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Gounot A, Charlot A, Guillon P, Schaefer A, Moslemi A, Boutroux P, Sautet A. The use of uncemented stems in femoral neck fractures in elderly patients: A comparative study of 671 cases. Orthop Traumatol Surg Res 2024; 110:103878. [PMID: 38582221 DOI: 10.1016/j.otsr.2024.103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/07/2023] [Accepted: 02/14/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The use of cemented stems in elderly patients is associated with the risk of intraoperative embolic complications. Uncemented stems eliminate this risk, but their use is controversial because of the risk of mechanical complications, with estimated subsidence between 3.6 and 30% and periprosthetic fractures between 2.1 and 11% at 6 weeks. A retrospective multicenter comparative study was conducted using a propensity score analysis to evaluate mechanical performances of uncemented stems in femoral neck fractures in elderly patients to (1) compare the risk of mechanical complications and (2) assess the use of metaphyseal-anchored stems for this indication. HYPOTHESIS There is no difference in the risk of mechanical complications, intraoperatively or postoperatively, between these stems. MATERIALS AND METHODS We conducted a multicenter retrospective comparative study including 358 uncemented and 313 cemented stems. The mean age was 84.5 years [83.9-85.1]. The inclusion criteria were patients 70 years and older and a follow-up of at least 6 weeks. The primary endpoint was a composite endpoint comprised of stem subsidence≥2mm or periprosthetic fracture (up to 3 months postoperatively). The secondary endpoints were infection, stem subsidence≥2mm, and operative time. These endpoints were analyzed using a propensity score to control confounding factors. A secondary analysis used the same endpoints to compare metaphyseal-anchored (short stems) versus Corail-like stems. RESULTS After adjusting for the propensity score, we found 11.17% mechanical complications in the uncemented group (n=40, 5.59% subsidence, and 5.59% fractures) versus 13.42% for the cemented group (n=42, 7.99% subsidence, and 5.43% fractures). There was no statistically significant difference between the 2 values (Odds Ratio [OR]=0.64 [95% Confidence Interval [CI]: 0.14-2.85] [p=0.7]). The mortality rate due to cement embolism was 1%. There was no difference in the rate of subsidence (OR=0.55 [95% CI: 0.02-12.5] [p=0.7]), periprosthetic fracture (OR=0.65 [95% CI: 0.13-3.12] [p=0.7]) or infection (OR=0.71 [95% CI: 0.32-1.55] [p=0.4]). However, the operative times were longer in the cemented group (p=0.03 for hemiarthroplasties [mean additional time 16minutes] and p=0.02 for total hip arthroplasties [mean additional time 22minutes]). No difference was observed between the metaphyseal-anchored (short stems) and Corail-like stems regarding operative time, rate of infection, and rate of stem subsidence or periprosthetic fractures. DISCUSSION This is one of the first studies to highlight cemented stem subsidence when used for femoral neck fractures in elderly patients. Using uncemented stems in this indication is still warranted, especially since they do not bring about more mechanical complications in the first few months. Metaphyseal-anchored short stems seem to give the same results as "standard" stems. However, these findings need to be assessed in the longer term. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Alexandre Gounot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - Anahita Charlot
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Pascal Guillon
- Département de chirurgie orthopédique et traumatologique, GHI Le Raincy Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Augustin Schaefer
- Département d'anesthésie, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Aymane Moslemi
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Pierre Boutroux
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Alain Sautet
- Département de chirurgie orthopédique et traumatologique, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris (AP-HP), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Regmi S, Chaudhary RK, Pradhan I, Banskota B, Joshi A. Mean Tip Apex Distance in Patients undergoing Dynamic Hip Screw Fixation for Pertrochanteric Fractures without using Traction Table: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:1021-1025. [PMID: 36705110 PMCID: PMC9795122 DOI: 10.31729/jnma.7766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/28/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Dynamic Hip Screw fixation has shown to be equally effective compared to cephalomedullary nailing. The effectiveness of dynamic hip screw fixation for pertrochanteric fractures without using traction table is not well investigated. This study aimed to find out the mean tip apex distance in patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table. Methods A descriptive cross-sectional study was conducted among patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table between 1 September 2021 and 30 June 2022, after getting approval from institutional review committee (Reference number: IRC-2021-08-23-02). All patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table were included in the study. Patients with pre-existing ipsilateral or contralateral hip deformity, contra-lateral hip prosthesis, bilateral hip fractures, and history of prior ipsilateral hip surgeries were excluded. Point estimate and 95% confidence interval were calculated. Results Among 45 patients, the mean tip apex distance was 20.45±6.13 mm (18.66-22.24 mm, 95% Confidence Interval). Among 45 patients, 24 (53.33%) were males and 21 (46.66%) were females. The average age of the participants was 67.75±21.33 years. Conclusions The mean tip apex distance in patients undergoing dynamic hip Screw fixation for pertrochanteric fractures without using traction table was similar to that reported in other international studies. Keywords fracture fixation; hip fractures; operating tables.
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Affiliation(s)
- Subhash Regmi
- Department of Orthopedics, B&B Hospital, Gwarko, Lalitpur, Nepal,Correspondence: Dr Subhash Regmi, Department of Orthopedics, B&B Hospital, Gwarko, Lalitpur, Nepal. , Phone: +977-9855082030
| | | | - Ishor Pradhan
- Department of Orthopedics, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Bibek Banskota
- Department of Orthopedics, B&B Hospital, Gwarko, Lalitpur, Nepal
| | - Amit Joshi
- Department of Orthopedics, B&B Hospital, Gwarko, Lalitpur, Nepal
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Bertault-Le Gourrierec J, Cavaignac E, Berard E, Moretti F, Marot V, Chiron P, Reina N. Comparative study of total hip arthroplasties with dual mobility cups versus hemiarthroplasties in management of femoral neck fractures: Survival and dislocation rate at 5 years of follow-up? Orthop Traumatol Surg Res 2022; 108:103098. [PMID: 34624538 DOI: 10.1016/j.otsr.2021.103098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/02/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instability after hip arthroplasty, whether it is a total (THA) or intermediate (HA), poses a major risk, however arthroplasty is the standard treatment for displaced intracapsular fractures of the femoral neck of the elderly. Three types of arthroplasties can be proposed: total prostheses with or without a dual mobility cup (DM THA) reducing the risk of dislocation, and hemiarthroplasties. In the absence of clear recommendations regarding the type of implant to be used and the scarcity of studies comparing HA and DM THA, we conducted a monocentric comparative retrospective study using the propensity score method to compare DM THA versus HA on recently displaced femoral neck fractures: (1) survival and risk of dislocation, (2) functional results, (3) mortality. HYPOTHESIS The rate of dislocation of THA fitted with a DM cup is lower than that of HA. PATIENTS AND METHODS We retrospectively identified 112 patients in the HA group and 153 patients in the DM THA group who underwent an emergency arthroplasty for a displaced cervical fracture between 2010 and 2013. The minimum follow-up was 5 years (range, 5-9 years). The mean age at surgery was 81 years (range, 55-101 years). Elective surgery patients (n=2), hardware fractures (n=10), pathological fractures of the femoral neck (n=6), associated fractures (n=3), and revision surgeries (n=5) were excluded. The primary outcome measure was instability. Clinical follow-up was performed by the WOMAC score and the risk of mortality was determined after adjusting for confounding factors using the propensity score method. RESULTS After adjustment by the propensity score, the dislocation rate at 2-years was 2.2% (n=3/153) in the dual mobility THA group and 6.3% (n=7/112) in the HA group (OR=0.34 [95% CI: 0.06-1.96] (p=0.23)). After adjustment by the propensity score, the mean WOMAC score was 8.20 (±6.56) in the THA group, compared to 10.78±3.92 on average in the HA group (p=0.031). After adjustment by the propensity score, we did not find any significant difference in the reoperation rate without changing implants and revisions, and postoperative complications. After adjustment by the propensity score, mortality was significantly higher in the HA group 45.5% (n=69/152) versus 91.5% (n=102/112) in the HA group (OR=0.50 [95% CI: 0.25-0.98] (p=0.042)). DISCUSSION Few studies have compared these two types of implant in the context of trauma. Although the results of our study are not significant regarding the risk of dislocation, the use of a dual mobility cup seems to be a very satisfactory solution in this trauma context. LEVEL OF EVIDENCE III; comparative retrospective cohort.
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Affiliation(s)
- Juliette Bertault-Le Gourrierec
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Etienne Cavaignac
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Emilie Berard
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France; CERPOP, Inserm, UPS, Purpan faculty of medicine, university of Toulouse, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Federico Moretti
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Vincent Marot
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Philippe Chiron
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Nicolas Reina
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France.
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Moslemi A, Kierszbaum E, Descamps J, Sigonney F, Biau D, Anract P, Hardy A. Does using the direct anterior approach with a standard table for total hip arthroplasty reduce leg length discrepancies? Comparative study of traction table versus standard table. Orthop Traumatol Surg Res 2021; 107:102752. [PMID: 33316445 DOI: 10.1016/j.otsr.2020.102752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/20/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Primary total hip replacement (THR) comes with a risk of leg length discrepancy (LLD), which occurs in 25 % of cases, especially when the surgery is done using an anterior approach on a traction table, since it is not easy to verify the lengths of the legs. By doing the anterior approach on a standard table an intraoperative visual evaluation of leg lengths can be done after the trial implants are in place. As far as we know, the ability to set the leg length has not been compared between procedures done on a standard table or a traction table. This led us to carry out a retrospective comparative study to determine whether using a standard table for anterior THR will 1) allow better control over leg length, 2) increase the risk of incorrect implant positioning, 3) increase the surgical complication rate. HYPOTHESIS Anterior THR on a standard table will allow better control over leg length than anterior THR on a traction table. MATERIAL AND METHODS This single center retrospective study included 266 THRs done between January 1, 2018 and November 2, 2019 for primary (n=219) or secondary (n=47) hip osteoarthritis. The 137 cases done with a traction table were compared to the 129 cases with a standard table. The two groups were comparable in terms of age, sex, body mass index, indication and bilateral implants. They were not comparable in the surgeon experience (more junior surgeons in the standard table group [p<0.001]) and types of implants used (more cementless cups and stems in the standard table group [p=0.001]). Radiographs were used to measure the LLD, cup inclination, and femoral stem placement in the frontal plane. Any early complications were documented. The target was for the operated leg to be the same length as the contralateral leg, which was defined as within 10mm of each other. RESULTS The mean postoperative LLD was comparable between the traction table group 1.56±7.32 mm (min -15.6 max 17.2) and the standard table group 0.53±6.93 mm (min -16.4 max 13.7) (p=0.24). In the traction table group, 81 % (111/137) of patients had legs of the same length, versus 84 % (109/129) in the standard table group (p=0.7). Cup inclination was comparable with a mean of 40.4±7.1 degrees (min 23.4; max 58.5) in the traction table group versus 39.3±7.5 degrees (min 19.9; max 60.9) in the standard table group (p=0.21). The frontal position of the femoral stem was comparable between groups with a mean of 0.09±0.45 degrees (min -1; max 3.98) in the traction table group versus 0.08±0.59 degrees (min -4.97; max 1.93) in the standard table group (p=0.86). There were 5 complications (3.7 %) in the traction table group versus 11 (8.5 %) in the standard table group (p=0.16). CONCLUSION Use of a standard table to carry out THR by the direct anterior approach does not provide better control over leg length than using a traction table, subject to preoperative planning. When doing the procedure on a standard table, the implant placement is at least comparable, with a similar risk of complications. LEVEL OF EVIDENCE III; case matched study.
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Affiliation(s)
- Aymane Moslemi
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Elliott Kierszbaum
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Jules Descamps
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - François Sigonney
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - David Biau
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Philippe Anract
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Alexandre Hardy
- Service de chirurgie orthopédique et traumatologique, CHU de Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
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