Subhash Sadhin, Archunan Maheswaran W, Choudhry Nameer, Leong Justin, Bitar Khaldoun, Beh Sheryl, Tharmakulasingam Sarmila, Subhash Sayam, Melling David, Liew Ignatius
Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, GBR.
Trauma and Orthopaedics, Whiston Hospital, St Helens and Knowsley Teaching Hospitals, Liverpool, GBR.
Cureus. 2021 Oct 22;13(10):e18971. doi: 10.7759/cureus.18971. eCollection 2021 Oct.
Objective Hemiarthroplasty has been identified as the treatment of choice for displaced intracapsular femoral neck fractures. A modular prosthesis is sometimes preferred for its sizing options in narrow femoral canals, despite its higher cost and no advantage in clinical outcomes. Thus, in this study, we investigated the factors affecting surgeons' choice of prosthesis, hypothesizing that modular hemiarthroplasty is overused for narrow femoral canals compared to monoblock hip hemiarthroplasty. Methods A retrospective study of a regional level 1 trauma center was conducted. Patients who had sustained femoral neck fractures from March 2013 to December 2016 were included in this study. Inclusion criterion was modular hemiarthroplasty for a narrow femoral canal. A matched group of patients who underwent monobloc hemiarthroplasty (MH) was created through randomization. The main outcome measurements were sex, age, Dorr classification, and femoral head size. We measured the protrusion of the greater trochanter beyond the level of the lateral femoral cortex postoperatively. Modular hemiarthroplasty patients were templated on radiographs using TraumaCad for Stryker Exeter Trauma Stem (ETS®). Results In total, 533 hemiarthroplasty procedures were performed, of which 27 were modular for a narrow femoral canal. The ratio of modular to monobloc was 1:18. Average head size was 46.7 mm ± 3.6 mm for monobloc and 44.07 ± 1.5 for modular (P= 0.001). There were four malaligned stems in the monobloc group versus 14 in the modular group (P= 0.008). Unsatisfactory lateralization was noted in 18 patients (7 mm ± 2.9 mm) in the modular group compared with 8 (4.7 mm ± 3.9 mm) in the monobloc group (P= 0.029). Dorr classification was A or B in 24 patients in the modular group and 18 in the monobloc group (P = 0.006). Templating revealed that modular was not required in 25 patients. Conclusions As per our findings, it was determined that patients with a narrow femoral canal intraoperatively should not receive modular hemiarthroplasty. This is especially true for female patients with small femoral head and narrow femoral canal dimensions (Dorr A and B). They would require extensive careful planning. Surgical techniques should be explored through education intraoperatively to achieve lateralization during femoral stem preparation. This may avoid prolonged anesthetic time and achieve potential cost savings.
目的 半髋关节置换术已被确定为治疗移位型囊内股骨颈骨折的首选方法。模块化假体有时因其在狭窄股骨髓腔中的尺寸选择而更受青睐，尽管其成本较高且在临床结果方面并无优势。因此，在本研究中，我们调查了影响外科医生选择假体的因素，假设与一体式半髋关节置换术相比，模块化半髋关节置换术在狭窄股骨髓腔中被过度使用。方法 对一个地区一级创伤中心进行了一项回顾性研究。纳入2013年3月至2016年12月期间发生股骨颈骨折的患者。纳入标准为针对狭窄股骨髓腔的模块化半髋关节置换术。通过随机分组创建了一组接受一体式半髋关节置换术（MH）的匹配患者。主要观察指标为性别、年龄、Dorr分类和股骨头大小。我们测量了术后大转子超出股骨外侧皮质水平的突出情况。使用TraumaCad软件对模块化半髋关节置换术患者的X线片进行模板测量以适配史赛克埃克塞特创伤柄（ETS®）。结果 总共进行了533例半髋关节置换手术，其中27例为针对狭窄股骨髓腔的模块化手术。模块化与一体式的比例为1:18。一体式组的平均股骨头大小为46.7 mm±3.6 mm，模块化组为44.07±1.5（P = 0.001）。一体式组有4例柄排列不齐，模块化组有14例（P = 0.008）。模块化组有18例患者（7 mm±2.9 mm）出现不满意的大转子外移，而一体式组有8例（4.7 mm±3.9 mm）（P = 0.029）。模块化组24例患者的Dorr分类为A或B，一体式组为18例（P = 0.006）。模板测量显示25例患者不需要模块化假体。结论 根据我们的研究结果，确定术中股骨髓腔狭窄的患者不应接受模块化半髋关节置换术。对于股骨头小且股骨髓腔狭窄（Dorr A和B）的女性患者尤其如此。她们需要进行广泛而仔细的规划。应通过术中培训探索手术技术，以在股骨柄准备过程中实现大转子外移。这可能避免延长麻醉时间并实现潜在的成本节约。
