Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Injury. 2022 Mar;53(3):1114-1121. doi: 10.1016/j.injury.2021.11.010. Epub 2021 Nov 14.
Chronic kidney disease (CKD) is commonly associated with aging and disorders of mineral and bone metabolism. Femoral neck fracture (FNF) is one of the most common fractures among older adults with coexisting CKD, and bipolar hemiarthroplasty (BHA) is a preferred treatment. However, the optimal method of stem fixation has not been conclusively determined. Accordingly, this study aimed to investigate the reoperation rate and implant survivorship compared between cementless and cemented BHA in FNF patients with CKD.
A total of 183 FNF patients with moderate to severe CKD who underwent BHA during 2003 to 2019 were recruited and divided into either the cemented (CT group, n = 56) or cementless (CL group, 127) groups. Demographic data, preoperative laboratory investigations, preoperative radiographic outcomes, perioperative outcomes, and 90-day morbidity, mortality, and reoperation rates for any reason were recorded and compared between groups. Kaplan-Meier survival analysis was used to compare implant survivorship between the CT and CL groups. Cox proportional hazards regression model was used to identify independent risk factors for implant survivorship.
There were no significant differences in patient characteristics or preoperative data between groups, except for Dorr's classification of proximal femoral geometry. The CT group had a significantly lower proportion of Dorr type A (p = 0.020), and a higher proportion of Dorr type C (p<0.001). The CT group also had significantly more intraoperative blood loss (p<0.01). No significant differences in morbidity or mortality were observed. The median follow-up time in the CT group and CL group was 22.6 months (range: 0-151) and 22.6 months (range 0-154), respectively (p = 0.607). The reoperation rate was 5.4% and 4.7% among CT and CL patients, respectively (p = 1.000). There was no significant difference in the mean survival time between the CT (139.5 ± 6.3 months, 95%CI: 127.1-151.8) and CL (142.5 ± 4.7 months, 95%CI: 133.2-151.7) groups (p = 0.880). Univariate and multivariate analyses revealed no independent risk factors for implant survivorship.
The results of this study showed no significant differences in the reoperation rate or implant survivorship between cemented and cementless BHA for treating FNF in moderate to severe CKD patients. A well-designed larger and longer-term study is needed to confirm these results.
慢性肾脏病（CKD）常与衰老和矿物质及骨代谢紊乱有关。股骨颈骨折（FNF）是合并 CKD 的老年患者中最常见的骨折之一，双极半髋关节置换术（BHA）是首选的治疗方法。然而，最佳的假体固定方法尚未确定。因此，本研究旨在比较中重度 CKD 患者 FNF 行 BHA 术后骨水泥型和非骨水泥型假体的翻修率和假体生存率。
共纳入 2003 年至 2019 年间因 FNF 接受 BHA 的 183 例中重度 CKD 患者，并将其分为骨水泥组（CT 组，n=56）和非骨水泥组（CL 组，127 例）。记录并比较两组间患者的人口统计学数据、术前实验室检查、术前影像学结果、围手术期结果和 90 天内任何原因的发病率、死亡率和翻修率。Kaplan-Meier 生存分析用于比较 CT 组和 CL 组的假体生存率。Cox 比例风险回归模型用于识别假体生存率的独立危险因素。
两组患者的特征和术前数据无显著差异，除了股骨近端几何形态的 Dorr 分类。CT 组 Dorr 型 A 的比例明显较低（p=0.020），Dorr 型 C 的比例明显较高（p<0.001）。CT 组术中出血量也明显较多（p<0.01）。两组发病率和死亡率无显著差异。CT 组和 CL 组的中位随访时间分别为 22.6 个月（范围：0-151）和 22.6 个月（范围 0-154）（p=0.607）。CT 组和 CL 组的翻修率分别为 5.4%和 4.7%（p=1.000）。CT 组（139.5±6.3 个月，95%CI：127.1-151.8）和 CL 组（142.5±4.7 个月，95%CI：133.2-151.7）的平均生存时间无显著差异（p=0.880）。单因素和多因素分析均未发现假体生存率的独立危险因素。
本研究结果表明，中重度 CKD 患者 FNF 行 BHA 时，骨水泥型和非骨水泥型假体的翻修率和假体生存率无显著差异。需要进行设计良好的更大规模和更长时间的研究来证实这些结果。
