Femur boyun kırığı nedeniyle hemiartroplasti yapılan hastalarda Dorr tipinin klinik sonuçlara ve perioperatif komplikasyonlara etkisi

Year 2022, Volume: 13 Issue: 45, 18 - 24, 07.04.2022

Gökay Eken

https://doi.org/10.17944/mkutfd.925699

Abstract

Amaç: Femur boyun kırıkları, özellikle ileri yaş grubunda dünya çapında epidemik olarak tanımlanmakta ve toplum sağlığı açısından önemli bir risk oluşturmaktadır. Hemiartroplasti uygulanan yaşlı femur boyun kırıklarında Dorr tipine göre proksimal femur anatomisindeki farklılıkların perioperatif komplikasyonlara ve fonksiyonel sonuçlara etkisi henüz tam olarak ortaya konulmamıştır. Çalışmamızda, femur boyun kırığı nedeniyle çimentosuz hemiartroplasti uygulanan hastalarda proksimal femur anatomisinin klinik sonuçlara etkisini araştırmayı amaçladık.
Yöntem: Femur boyun kırığı nedeni ile çimentosuz hemiartroplasti yapılmış olan 65 yaş üzeri 107 hastaya röntgen görüntüleri incelenerek Dorr sınıflaması yapıldı ve bu sınıflandırmaya göre hastalar A, B ve C tipi olmak üzere üç gruba ayrıldı. Demografik veriler, ameliyat süreleri, ameliyat sırası kan kaybı, ameliyat sonrası kan transfüzyon miktarları, komplikasyonları, yoğun bakım ihtiyaçları, 1 yıllık mortalite oranları, ameliyat öncesi ve sonrası radyografik bulguları incelendi. Klinik sonuçlar için son kontrollerindeki Harris Kalça Skoru (HKS) ve Likert ağrı skalaları hesaplandı.
Bulgular: Hastaların 11’inde (%10.3) Dorr tip A, 32’sinde (%29.9) Dorr tip B, 64’ünde (%59.8) Dorr tip C saptandı. Ortalama yaş 79,7 ve tip C olan hastalarda anlamlı olarak yüksek saptandı (p<0.001). Ortalama HKS ve Likert düzeyi, A tipinde B’ye göre ve B tipinde C’ye göre daha iyi idi fakat gruplar arası anlamlı fark olmadığı saptandı (p=0.205, p=0.091). Periprostetik kırık ve trokanter major kırığı oranlarının C tipinde diğer tiplere göre daha fazla olduğu saptandı (p=0.020).
Sonuç: Dorr tip C’ nin daha sık görülmesi ile klinik skorlar anlamlı olarak etkilenmemekle beraber ameliyat sırasında periprostetik kırık ve trokanter major kırığının daha yüksek oranda görüldüğü saptanmıştır. Ameliyat sırası bu komplikasyonları azaltmak adına özellikle Dorr tip C femur anatomisine sahip hastalarda titiz bir preoperatif planlama ve ameliyat sırasında da dikkatli bir implant yerleştirilmesi yapılmalıdır.

Keywords

Dorr sınıflaması, hemiartroplasti, femur boyun kırığı, Harris kalça skoru

Supporting Institution

-

Project Number

-

Thanks

Yok

Effect of Dorr type on clinical outcomes and perioperative complications in patients who underwent hemiarthroplasty for femoral neck fracture

Abstract

Objective: Femoral neck fractures are defined as epidemics worldwide, especially in the advanced age group, and pose an important risk for public health. Effect of proximal femur anatomy variations according to the Dorr type in elderly patients who underwent hemiarthroplasty for intracapsular femur fractures on perioperative complications and functional outcomes have not been identified clearly yet. In our study we aimed to investigate the effect of proximal femur anatomy on clinical outcomes in patients who underwent cementless hemiarthroplasty.
Method: 107 patients who were older than 65 years with displaced intracapsular femur neck fracture and underwent cementless hemiarthroplasty were included. Preoperative radiographies were assessed according to Dorr classification and patients were grouped into 3 groups as type A, B and C. Demographic findings, surgery time, blood loss during surgery, postoperative transfusion amount, complications, intensive care requirement, one year mortality and radiographic findings were assessed. Harris Hip Score (HHS) and Likert pain scores at the last examinations were analyzed for clinical outcomes.
Results: 11 (10.3%) type A, 32 (29.9%) type B, 64 (59.8%) type C were detected. Mean age was 79.7 and it was significantly higher in type C patients compared with others (p<0.001). Mean HHS and Likert scores were better in group A compared with B and in group B compared with C however these were statistically insignificant (p=0.205, p=0.091). Periprosthetic and trochanter major fractures were significantly higher in group C compared with other groups (p=0.020).
Conclusion: Periprosthetic and trochanter major fractures increase but the clinical outcomes are not affected by a worse Dorr type. A rigorous preoperative planning and cautious implantation should be performed especially in patients who has Dorr type C femur.

Keywords

Dorr classification, hemiarthroplasty, femoral neck fractures, Harris Hip Score

Project Number

-

References

• Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. International Journal of General Medicine 2010;3:1–17. https://doi.org/10.2147/ijgm.s5906.
• Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures: Systematic literature review of German data and an overview of the international literature. Zeitschrift Fur Gerontologie Und Geriatrie 2019;52:10–6. https://doi.org/10.1007/s00391-018-1382-z.
• Cooper C, Campion G, Melton 3rd LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992;2:285–9. https://doi.org/10.1007/BF01623184.
• Nash W, Harris A. The Dorr type and cortical thickness index of the proximal femur for predicting peri-operative complications during hemiarthroplasty. Journal of Orthopaedic Surgery 2014;22:92–5. https://doi.org/10.1177/230949901402200123.
• Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ 2010;340:c2332. https://doi.org/10.1136/bmj.c2332.
• Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Tornkvist H, Ponzer S, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 2011;93:445–50. https://doi.org/10.2106/JBJS.J.00474.
• Veldman HD, Heyligers IC, Grimm B, Boymans TAEJ. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck. Bone and Joint Journal 2017;99B:421–31 https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-0758.R1.
• Robertson GAJ, Wood AM. Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence? World Journal of Orthopaedics 2018;9:235–44. https://doi.org/10.5312/wjo.v9.i11.235.
• Kim YH, Kim VE. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg Br 1993;75:6–13. https://doi.org/10.1302/0301-620X.75B1.8421036.
• Karayiannis PN, Cassidy RS, Hill JC, Dorr LD, Beverland DE. The Relationship Between Canal Diameter and the Dorr Classification. J Arthroplasty 2020;35:3204–7. https://doi.org/10.1016/j.arth.2020.05.066
• Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics 2005;28:s1033-6.
• Magill P, Hill J, O’Brien S, Stevenson M, Machenaud A, Beverland D. Observed effect of femoral component undersizing and a collarless design in the development of radiolucent lines in cementless total hip arthroplasty. Arthroplast Today 2020;6:99–103. https://doi.org/10.1016/j.artd.2019.11.009.
• Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone 1993;14:231–42. https://doi.org/10.1016/8756-3282(93)90146-2.
• Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737–55.
• Ham OK, Kang Y, Teng H, Lee Y, Im EO. Consistency and Accuracy of Multiple Pain Scales Measured in Cancer Patients From Multiple Ethnic Groups. Cancer Nurs 2015;38:305–11. https://doi.org/10.1097/NCC.0000000000000179.
• Issa K, Stroh AD, Mont MA, Bonutti PM. Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties. Journal of Orthopaedic Research 2014;32:1214–20. https://doi.org/10.1002/jor.22648.
• Kim YH, Park JW, Kim JS. Long-Term Results of Third-Generation Ceramic-on-Ceramic Bearing Cementless Total Hip Arthroplasty in Young Patients. Journal of Arthroplasty 2016;31:2520–4. https://doi.org/10.1016/j.arth.2016.03.058.
• Ito M, Nakata T, Nishida A, Uetani M. Age-related changes in bone density, geometry and biomechanical properties of the proximal femur: CT-based 3D hip structure analysis in normal postmenopausal women. Bone 2011;48:627–30. https://doi.org/10.1016/j.bone.2010.11.007.
• Yuen KWK, Kwok TCY, Qin L, Leung JCS, Chan DCC, Kwok AWL, et al. Characteristics of age-related changes in bone compared between male and female reference Chinese populations in Hong Kong: A pQCT study. Journal of Bone and Mineral Metabolism 2010;28:672–81. https://doi.org/10.1007/s00774-010-0170-7.
• Lindberg-Larsen M, Jørgensen CC, Solgaard S, Kjersgaard AG, Kehlet H. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. Acta Orthopaedica 2017;88:390–4. https://doi.org/10.1080/17453674.2017.1302908.
• Sah AP, Thornhill TS, LeBoff MS, Glowacki J. Correlation of plain radiographic indices of the hip with quantitative bone mineral density. Osteoporosis International 2007;18:1119–26. https://doi.org/10.1007/s00198-007-0348-6.
• Weinrauch P. Intra-operative error during Austin Moore hemiarthroplasty. Journal of Orthopaedic Surgery (Hong Kong) 2006;14:249–52. https://doi.org/10.1177/230949900601400304.
• Yau WP, Chiu KY. Critical radiological analysis after Austin Moore hemiarthroplasty. Injury 2004;35:1020–4. https://doi.org/10.1016/j.injury.2003.08.016.
• Barlas KJ, Ajmi QS, Bagga TK, Howell FR, Roberts JA, Eltayeb M. Association of intra-operative metaphyseal fractures with prosthesis size during hemiarthroplasty of the hip. Journal of Orthopaedic Surgery (Hong Kong) 2008;16:30–4. https://doi.org/10.1177/230949900801600108.
• Bonnin MP, Neto CC, Aitsiselmi T, Murphy CG, Bossard N, Roche S, et al. Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty-why? 2015. https://doi.org/10.1302/0301-620X.97B6.
• Gromov K, Bersang A, Nielsen CS, Kallemose T, Husted H, Troelsen A. Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component. Bone and Joint Journal 2017;99B:451–7. https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-0266.R2.
• Carli A v., Negus JJ, Haddad FS. Hip arthroplasty: Avoiding and managing problems periprosthetic femoral fractures and trying to avoid them what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone and Joint Journal, vol. 99B, British Editorial Society of Bone and Joint Surgery; 2017, p. 50–9. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0220.R1.
• Park CW, Eun HJ, Oh SH, Kim HJ, Lim SJ, Park YS. Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs. Journal of Arthroplasty 2019;34:527–33. https://doi.org/10.1016/j.arth.2018.11.004.
• Bezwada HP, Shah AR, Harding SH, Baker J, Johanson NA, Mont MA. Cementless bipolar hemiarthroplasty for displaced femoral neck fractures in the elderly. Journal of Arthroplasty, vol. 19, J Arthroplasty; 2004, p. 73–7. https://doi.org/10.1016/j.arth.2004.06.018.
• Bonutti PM, Stroh AD, Isa K, Harwin SF, Patel D v., Mont MA. Proximally coated cementless bipolar hemiarthroplasty in Dorr type C bone. Orthopedics 2014;37. https://doi.org/10.3928/01477447-20140401-54.
• Bozkurt M, Gursoy S, Shohat N, Simsek ME, Akkaya M, Parvizi J. Definition of a Novel Proximal Femur Classification in the Sagittal Plane According to the Femur Morphometric Analysis. J Arthroplasty. 2019;34(7):1502-1508. https://doi.org/10.1016/j.arth.2019.03.005