Comparison of clinical results of flattapered and rectangular stems in partial hip replacement based on proximal femur fracture

Yıl 2024, Cilt: 29 Sayı: 2, 170 - 177, 29.05.2024

Mehmet Fevzi Çakmak Levent Horoz

https://doi.org/10.21673/anadoluklin.1357702

Öz

Aim: Hemiarthroplasty is commonly used in proximal femur fractures to provide early mobilization and weight bearing to the patient. Cemented and cementless femoral stems are commonly used in this procedure. Cementless prostheses have many advantages and disadvantages, and their relevance to stem design is controversial. This study aimed to compare flat-tapered and rectangular femoral stems in hemiarthroplasty.

Methods: The study population consisted of a third-level hospital’s archive orthopedics and traumatology clinic. Our study was retrospective. A total of 176 patients who underwent cementless hemiarthroplasty in proximal femoral fractures between January 2017 and January 2022 were included in the study. Within these protocols, 64 patients underwent hemiarthroplasty using a flat-tapered stem (Group 1), and 58 patients underwent hemiarthroplasty using a rectangular stem (Group 2). At the last follow-up of the patients, the Harris hip score, Visual Analogue Scale, and early and long-term complications were evaluated.

Results: No significant differences among the patients were observed regarding Harris hip scores and Visual Analogue Scale values. The study groups were analyzed in terms of developing complications. Similar results were found in both groups regarding periprosthetic femur fractures.

Conclusion: Our study found no significant difference between flat-tapered and rectangular stems in terms of clinical outcomes and periprosthetic femur fracture in cases of cementless hemiarthroplasty. As a result, rectangular stems can be safely preferred in hemiarthroplasty.

Anahtar Kelimeler

Femoral neck fractures, hemiarthroplasty, hip prosthesis, periprosthetic fractures

Proksimal femur kırığında düz-konik ve kare kesit stemler ile yapılan parsiyel kalça protezlerinin klinik sonuçlarının karşılaştırılması

Öz

Amaç: Hemiartroplasti, proksimal femur kırıklarında da hastaya erken mobilizasyon ve yük verme olanağı sağlamak amacıyla sık kullanılan bir yöntemdir. Bu prosedürde yaygın olarak çimentolu ve çimentosuz femoral gövdeler kullanılır. Çimentosuz protezlerin birçok avantajı ve dezavantajı vardır ve gövde tasarımıyla ilişkisi tartışmalıdır. Bu çalışmanın amacı hemiartroplastide konik ve kare kesit femur gövdelerini karşılaştırmaktır.

Yöntemler: Araştırma, üçüncü basamak bir hastanenin ortopedi ve travmatoloji kliniğinin arşivinden oluşturulan, retrospektif bir çalışmadır. Proksimal femur kırığı tanısıyla 2017- 2022 yıllarında çimentosuz hemiartroplasti uygulanan 64 konik (Grup 1) ve 58 kare kesit stem (Grup 2) olmak üzere toplam 176 hastaya hemiartroplasti uygulanan hasta çalışmaya dahil edildi. Hastaların son kontrollerinde Harris kalça skoru, Visual Analogue Scale ve erken ve geç dönem komplikasyonları değerlendirildi.

Bulgular: Gruplar arasında Harris kalça skoru ve Visual Analogue Scale değerleri açısından anlamlı fark gözlenmedi. Periprostetik kırıklar açısından karşılaştırıldığında her iki grupta da benzer sonuçlar elde edildi.

Sonuç: Çalışmamızda çimentosuz hemiartroplasti olgularında konik gövde ve kare kesit gövde arasında klinik sonuçlar ve periprostetik femur kırığı açısından anlamlı bir fark bulunmamıştır. Bu nedenle proksimal femur kırığı zemininde kare kesit femoral stem ile yapılan hemiartroplasti prosedürü güvenli bir yöntem olarak kabul edilmektedir.

Anahtar Kelimeler

Hemiartroplasti, femoral boyun kırıkları, kalça protezleri, protez çevresi kırıklar

Kaynakça

• Karachalios T, Komnos G, Koutalos A. Total hip arthroplasty: Survival and modes of failure. EFORT Open Rev. 2018;3(5):232-9.
• Nishi M, Okano I, Sawada T, Midorikawa N, Inagaki K. Cementless Bipolar Hemiarthroplasty for Low-energy Intracapsular Proximal Femoral Fracture in Elderly East-Asian Patients: A Longitudinal 10-year Follow-up Study. Hip Pelvis. 2019;31(4):206-15.
• Liu B, Ma W, Li H, Wu T, Huo J, Han Y. Incidence, Classification, and Risk Factors for Intraoperative Periprosthetic Femoral Fractures in Patients Undergoing Total Hip Arthroplasty With a Single Stem: A Retrospective Study. J Arthroplasty. 2019;34(7):1400-11.
• Lamb JN, Baetz J, Messer-Hannemann P, et al. A calcar collar is protective against early periprosthetic femoral fracture around cementless femoral components in primary total hip arthroplasty: a registry study with biomechanical validation. Bone Joint J. 2019;101-B(7):779-86.
• Lindberg-Larsen M, Jørgensen CC, Solgaard S, Kjersgaard AG, Kehlet H; Lunbeck Foundation Centre for Fast-track Hip and Knee Replacement. Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems. Acta Orthop. 2017;88(4):390-4.
• Carli AV, Negus JJ, Haddad FS. 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 Joint J. 2017;99-B(1 Supple A):50-9.
• Jeong SJ, Park CW, Cho K, Jeong J, Lim SJ, Park YS. Rectangular Taper Stem Designs Are Associated With a Higher Risk for Periprosthstic Femoral Fractures After Cementless Total Hip Arthroplasty. J Arthroplasty. 2023;38(11):2379-85.
• Sershon RA, McDonald JF 3rd, Ho H, Hamilton WG. Periprosthetic Femur Fracture Risk: Influenced by Stem Choice, Not Surgical Approach. J Arthroplasty. 2021;36(7S):363-6.
• Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA. Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am. 2008;90(9):2000-12.
• Zhang Z, Zhuo Q, Chai W, Ni M, Li H, Chen J. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study. Medicine (Baltimore). 2016;95(35):e4751.
• Ricciardi BF, Nodzo SR, Oi K, Lee YY, Westrich GH. Radiographic outcomes of cable-plate versus cable-grip fixation in periprosthetic fractures of the proximal femur. Hip Int. 2017;27(6):584-8.
• Colacchio ND, Robbins CE, Aghazadeh MS, Talmo CT, Bono JV. Total Hip Intraoperative Femur Fracture: Do the Design Enhancements of a Second-Generation Tapered-Wedge Stem Reduce the Incidence?. J Arthroplasty. 2017;32(10):3163-8.
• Scott T, Salvatore A, Woo P, Lee YY, Salvati EA, Gonzalez Della Valle A. Polished, Collarless, Tapered, Cemented Stems for Primary Hip Arthroplasty May Exhibit High Rate of Periprosthetic Fracture at Short-Term Follow-Up. J Arthroplasty. 2018;33(4):1120-5.
• 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. J Arthroplasty. 2019;34(3):527-33.
• Lim SJ, Lee KJ, Min BW, Song JH, So SY, Park YS. High incidence of stem loosening in association with periprosthetic femur fractures in previously well-fixed cementless grit-blasted tapered-wedge stems. Int Orthop. 2015;39(9):1689-93.
• Mont MA, Maar DC, Krackow KA, Hungerford DS. Hoop-stress fractures of the proximal femur during hip arthroplasty. Management and results in 19 cases. J Bone Joint Surg Br. 1992;74(2):257-60.
• Han KS, Kang SR, Yoon SJ. Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty?. Clin Orthop Surg. 2023;15(1):42-9.
• Dhillon MS, Jindal K, Kumar P, Rajnish RK, Neradi D. Long-term survival of CLS Spotorno femoral stem: a systematic review of literature. Arch Orthop Trauma Surg. 2022;142(6):1239-51.
• Zang J, Uchiyama K, Moriya M, et al. Long-term clinical and radiographic results of the cementless Spotorno stem in Japanese patients: A more than 15-year follow-up. J Orthop Surg (Hong Kong). 2018;26(1):2309499017750310.
• Ohly NE, Whitehouse MR, Duncan CP. Periprosthetic femoral fractures in total hip arthroplasty. Hip Int. 2014;24(6):556-67.
• Ricioli W Jr, Queiroz MC, Guimarães RP, Honda EK, Polesello G, Fucs PM. Prevalence and risk factors for intra-operative periprosthetic fractures in one thousand eight hundred and seventy two patients undergoing total hip arthroplasty: a cross-sectional study. Int Orthop. 2015;39(10):1939-43.
• Chandran P, Kamath RP, Johnson GV. Intraoperative fractures during uncemented Furlong bipolar hemiarthroplasty Eur J Orthop Surg Traumatol. 2007;17:273–7.
• Elias JJ, Nagao M, Chu YH, Carbone JJ, Lennox DW, Chao EY. Medial cortex strain distribution during noncemented total hip arthroplasty. Clin Orthop Relat Res. 2000;(370):250-8.
• Fitzgerald RH Jr, Brindley GW, Kavanagh BF. The uncemented total hip arthroplasty. Intraoperative femoral fractures. Clin Orthop Relat Res. 1988;(235):61-6.
• Veldman HD, Heyligers IC, Grimm B, Boymans TA. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems. Bone Joint J. 2017;99-B(4):421-31.
• Cankaya D, Ozkurt B, Tabak AY. Cemented calcar replacement versus cementless hemiarthroplasty for unstable intertrochanteric femur fractures in the elderly. Ulus Travma Acil Cerrahi Derg. 2013;19(6):548-53.
• Azegami S, Gurusamy KS, Parker MJ. Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials. Hip Int. 2011;21(5):509-17.
• Brodén C, Mukka S, Muren O, et al. High risk of early periprosthetic fractures after primary hip arthroplasty in elderly patients using a cemented, tapered, polished stem. Acta Orthop. 2015;86(2):169-74.
• Oztürkmen Y, Karamehmetoğlu M, Caniklioğlu M, Ince Y, Azboy I. Cementless hemiarthroplasty for femoral neck fractures in elderly patients. Indian J Orthop. 2008;42(1):56-60.
• Marya S, Thukral R, Hasan R, Tripathi M. Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly. Indian J Orthop. 2011;45(3):236-42.
• Kim JT, Kim HH, Kim JH, Kwak YH, Chang EC, Ha YC. Mid-Term Survivals After Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients. J Arthroplasty. 2018;33(3):777-82.