Song Jin Soo A, Dillman Daryl, Wilson Dave, Dunbar Michael, Richardson Glen
Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Hip Int. 2019 Mar;29(2):177-183. doi: 10.1177/1120700018772291. Epub 2018 Apr 23.
: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures in elderly patients. Recently, short tapered-wedge cementless stems have increasingly been used in this population. However, historic data has consistently shown higher rates of periprosthetic fracture with uncemented stems in hip fracture patients. This study aims to evaluate the rate of periprosthetic fracture requiring re-operation and all-cause mortality between cemented and uncemented femoral stem designs including more recent short tapered-wedge cementless stems in hip fracture patients.
: A retrospective chart and radiographic review of patients received bipolar hemiarthroplasty for femoral neck fractures from 2010-2016. Patients biologically (age ≥ 65 years) or physiologically (American Society of Anesthesiologists (ASA) class ≥ 3) elderly were eligible. The uncemented group was subdivided into tapered-wedge stems (a broach only system) and reamed uncemented stems. The primary outcome was periprosthetic fracture requiring re-operation.
: We included 657 patients in total, with 296 and 361 patients in the uncemented and cemented stem groups respectively. In the uncemented group there were 197 tapered-wedge and 99 reamed uncemented stems. There was a significantly higher rate of periprosthetic fracture requiring re-operation in the uncemented group (3.0% vs. 0.6%) ( p ≤ 0.05). There were no significant differences in rates of all-cause mortality, infection or all-cause re-operation.
: Compared to modern uncemented femoral stem designs, cemented stems yield lower rates of periprosthetic fracture requiring re-operation, without increasing risk of all-cause mortality. Tapered-wedge stems had similar rates of re-operation due to periprosthetic fracture as reamed uncemented stems.
半髋关节置换术是老年患者移位型股骨颈骨折的首选治疗方法。近年来，短锥形楔形无骨水泥柄越来越多地应用于这一人群。然而，历史数据一直显示，髋部骨折患者使用无骨水泥柄时假体周围骨折的发生率较高。本研究旨在评估髋部骨折患者中，骨水泥型和无骨水泥型股骨柄设计（包括最近的短锥形楔形无骨水泥柄）之间需要再次手术的假体周围骨折发生率和全因死亡率。
对2010年至2016年接受双极半髋关节置换术治疗股骨颈骨折的患者进行回顾性病历和影像学检查。符合生物学标准（年龄≥65岁）或生理学标准（美国麻醉医师协会（ASA）分级≥3级）的老年患者纳入研究。无骨水泥组再细分为锥形楔形柄（仅使用髓腔锉系统）和扩髓无骨水泥柄。主要结局是需要再次手术的假体周围骨折。
我们共纳入657例患者，无骨水泥柄组和骨水泥柄组分别有296例和361例患者。在无骨水泥组中，有197例锥形楔形柄和99例扩髓无骨水泥柄。无骨水泥组中需要再次手术的假体周围骨折发生率显著更高（3.0%对0.6%）（p≤0.05）。全因死亡率、感染率或全因再次手术率无显著差异。
与现代无骨水泥股骨柄设计相比，骨水泥柄导致需要再次手术的假体周围骨折发生率更低，且不增加全因死亡率风险。锥形楔形柄因假体周围骨折导致的再次手术率与扩髓无骨水泥柄相似。
