunluk farkı anlamlı olarak daha yüksekti. (p = 0.0001) . Kemik mineral yoğunluğu ile elde edilen ortalama T skorları bu gruplarda daha düşüktü (p = 0.0001).
Sonuç
Bipolar kalça artroplastisi'nde hastanın doğal femur başı ile aynı boyutta bipolar protez başı kullanmak daha güvenilirdir. Bu çalışmada asetabular protrüzyon ve revizyon cerrahi oranı göz önüne alındığında, küçük boyutlu bipolar protez baş implantasyonu önerilmemektedir ve yıkıcı komplikasyonlara neden olabilir.

Keywords

bipolar kalça hemiarthroplastisi,, asetabular protrusyon, revizyon cerrahisi, femur boyun kırığı

References

• Referans 1. Yang B, Lin X, Yin XM, Wen XZ. Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol. 2015;25:425-33.
• Referans 2. Guyen O. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res. 2019 Feb;105(1S):S95-S101.
• Referans 3. Liu Y, Tao X, Wang P, Zhang Z, Zhang W, Qi Q. Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures. Int Orthop. 2014;38:1691–6.
• Referans 4. Kim YS, Kim YH, Hwang KT, Choi IY. The cartilage degeneration and joint motion of bipolar hemiarthroplasty. Int Orthop. 2012;36:2015-20.
• Referans 5. Lim JB, Ang CL, Pang HN. Acetabular Prosthetic Protrusio after Bipolar Hemi-Arthroplasty of the Hip: Case Report and Review of the literature. J Orthop Case Rep. 2016;6:28-31.
• Referans 6. Inngul C, Hedbeck CJ, Blomfeldt R, Lapidus G, Ponzer S, Enocson A. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. Int Orthop. 2013;37:2457-64.
• Referans 7. Ong BC, Maurer SG, Aharonoff GB, Zuckerman JD, Koval KJ. Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up. J Orthop Trauma. 2002;16:317-22.
• Referans 8. Kosashvili Y, Backstein D, Safir O, Ran Y, Loebenberg MI, Ziv YB. Hemiarthroplasty of the hip for fracture-what is the appropriate sized femoral head? Injury. 2008;39:232-7.
• Referans 9. Moon KH, Kang JS, Lee TJ, Lee SH, Choi SW, Won MH. Degeneration of Acetabular Articular Cartilage to Bipolar Hemiarthroplasty. Yonsei Med J. 2008;49:719-24.
• Referans 10. Söderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res. 2001;384:189-97.
• Referans 11. Kurrat HJ, Oberländer W. The thickness of the cartilage in the hip joint. J Anat. 1978;126:145-55.
• Referans 12. Drinker H, Murray WR. The universal proximal femoral endoprosthesis. A short-term comparison with conventional hemi- arthroplasty. J Bone Joint Surg Am. 1979;61:1167-74.
• Referans 13. Bochner RM, Pellicci PM, Lyden JP. Bipolar hemiarthroplasty for fracture of the femoral neck. Clinical review with special emphasis on prosthetic motion. J Bone Joint Surg Am. 1988;70:1001–10.
• Referans 14. Rubio I, Bellostas L, Garcia-Rey E. Radiological subsidence and acetabular erosion after tapered uncemented hemiarthroplasty in femoral neck fractures a 10- to 13- year follow-up study. Injury. 2020;51 Suppl 1:S37-41.
• Referans 15. Mazen S, Julien G, Riad F. Retrospective evaluation of bipolar hip arthroplasty in fractures of the proximal femur. N Am J Med Sci. 2010;2:409–15.
• Referans 16. Minihane KP, Turner TM, Urban RM, Williams JM, Thonar EJ, Sumner DR. Effect of hip hemiarthroplasty on articular cartilage and bone in a canine model. Clin Orthop Relat Res. 2005;437:157–63.
• Referans 17. van der Meulen MCH, Beaupré GS, Smith RL, Giddings VL, Allen WA, Athanasiou KA, et al. Factors influencing changes in articular cartilage following hemiarthroplasty in sheep. J Orthop Res. 2002;204:669–75.
• Referans 18. Schiavi P, Pogliacomi F, Colombo M, Amarossi A, Ceccarelli F, Vaienti E. Acetabular erosion following bipolar hemiarthroplasty: A role for the size of femoral head? Injury. 2018;50 Suppl 4:S21-5.
• Referans 19. Rushfeldt PD, Mann RW, Harris WH. Improved techniques for measuring in vitro the geometry and pressure distribution in the human acetabulum. II Instrumented endoprosthesis measurement of articular surface pressure distribution. J Biomech. 1981;145:315-23.
• Referans 20. Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Am. 2006;88:2583-9.
• Referans 21. D’Arcy J, Devas M. Treatment of fractures of the femoral neck by replacement with the Thompson prosthesis. J Bone Joint Surg Br. 1976;58:279-86.
• Referans 22. Athanasiou KA, Agarwal A, Dzida FJ. Comparative study of the intrinsic mechanical properties of the human acetabular and femoral head cartilage. J Orthop Res. 1994;12:340-9.
• Referans 23. Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken). 2011;63 Suppl 1:S200-7.
• Referans 24. Lane JM, Russell L, Khan SN. Osteoporosis. Clin Orthop Relat Res. 2000;372;139-50.