Son dönem böbrek yetmezliği olan femur boyun kırıklı hastalarda çimentolu ve çimentosuz parsiyel kalça protezi sonuçları

Yıl 2024, Cilt: 15 Sayı: 3, 383 - 386, 30.09.2024

Enver Kılıç , Güzelali Özdemir , Olgun Bingöl , Taner Karlidag , Atahan Durgal , Mehmet Önüt

https://doi.org/10.18663/tjcl.1460011

Öz

Amaç: Çalışmanın amacı son dönem böbrek yetmezliği (SDBY) olan femur boyun kırıklı hastalarda çimentolu ve çimentosuz parsiyel kalça protezi uygulamalarının sonuçlarını değerlendirmektir.
Gereç ve Yöntemler: Çalışmamıza SDBY olan ve hastanemize Ocak 2019 ve Haziran 2021 tarihleri arasında femur boyun kırığı nedeni ile başvuran 65 yaş üstü hastalar dahil edildi. Grup 1’e SDBY olan ve femur boyun kırığı nedeni çimentolu parsiyel kalça protez yapılan hastalar dahil edilirken, Grup 2’ye SDBY olan ve femur boyun kırığı nedeni ile çimentosuz parsiyel kalça protezi yapılan hastalar dahil edildi. Hastaların fonksiyonel skorları, femoral stem gevşeme oranları, Harris kalça Skorları (HSK) ve radyografileri değerlendirildi.
Bulgular: Çalışmaya 21 erkek, 27 kadın toplam 48 hasta dahil edildi. Hastaların 20’si posterior yaklaşım ile, 28’I ise anterolateral yaklaşım ile tedavi edildi. Hastaların ortalama yaşı 78,6±11,32 olarak belirlendi (aralık: 65-93 yaş). Ortalama takip süresi 28,9 aydı (24-36 ay). Çimentolu ve çimentosuz protezlerin gevşeme oranları arasında anlamlı bir fark izlenmedi (p=0,087). Grup 1 için ortalama HSK 69,5 iken, grup 2 için 71,8’di. HSK açısından iki grup arasında anlamlı bir fark yoktu.
Sonuç: SDBY olan ve parsiyel kalça protezi yapılan hastaların komplikasyon riskleri yükserktir. Yapılan çimentolu ve çimentosuz parsiyel kalça protezlerinn gevşeme oranları ve fonksiyonel sonuçları benzerdir.

Anahtar Kelimeler

Böbrek yetmezliği, femur boyun kırığı, parsiyel kalça protezi

Uncemented and cemented hemiarthroplasty for femoral neck fracture with end-stage renal failure

Öz

Aim: The aim of this study is to evaluate the results of hemiarthroplasty performed with cemented and uncemented femoral stem in femoral neck fractures with ESRF.
Material and Methods: Patients aged over 65 years with ESRF who admitted to our clinic for femoral neck fractures between January 2019 and June 2021 and underwent hemiarthroplasty, included in the study. Group 1 included patients with ESRF who underwent hemiarthroplasty with cemented stem due to femoral neck fracture. And group 2 included patients with ESRF who underwent hemiarthroplasty with uncemented stem due to femoral neck fracture. Functional scores of the patients and femoral stem loosening rates were evaluated with Harris Hip Score and radiographs.
Result: 48 patients (21 male, 27 female) were included in the study. Twenty of the patients were treated with posterior approach and 28 were treated with anterolateral approach. The mean age of the patients was 78,6±11,32 years (range: 65-93 years).The mean follow up time was 28,9 months (24-36 months).There was no significant difference between loosening of cemented and uncemented stems (p= 0,087). The mean HHS of the patients was 69.5 for group 1 and 71.8 for group 2 (range 40-85). There was no significant difference between HHS of group 1 and 2 (p>0.05).
Conclusion: Patients with ESRF who underwent hemiarthroplasty due to femoral neck fracture have a higher complication risk. The loosening rates and functional scores of cemented and uncemented hemiarthroplasty are similar.

Anahtar Kelimeler

Renal failure, femoral neck fracture, hemiarthroplasty

Kaynakça

• Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000;58(1):396-9. doi: 10.1046/j.1523-1755.2000.00178.x.
• Kaneko TM, Foley RN, Gibertson DT, Collins AJ. Clinical epidemiology of long-bone fractures in patients receiving hemodialysis. ClinOrthop. 2006;457:188-93. doi: 10.1097/BLO.0b013e318031465b.
• Holmberg S, Kalen R, Thorngren KG. Treatment and outcome of femoral neck fractures: an analuysis of 2418 patients admitted from their own homes. ClinOrthop. 1987;218:42-52.
• Tzamaloukas AH, Murphy G, Schaab PC, Worrel RV. Conservative versus operative management of femoral neck fractures in patinets on long-term dialysis. Nephron. 1990;55(2):229-30. doi: 10.1159/000185963.
• Schaab PC, Murphy G, Tzamaloukas AH, Hays MB, Merlin TL, Eisenberg B, Avasthi PS, Worrel RV. Femoral neck fractures in patients receiving long-term dialysis. ClinOrthop 1990;260:224-31.
• Hardy P, Benoit J, Donneaud B, Jehanno P, Lortat-Jacop A. Pathological fractures of the femoral neck in hemodialyzed patients. Apropos of 26 cases. Rec ChirOrthopReparaticeAppar Mot. 1994;80(8):702-10.
• Kalra S, McBryde CR, Lawrence T. Intracapsular hip fractures in end stage renal failure. Injury. 2006;37(2):175-84. doi: 10.1016/j.injury.2005.22.006.
• Karaeminogullari O, Demirors H, Sahin O, Ozalar M, Ozdemir N, Tandogan R. Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis. J Bone Joint Surg (Am). 2007;89(2):324-31. doi: 10.2106/JBJS.E.01320.
• Beaubrun AC, Kilpatrick RD, Freburger JK, et al. Temporal trends in fracture rates and post discharge outcomes among hemodialysis patients. J Am SocNephrol 2013; 24:1461-9.
• Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis 2004; 44:672-9.
• Tentori F, McCullough K, Kilpatrick RD, et al. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int 2014; 85:166-73.
• Blacha J, Kolodziej R, Karwanski M. Bipolar cemented hip hemiarthroplasty in patients with femoral neck fracture who are on hemodialysis is associated with risk of stem migration. ActaOrthopaedica. 2009;80(2):174-8. doi: 10.3109/17453670902875237.
• Gaultieri G, Vellani G, Dallari D, Catamo L, Gaultieri I, Fatone F, Bonomini V. Total hip arthroplasty in patient dialysed or with renal transplants. ChirOrgani Mov. 1995;80(2):139-45.
• Mataliotakis G, Lykissas MG, Mavrodontidis AN, Kontogeorgakos VA, Beris AE. Femoral neck fractures secondary to renal osteodystrophy. Literature review and treatment algorithm. J Musculoskelet Neuronal Interact. 2009;9:130-7.
• Nagoya S, Nagoa M, Takada J, Kuwabara H, Kaya M. Yamashita T, Efficiacy of cementless total hip arthroplasty in patients on long-term hemodialysis. J Arthroplasty. 2005;20(1):66-71. doi: 10.1016/j.arth.2004.09.055.
• Ding BT, Shinde A, Tan KG. Hip hemiarthroplasty for femoral neck fractures in end-stage renal disease patients on dilysis compared to patients with late-stage chronic kidney disease. Singapore Med J. 2019;60(8):403-8. doi: 10.11622/smedj.2019090.
• Salduz A, Polat G, Akgül T, Ergin ON, Şahin K, Yazıcıoğlu Ö. Complications and midterm outcomes of hemiarthroplasty in hemodialysis patients. ActaOrthop Bras. 2017;25(5):220-3. doi: 10.1590/1413-785220172505167373.
• Dong C, Wang Y, Wang Z, Wang Y, Wu S, Du Q, Wang A. Damage control orthopedics management as viatl procedure in elderly patients with femoral neck fractures complicated with chronic renal failure: a retrospective cohort study.PloSONE. 2016;11(5):e0154906. Doi: 10.1371/journal.pone.0154906.
• Tan TL, Ho SW, Graetz AE, Kwek EB. Hemiarthroplasty in the hip frature patient with renal impairment: to cement or not not to cement. Hip Pelvis. 2019;31(4):216-23. doi: 10.5371/hp.2019.31.4.216.
• Li WC, Shih CH, Ueng SW, Shih HN, Lee MS, Hsieh PH. Uncemented total hip arthroplasty in chronic hemodialysis patients. ActaOrthop. 2010;81(2):178-82. doi: 10.3109/17453671003628749.