Can a cementless partial hip prosthesis be preferred in patients with hip fractures when the Spotorno criterion is greater than 5?

Yıl 2024, Cilt: 7 Sayı: 5, 509 - 512, 27.09.2024

Tuğcan Demir , Halil Karaca , Emre Tekşan , Emre Kurt

https://doi.org/10.32322/jhsm.1519300

Öz

Aims: Partial hip arthroplasty is preferred in elderly patients with low activity levels, numerous comorbidities, and limited mobility for hip fractures. To decide whether to use cement in femoral stem implantation, scoring systems such as Spotorno, Dorr, and Canale Flare Indices are used. Generally, cemented application is frequently for patients with over 5 points according to Spotorno criteria. In this study, our aim is to present the outcomes of patients who had a score of 5 or more according to the Spotorno criteria and required cemented prostheses but instead received cementless partial hip prostheses.
Methods: Patients who underwent partial hip arthroplasty due to post-traumatic femoral neck fractures in our hospital’s orthopedics and traumatology clinic between 2017 and 2021 were retrospectively evaluated. To calculate the total score according to the Spotorno criteria, which evaluate age, sex, singh index and morphological cortical index, the radiographs of the patients included in the study were assessed, and the Singh index and morphological cortical index (MCI) were calculated.Periprosthetic fractures, prosthesis dislocations, heterotopic ossification, femoral loosening and mortality had been recorded. A total of 192 patients over the age of 70 with ASA III and ASA IV who underwent cementless partial hip arthroplasty were included in the study. Among these patients, 126 were female (% 5.7) and 66 were male (%34.3). Mean follow up was 5.8 years (0-7 years).
Results: According to the Spotorno criteria, the total score for all patients was greater than 6. Periprosthetic fractures were detected in % 3.1. Heterotopic ossification was observed in %9.3. In the postoperative 1st month, mortality was observed in %5.
Conclusion: Cementless hip arthroplasty in elderly patients with a Spotorno score of 5 or higher can be as effective and applicable as cemented hip arthroplasty. Although the literature generally recommends cemented hip prostheses for such patients, cementless partial hip arthroplasty can be a viable option if standard latest-generation cementing systems are not available.

Anahtar Kelimeler

Spotorno criteria, cementless partial hip arthroplasty, elderly patients

Kaynakça

• Quinlan ND, Hogarth DA, Chen DQ, Werner BC, Browne JA. Hospital and surgeon reimbursement trends for femoral neck fractures treated with hip hemiarthroplasty and total hip arthroplasty. J Arthroplasty. 2020;35(11):3067-3075. doi:10.1016/j.arth.2020.05.059
• Stevens JA, Rudd RA. The impact of decreasing US hip fracture rates on future hip fracture estimates. Osteoporos Int. 2013; 24(10):2725-2728. doi:10.1007/s00198-013-2375-9
• Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285-289. doi: 10.1007/BF01623184
• Bovonratwet P, Yang BW, Wang Z, Ricci WM, Lane JM. Operative fixation of hip fractures in nonagenarians: is it safe?. J Arthroplasty. 2020;35(11):3180-3187.
• Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J. Quality of life after hip fracture in the elderly: a systematic literature review. Injury. 2016;47(7):1369-1382. doi:10. 1016/j.injury.2016.04.018
• Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures: a propensity score-matched, population-based study. J Bone Joint Surg Am. 2019;101(7):572-579. doi:10.2106/JBJS.18.00539
• Wang Z, Bhattacharyya T. Outcomes of hemiarthroplasty and total hip arthroplasty for femoral neck fracture: a medicare cohort study. J Orthop Trauma. 2017;31(5):260-263. doi:10.1097/BOT.0000000000000814
• Thuan VL, Swiontkowski MF. Intracapsular hip fractures. In: Browner BD, Jupiter JB, Krettek, C, Anderson P, editors. Skeletal Trauma: Basic Science, Management and Reconstruction. Philadelphia, PA: Elsevier Saunders; 2015.p.1607-1681.
• Morris VA, Baumgaertner MR, Cooney LM. Medical management of the patient with hip fracture. In: Browner BD, Jupiter JB, Krettek C, Anderson P, editors. Skeletal Trauma: Basic Science, Management and Reconstruction. Philadelphia, PA: Elsevier Saunders; 2015.p.1597-1606.
• Burgers PT, Van Geene AR, Van den Bekerom MP, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop. 2012;36(8):1549-1560. doi:10.1007/s00264-012-1569-7
• Kacmaz IE, Turgut A, Basa CD, Bilgin E, Reisoglu A, Kalenderer O. Comparison of the reliability of three scoring systems used to decide whether to apply cement in hip arthroplasty among fracture patients and the effect of surgical experience: the Spotorno, Dorr, and canal flare indices. J Arthroplasty. 2022; 37(7):1348-1353. doi:10.1016/j.arth.2022.03.062
• Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;(6):CD001706. doi:10.1002/ 14651858.CD001706.pub4
• 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(8):1691-1696. doi:10.1007/s00264-014-2355-5
• Lo WH, Chen WM, Huang CK, Chen TH, Chiu FY, Chen CM. Bateman bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures. Uncemented versus cemented. Clin Orthop Relat Res. 1994;(302):75-82.
• Vaishya R, Chauhan M, Vaish A. Bone cement. J Clin Orthop Trauma. 2013;4(4):157-163. doi:10.1016/j.jcot.2013.11.005
• Costa ML, Griffin XL, Pendleton N, Pearson M, Parsons N. Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur?. J Bone Joint Surg Br. 2011;93(12): 1679-1680. doi:10.1302/0301-620X.93B10.26690
• Sonne-Holm S, Walter S, Jensen JS. Moore hemi-arthroplasty with and without bone cement in femoral neck fractures. A clinical controlled trial. Acta Orthop Scand. 1982;53(6):953-956. doi:10.3109/17453678208992854
• Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12-22. doi:10.1093/bja/aen328
• Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg Br. 1994;76(3):409-412.
• Wu X, Wang Y, Sun W, Tan M. Cemented and uncemented hemiarthroplasty for femoral neck fracture in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. 2021; 33(8):2087-2111. doi:10.1007/s40520-020-01731-9
• Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012;94(7):577-583. doi:10.2106/JBJS.K.00006
• Grammatopoulos G, Wilson HA, Kendrick BJ, et al. Hemiarthroplasty using cemented or uncemented stems of proven design: a comparative study. Bone Joint J. 2015;97(1):94-99. doi:10.1302/0301-620X.97B1.34138
• Ng ZD, Krishna L. Cemented versus cementless hemiarthroplasty for femoral neck fractures in the elderly. J Orthop Surg (Hong Kong). 2014;22(2):186-189. doi:10.1177/230949901402200214
• Rajak MK, Jha R, Kumar P, Thakur R. Bipolar hemiarthroplasty for intracapsular femoral neck fractures in elderly patients. J Orthop Surg (Hong Kong). 2013;21(3):313-316. doi:10.1177/ 230949901302100310
• Elmenshawy AF, Salem KH. Cemented versus cementless bipolar hemiarthroplasty for femoral neck fractures in the elderly. EFORT Open Rev. 2021;6(5):380-386. doi:10.1302/2058-5241.6.200057