Factors associated with acetabular degeneration and protrusion in bipolar hip hemiarthroplasty

Yıl 2022, , 564 - 570, 29.10.2022

Fahri Emre , Erkan Sabri Ertaş , Murat Bozkurt

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

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

Bipolar kalca hemiartroplastisinde asetabuler dejenerasyon ve protruzyon ile iliskili faktorler

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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