Cementless Stem for Femoral Neck Fractures in a Patient’s 10th Decade of Life: High Rate of Periprosthetic Fractures
| Autor: | Yannick Fritz, Christoph Meier, Patrick Grueninger, Michael Dietrich, Patrick Fries, Method Kabelitz |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
BCIS cementless stem Periprosthetic lcsh:Geriatrics femoral neck fractures Femoral Neck Fractures 03 medical and health sciences 0302 clinical medicine lcsh:Orthopedic surgery Geriatric trauma Medicine Orthopedics and Sports Medicine 030212 general & internal medicine subsidence Old patients High rate 030222 orthopedics anterior minimal invasive approach business.industry Rehabilitation bone cement implant syndrome intraoperative periprosthetic fractures medicine.disease AMIS Surgery lcsh:RD701-811 lcsh:RC952-954.6 very old patients Orthopedic surgery Original Article geriatric trauma Geriatrics and Gerontology business |
| Zdroj: | Geriatric Orthopaedic Surgery & Rehabilitation Geriatric Orthopaedic Surgery & Rehabilitation, Vol 9 (2018) |
| ISSN: | 2151-4593 |
| DOI: | 10.1177/2151459318765381 |
| Popis: | Background: Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. Methods: We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. Results: We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B2) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B1 and 2 Vancouver AG) were treated conservatively. One periprosthetic femoral fracture (Vancouver B1) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Conclusion: Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level of Evidence: Level III, Therapeutic study. |
| Databáze: | OpenAIRE |
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