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Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age

Year 2020, Volume: 4 Issue: 10, 857 - 860, 01.10.2020
https://doi.org/10.28982/josam.798123

Abstract

Aim: The most appropriate treatment option for intertrochanteric femoral fractures is still controversial. While there are articles showing that proximal femoral nails are superior to partial prostheses, other studies claim that partial prostheses result in better patient outcomes. We aimed to compare long-stemmed cementless hemiarthroplasty (LFS-BPH) and proximal femur nail (PFN), which are the treatment options applied in unstable intertrochanteric hip fractures in patients over 85 years of age.
Methods: The records of 64 patients with unstable intertrochanteric femur fractures who were operated between May 2016 and December 2018 in the Orthopedics and Traumatology Clinic of Maltepe University Medical Faculty Hospital were evaluated. A retrospective cohort study was conducted and 42 patients who met the inclusion criteria were included in the study. The patients were divided into 2 groups as the proximal nail group and the prosthesis group, and evaluated in terms of total hospitalization time, operation time, amount of blood transfusion, time until the patient walked independently, postoperative complications, and Harris hip scores.
Results: There were statistically significant differences in favor of the PP group in terms of total length of stay, fully independent mobilization time, deep vein thrombosis and decubitus development in the postoperative period. There was no difference between LFS-BPH and PFN in terms of total hospitalization time, blood transfusion amount, and Harris hip scores in unstable intertrochanteric hip fractures occurring above 85 years of age.
Conclusion: LFS-BPH was superior to PFN in terms of operation time, early independent mobilization, reduction of deep vein thrombosis and decubitus development rate in the postoperative period.

References

  • 1. Akman Ş, Şen C, Aşık M, Akpınar S, Gedik HK. Our Experience with Leinbach Prosthesis in Intertrochanteric Femoral Fractures. Turkish J Trauma Emerg Surg. 1999;5:208–12.
  • 2. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: A systematic review. BMC Geriatr. 2016 Aug 31;16(1):157.
  • 3. Kesmezacar H, Ogüt T, Bilgili MG, Gökay S, Tenekecioglu Y. Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty? Acta Orthop Traumatol Turc. 2005 ;39(4):287-94.
  • 4. Adanaş C, Özkan S, Makalesi A, Yüzüncü V, Üniversitesi Y, Odabaş D, et al. Comparison of external fixation and intramedullary nailing in geriatric patients with intertrochanteric fractures of the femur. J Surg Med. 2019;3(12):833-6.
  • 5. Sine K, Lee Y, Zullo AR, Daiello LA, Zhang T, Berry SD. Incidence of Lower-Extremity Fractures in US Nursing Homes. J Am Geriatr Soc. 2019;67:1253–7.
  • 6. Bhattacharjee A, Richards O, Marusza C, Topliss CJ, Wilson I, Phillips S, et al. Neck of femur fracture: who gets a total hip replacement? A review of 230 eligible patients. Eur J Trauma Emerg Surg. 2020 Apr 10. doi: 10.1007/s00068-020-01358-5. Epub ahead of print. PMID: 32277249.
  • 7. Green S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop Relat Res. 1987 Nov;(224):169-77.
  • 8. Huang J, Shi Y, Pan W, Wang Z, Dong Y, Bai Y, et al. Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients. Sci Rep. 2020 Mar 16;10(1):4840.
  • 9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Jt Surg Am. 1969 Jun;51(4):737-55.
  • 10. Liu J, Mi B, Hu L, Xiong Y, Xue H, Zhou W, et al. Preventive strategy for the clinical treatment of hip fractures in the elderly during the COVID-19 outbreak: Wuhan’s experience. Aging (Albany NY). 2020;12:7619–25. doi:10.18632/aging.103201.
  • 11. Gursoy S, Simsek ME, Akkaya M, Dogan M, Bozkurt M. Transtrochanteric approach can provide better postoperative care and lower complication rate in the treatment of hip fractures. Clin Interv Aging. 2019;14:137–43. doi:10.2147/CIA.S194880.
  • 12. Kazley J, Bagchi K. Femoral Neck Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
  • 13. Vidovic D, Matejcic A, Punda M, Ivica M, Tomljenovic M, Bekavac-Beslin M, et al. Periprosthetic bone loss following hemiarthroplasty: A comparison between cemented and cementless hip prosthesis. Injury. 2013 Sep;44 Suppl 3:S62-6.
  • 14. Lee YK, Won H, Roa KRU, Ha YC, Koo KH. Bipolar hemiarthroplasty using microarc oxidation-coated cementless stem in patients with unstable intertrochanteric fracture. J Orthop Surg. May-Aug 2019;27(2):2309499019847815. doi:10.1177/2309499019847815.
  • 15. Ju J bao, Zhang P xun, Jiang B guo. Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta-Analysis. Orthopaedic Surgery. 2019;11:745–54. doi:10.1111/os.12532.
  • 16. Nie B, Wu D, Yang Z, Liu Q. Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly. Med (United States). 2017 Jul;96(27):e7446.
  • 17. Korkmaz Ö. Treatment of intertrochanteric femur fractures in the elderly via bipolar hip arthroplasty or proximal femoral nail. South. Clin. Ist. Euras. 2018;29(2):115-9.
  • 18. Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res. 2014 Apr;472(4):1291-9.
  • 19. Lin PH, Chien JT, Hung JP, Hong CK, Tsai TY, Yang CC. Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: A retrospective case control study. BMC Musculoskelet Disord. 2020 Apr 15;21(1):244.
  • 20. Gormeli G. Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems. Turkish J Trauma Emerg Surg. 2015 Dec;21(6):503-8.
  • 21. Dong J Bin, Wang ZY, Lu H, Tian Y, Wang XR, Zhang ZQ. Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures. 2015 Mar;28(3):245-51.
  • 22. Beauchamp-Chalifour P, Belzile EL, Racine LC, Nolet MP, Lemire S, Jean S, et al. The long-term postoperative trajectory of geriatric patients admitted for a hip fracture: A prospective observational cohort study. Orthop Traumatol Surg Res. 2020 Jun;106(4):621-5.
  • 23. Galivanche AR, Kebaish KJ, Adrados M, Ottesen TD, Varthi AG, Rubin LE, et al. Postoperative Pressure Ulcers after Geriatric Hip Fracture Surgery Are Predicted by Defined Preoperative Comorbidities and Postoperative Complications. J Am Acad Orthop Surg. 2020 Apr 15;28(8):342-51.
  • 24. Kim Y-S, Hur J-S, Hwang K-T, Choi I-Y, Kim Y-H. The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures. Hip Pelvis. 2014 Jun;26(2):99-106.
  • 25. Ucpunar H, Camurcu Y, Çöbden A, Sofu H, Kis M, Demirel H. Comparative evaluation of postoperative health status and functional outcome in patients treated with either proximal femoral nail or hemiarthroplasty for unstable intertrochanteric fracture. J Orthop Surg. Sep-Dec 2019;27(3):2309499019864426.
  • 26. Kabelitz M, Fritz Y, Grueninger P, Meier C, Fries P, Dietrich M. Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures. 2018 Mar 29;9:2151459318765381.
  • 27. Wang C, Ikemoto T, Hirasawa A, Arai YC, Kikuchi S, Deie M. Assessment of locomotive syndrome among older individuals: A confirmatory factor analysis of the 25-question Geriatric Locomotive Function Scale. PeerJ. 2020 Apr 14;8:e9026.
  • 28. Kuru T, Olcar HA. Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: A retrospective analysis. Turkish J Med Sci. 2020 Feb 13;50(1):117-25.
  • 29. Jonnes C, Shishir SM, Najimudeen S. Type II intertrochanteric fractures: Proximal femoral nailing (PFN) versus Dynamic Hip Screw (DHS). Arch Bone Jt Surg. 2016 Jan;4(1):23-8.

85 yaş üstü instabil intertrokanterik femur kırıklarında uzun stemli sementsiz hemiartroplasti ile proksimal femur çivisinin karşılaştırılması

Year 2020, Volume: 4 Issue: 10, 857 - 860, 01.10.2020
https://doi.org/10.28982/josam.798123

Abstract

Amaç: İntertrokanterik femur kırıkları için en uygun tedavi seçeneği halen tartışmalıdır. Proksimal femoral tırnakların parsiyel protezlerden üstün olduğunu gösteren makaleler varken, diğer çalışmalar kısmi protezlerin daha iyi hasta sonuçları verdiğini iddia etmektedir. Mayıs 2016 ile Aralık 2018 tarihleri arasında Maltepe Üniversitesi Tıp Fakültesi Hastanesi Ortopedi ve Travmatoloji Kliniğinde opere edilen 85 yaş üstü instabil intertrokanterik kalça kırığı vakalarında uygulanan tedavi seçeneklerinden uzun stemli sementsiz hemiartroplasti (UFS-BPH) ile proksimal femur çivisinin(PFN)karşılaştırılması amaçlandı.
Yöntemler: 64 AO/OTA 31-A2.3 instabil intertrokanterik femur kırığı hastasının kayıtları retrospektif olarak değerlendirildi. Dâhil edilme kriterlerine uyan 42 hasta çalışmaya alınıp 2 homojen gruba ayrıldı. Gruplar toplam yatış süresi, operasyon süresi, kan transfüzyon miktarı, hastanın tek başına bağımsız olarak yürümesine kadar geçen süre, postoperatif dönemde gelişebilecek derin ven trombozu ve dekübitüs yara gelişimi ve Harris kalça skorları açısından değerlendirildi.
Bulgular: Gruplar arasında toplam yatış süresi, tam bağımsız mobilizasyon süresi ve postoperatif dönemde derin ven trombozu ve dekübitüs gelişimi açısından PP grubu lehine istatistiksel olarak anlamlı fark saptanmıştır. Yapılan çalışma sonucunda 85 yaş üstü instabil intertrokanterik kalça kırığı vakalarında toplam yatış süresi, kan transfüzyon miktarı ve Harris kalça skorları açısından UFS-BPH ile PFN arasında bir farka rastlanmadı.
Sonuç: Ameliyat süresi, erken bağımsız mobilizasyon ve postoperatif dönemde gelişebilecek derin ven trombozu ve dekübitüs yara gelişim oranının azaltılması açısından UFS-BPH nin PFN ne göre daha üstün olduğu görüldü.

References

  • 1. Akman Ş, Şen C, Aşık M, Akpınar S, Gedik HK. Our Experience with Leinbach Prosthesis in Intertrochanteric Femoral Fractures. Turkish J Trauma Emerg Surg. 1999;5:208–12.
  • 2. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: A systematic review. BMC Geriatr. 2016 Aug 31;16(1):157.
  • 3. Kesmezacar H, Ogüt T, Bilgili MG, Gökay S, Tenekecioglu Y. Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty? Acta Orthop Traumatol Turc. 2005 ;39(4):287-94.
  • 4. Adanaş C, Özkan S, Makalesi A, Yüzüncü V, Üniversitesi Y, Odabaş D, et al. Comparison of external fixation and intramedullary nailing in geriatric patients with intertrochanteric fractures of the femur. J Surg Med. 2019;3(12):833-6.
  • 5. Sine K, Lee Y, Zullo AR, Daiello LA, Zhang T, Berry SD. Incidence of Lower-Extremity Fractures in US Nursing Homes. J Am Geriatr Soc. 2019;67:1253–7.
  • 6. Bhattacharjee A, Richards O, Marusza C, Topliss CJ, Wilson I, Phillips S, et al. Neck of femur fracture: who gets a total hip replacement? A review of 230 eligible patients. Eur J Trauma Emerg Surg. 2020 Apr 10. doi: 10.1007/s00068-020-01358-5. Epub ahead of print. PMID: 32277249.
  • 7. Green S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop Relat Res. 1987 Nov;(224):169-77.
  • 8. Huang J, Shi Y, Pan W, Wang Z, Dong Y, Bai Y, et al. Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients. Sci Rep. 2020 Mar 16;10(1):4840.
  • 9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Jt Surg Am. 1969 Jun;51(4):737-55.
  • 10. Liu J, Mi B, Hu L, Xiong Y, Xue H, Zhou W, et al. Preventive strategy for the clinical treatment of hip fractures in the elderly during the COVID-19 outbreak: Wuhan’s experience. Aging (Albany NY). 2020;12:7619–25. doi:10.18632/aging.103201.
  • 11. Gursoy S, Simsek ME, Akkaya M, Dogan M, Bozkurt M. Transtrochanteric approach can provide better postoperative care and lower complication rate in the treatment of hip fractures. Clin Interv Aging. 2019;14:137–43. doi:10.2147/CIA.S194880.
  • 12. Kazley J, Bagchi K. Femoral Neck Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
  • 13. Vidovic D, Matejcic A, Punda M, Ivica M, Tomljenovic M, Bekavac-Beslin M, et al. Periprosthetic bone loss following hemiarthroplasty: A comparison between cemented and cementless hip prosthesis. Injury. 2013 Sep;44 Suppl 3:S62-6.
  • 14. Lee YK, Won H, Roa KRU, Ha YC, Koo KH. Bipolar hemiarthroplasty using microarc oxidation-coated cementless stem in patients with unstable intertrochanteric fracture. J Orthop Surg. May-Aug 2019;27(2):2309499019847815. doi:10.1177/2309499019847815.
  • 15. Ju J bao, Zhang P xun, Jiang B guo. Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta-Analysis. Orthopaedic Surgery. 2019;11:745–54. doi:10.1111/os.12532.
  • 16. Nie B, Wu D, Yang Z, Liu Q. Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly. Med (United States). 2017 Jul;96(27):e7446.
  • 17. Korkmaz Ö. Treatment of intertrochanteric femur fractures in the elderly via bipolar hip arthroplasty or proximal femoral nail. South. Clin. Ist. Euras. 2018;29(2):115-9.
  • 18. Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res. 2014 Apr;472(4):1291-9.
  • 19. Lin PH, Chien JT, Hung JP, Hong CK, Tsai TY, Yang CC. Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: A retrospective case control study. BMC Musculoskelet Disord. 2020 Apr 15;21(1):244.
  • 20. Gormeli G. Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems. Turkish J Trauma Emerg Surg. 2015 Dec;21(6):503-8.
  • 21. Dong J Bin, Wang ZY, Lu H, Tian Y, Wang XR, Zhang ZQ. Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures. 2015 Mar;28(3):245-51.
  • 22. Beauchamp-Chalifour P, Belzile EL, Racine LC, Nolet MP, Lemire S, Jean S, et al. The long-term postoperative trajectory of geriatric patients admitted for a hip fracture: A prospective observational cohort study. Orthop Traumatol Surg Res. 2020 Jun;106(4):621-5.
  • 23. Galivanche AR, Kebaish KJ, Adrados M, Ottesen TD, Varthi AG, Rubin LE, et al. Postoperative Pressure Ulcers after Geriatric Hip Fracture Surgery Are Predicted by Defined Preoperative Comorbidities and Postoperative Complications. J Am Acad Orthop Surg. 2020 Apr 15;28(8):342-51.
  • 24. Kim Y-S, Hur J-S, Hwang K-T, Choi I-Y, Kim Y-H. The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures. Hip Pelvis. 2014 Jun;26(2):99-106.
  • 25. Ucpunar H, Camurcu Y, Çöbden A, Sofu H, Kis M, Demirel H. Comparative evaluation of postoperative health status and functional outcome in patients treated with either proximal femoral nail or hemiarthroplasty for unstable intertrochanteric fracture. J Orthop Surg. Sep-Dec 2019;27(3):2309499019864426.
  • 26. Kabelitz M, Fritz Y, Grueninger P, Meier C, Fries P, Dietrich M. Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures. 2018 Mar 29;9:2151459318765381.
  • 27. Wang C, Ikemoto T, Hirasawa A, Arai YC, Kikuchi S, Deie M. Assessment of locomotive syndrome among older individuals: A confirmatory factor analysis of the 25-question Geriatric Locomotive Function Scale. PeerJ. 2020 Apr 14;8:e9026.
  • 28. Kuru T, Olcar HA. Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: A retrospective analysis. Turkish J Med Sci. 2020 Feb 13;50(1):117-25.
  • 29. Jonnes C, Shishir SM, Najimudeen S. Type II intertrochanteric fractures: Proximal femoral nailing (PFN) versus Dynamic Hip Screw (DHS). Arch Bone Jt Surg. 2016 Jan;4(1):23-8.
There are 29 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Research article
Authors

Mirza Zafer Dağtaş 0000-0001-6861-6555

Ömer Kays Unal 0000-0002-9445-1552

Publication Date October 1, 2020
Published in Issue Year 2020 Volume: 4 Issue: 10

Cite

APA Dağtaş, M. Z., & Unal, Ö. K. (2020). Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age. Journal of Surgery and Medicine, 4(10), 857-860. https://doi.org/10.28982/josam.798123
AMA Dağtaş MZ, Unal ÖK. Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age. J Surg Med. October 2020;4(10):857-860. doi:10.28982/josam.798123
Chicago Dağtaş, Mirza Zafer, and Ömer Kays Unal. “Comparison of Long-Stemmed Cementless Hemiarthroplasty With Proximal Femur Nail in Unstable Intertrochanteric Femur Fractures over 85 Years of Age”. Journal of Surgery and Medicine 4, no. 10 (October 2020): 857-60. https://doi.org/10.28982/josam.798123.
EndNote Dağtaş MZ, Unal ÖK (October 1, 2020) Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age. Journal of Surgery and Medicine 4 10 857–860.
IEEE M. Z. Dağtaş and Ö. K. Unal, “Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age”, J Surg Med, vol. 4, no. 10, pp. 857–860, 2020, doi: 10.28982/josam.798123.
ISNAD Dağtaş, Mirza Zafer - Unal, Ömer Kays. “Comparison of Long-Stemmed Cementless Hemiarthroplasty With Proximal Femur Nail in Unstable Intertrochanteric Femur Fractures over 85 Years of Age”. Journal of Surgery and Medicine 4/10 (October 2020), 857-860. https://doi.org/10.28982/josam.798123.
JAMA Dağtaş MZ, Unal ÖK. Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age. J Surg Med. 2020;4:857–860.
MLA Dağtaş, Mirza Zafer and Ömer Kays Unal. “Comparison of Long-Stemmed Cementless Hemiarthroplasty With Proximal Femur Nail in Unstable Intertrochanteric Femur Fractures over 85 Years of Age”. Journal of Surgery and Medicine, vol. 4, no. 10, 2020, pp. 857-60, doi:10.28982/josam.798123.
Vancouver Dağtaş MZ, Unal ÖK. Comparison of long-stemmed cementless hemiarthroplasty with proximal femur nail in unstable intertrochanteric femur fractures over 85 years of age. J Surg Med. 2020;4(10):857-60.