Factors associated with acetabular degeneration and protrusion in bipolar hip hemiarthroplasty
Öz
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.
Anahtar Kelimeler
Bipolar hip hemiarthroplasty, Acetabular protrusion, Revision surgery, Femoral neck fracture
Kaynakça
- 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.