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BMC Musculoskeletal Disorders

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Open Access 01-12-2022 | Periprosthetic Fracture | Research

Is there a role for cementless primary stem in hip arthroplasty for early or late fixation failures of intertrochanteric fractures?

Authors: Hsuan-Hsiao Ma, Te-Feng Arthur Chou, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, Wei-Ming Chen

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

The choice of femur stems during the hip arthroplasty procedures for patients with treatment failure of intertrochanteric fractures (ITF) remains controversial. We aimed to compare the surgical complication and reoperation rates between cementless primary and revision stems in the early (≤3 months) and late (> 3 months) fixation failures of ITF.

Methods

This was a retrospective, cohort study conducted in a single, tertiary referral hospital of Taipei, Taiwan. We included hip arthroplasty procedures for failed ITF using cementless primary or revision stems. There were 40 and 35 patients who had early and late fixation failure of ITF, respectively. The patient demographics, time to fixation failure, surgical complications and medical complications were recorded for analysis.

Results

We included 75 patients that underwent hip arthroplasty procedure for failed ITF using cementless primary (n = 38) or revision (n = 37) stems. The mean age was 79.3 years and 56% of the patients were female. In the early fixation failure group, the complication rate was similar between the primary and revision stems (44% vs. 29%, p = 0.343). However, there was a trend toward a higher reoperation rate (31% vs. 8%, p = 0.061) of using the primary stem, compared with the revision stem. In the late fixation failure group, the rate of complication and reoperation was similar between the two stem types.

Conclusion

For early fixation failures of ITFs, we caution against the use of cementless primary stems due to a trend towards an increased risk of reoperations compared to the use of cementless revision stems. However, in late fixation failures of ITFs, there is a role for cementless primary stems.

Level of evidence

III, retrospective cohort study.

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Kulachote N, Sa-Ngasoongsong P, Wongsak S, Chulsomlee K, Jarungvittayakon C, Fuangfa P, et al. Correlation between perioperative surgical factors and complications after hip arthroplasty, as a salvage procedure, following failure of internal fixation of osteoporotic intertrochanteric fractures. Orthop Res Rev. 2019;11:9–15.PubMedPubMedCentral

Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg Am. 2003;85(5):899–904.PubMedCrossRef

Tsai SW, Chen CF, Wu PK, Huang CK, Chen WM, Chang MC. Does implant selection impact postoperative complications following hip arthroplasty for failed intertrochanteric fractures? A retrospective comparative study. Artif Organs. 2016;40(8):798–804.PubMedCrossRef

Morice A, Ducellier F, Bizot P, Orthopaedics, Traumatology Society of Western F. Total hip arthroplasty after failed fixation of a proximal femur fracture: analysis of 59 cases of intra- and extra-capsular fractures. Orthop Traumatol Surg Res. 2018;104(5):681–6.PubMedCrossRef

Tsai SW, Lin CJ, Tzeng YH, Lin CC, Huang CK, Chang MC, et al. Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: an analysis of 176 patients. J Chin Med Assoc. 2017;80(9):587–94.PubMedCrossRef

Liu P, Jin D, Zhang C, Gao Y. Revision surgery due to failed internal fixation of intertrochanteric femoral fracture: current state-of-the-art. BMC Musculoskelet Disord. 2020;21(1):573.PubMedPubMedCentralCrossRef

Haidukewych GJ, Berry DJ. Salvage of failed treatment of hip fractures. J Am Acad Orthop Surg. 2005;13(2):101–9.PubMedCrossRef

Moon NH, Shin WC, Kim JS, Woo SH, Son SM, Suh KT. Cementless total hip arthroplasty following failed internal fixation for femoral neck and intertrochanteric fractures: a comparative study with 3-13 years’ follow-up of 96 consecutive patients. Injury. 2019;50(3):713–9.PubMedCrossRef

Xu Q, Lai J, Zhang F, Xu Y, Zhu F, Lin J, et al. Poor outcomes for osteoporotic patients undergoing conversion total hip arthroplasty following prior failed dynamic hip screw fixation: a nationwide retrospective cohort study. J Int Med Res. 2019;47(4):1544–54.PubMedPubMedCentralCrossRef

10.

Morsi EMZ, Drwish AEE, Saber AM, Nassar IM, Zaki AEM. The use of standard cemented femoral stems in Total hip replacement after failed internal fixation of intertrochanteric femoral fractures. J Arthroplast. 2020;35(9):2525–8.CrossRef

11.

Lizaur-Utrilla A, Miralles-Munoz FA, Ruiz-Lozano M, Martinez-Mendez D, Alonso-Montero C, Lopez-Prats FA. Outcomes of Total hip arthroplasty for healed intertrochanteric hip fractures. A matched retrospective cohort study. J Arthroplast. 2020;35(10):2926–30.CrossRef

12.

Zhang B, Chiu KY, Wang M. Hip arthroplasty for failed internal fixation of intertrochanteric fractures. J Arthroplast. 2004;19(3):329–33.CrossRef

13.

Yu W, Han X, Chen W, Mao S, Zhao M, Zhang X, et al. Conversion from a failed proximal femoral nail anti-rotation to a cemented or uncemented total hip arthroplasty device: a retrospective review of 198 hips with previous intertrochanteric femur fractures. BMC Musculoskelet Disord. 2020;21(1):791.PubMedPubMedCentralCrossRef

14.

Weiss RJ, Karrholm J, Hailer NP, Beckman MO, Stark A. Salvage of failed trochanteric and subtrochanteric fractures using a distally fixed, modular, uncemented hip revision stem. Acta Orthop. 2012;83(5):488–92.PubMedPubMedCentralCrossRef

15.

Shi X, Zhou Z, Yang J, Shen B, Kang P, Pei F. Total hip arthroplasty using non-modular Cementless long-stem distal fixation for salvage of failed internal fixation of intertrochanteric fracture. J Arthroplast. 2015;30(11):1999–2003.CrossRef

16.

Thakur RR, Deshmukh AJ, Goyal A, Ranawat AS, Rasquinha VJ, Rodriguez JA. Management of failed trochanteric fracture fixation with cementless modular hip arthroplasty using a distally fixing stem. J Arthroplast. 2011;26(3):398–403.CrossRef

17.

Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg Am. 2003;85-A(Suppl 4):1–6.CrossRef

18.

Lee SR, Kim ST, Yoon MG, Moon MS, Heo JH. The stability score of the intramedullary nailed intertrochanteric fractures: stability of nailed fracture and postoperative patient mobilization. Clin Orthop Surg. 2013;5(1):10–8.PubMedPubMedCentralCrossRef

19.

Klima ML. Comparison of early fatigue failure of the TFNa and gamma 3 Cephalomedullary nails in the United States from 2015 to 2019. J Orthop Trauma. 2021;35(2):e39–44.PubMedCrossRef

20.

Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;257:107–28.CrossRef

21.

Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.

22.

Engh CA, Hooten JP Jr, Zettl-Schaffer KF, Ghaffarpour M, McGovern TF, Macalino GE, et al. Porous-coated total hip replacement. Clin Orthop Relat Res. 1994;298:89–96.CrossRef

23.

Kheir MM, Drayer NJ, Chen AF. An update on Cementless femoral fixation in Total hip arthroplasty. J Bone Joint Surg Am. 2020;102(18):1646–61.PubMedCrossRef

24.

Abdelaal AH, Yamamoto N, Hayashi K, Takeuchi A, Morsy AF, Miwa S, et al. Radiological assessment of the femoral bowing in Japanese population. SICOT J. 2016;2:2.PubMedPubMedCentralCrossRef

25.

Su XY, Zhao Z, Zhao JX, Zhang LC, Long AH, Zhang LH, et al. Three-dimensional analysis of the curvature of the Femoral Canal in 426 Chinese femurs. Biomed Res Int. 2015;2015:318391.PubMedPubMedCentral

26.

Meek RM, Garbuz DS, Masri BA, Greidanus NV, Duncan CP. Intraoperative fracture of the femur in revision total hip arthroplasty with a diaphyseal fitting stem. J Bone Joint Surg Am. 2004;86(3):480–5.PubMedCrossRef

27.

Sumner DR. Long-term implant fixation and stress-shielding in total hip replacement. J Biomech. 2015;48(5):797–800.PubMedCrossRef

28.

Chen DW, Lin CL, Hu CC, Tsai MF, Lee MS. Biomechanical consideration of total hip arthroplasty following failed fixation of femoral intertrochanteric fractures - a finite element analysis. Med Eng Phys. 2013;35(5):569–75.PubMedCrossRef

29.

Enocson A, Mattisson L, Ottosson C, Lapidus LJ. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures. Acta Orthop. 2012;83(5):493–8.PubMedPubMedCentralCrossRef

Title: Is there a role for cementless primary stem in hip arthroplasty for early or late fixation failures of intertrochanteric fractures?
Authors: Hsuan-Hsiao Ma
Te-Feng Arthur Chou
Shang-Wen Tsai
Cheng-Fong Chen
Po-Kuei Wu
Wei-Ming Chen
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Periprosthetic Fracture
Hip-TEP
Hip-TEP
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05223-x

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Is there a role for cementless primary stem in hip arthroplasty for early or late fixation failures of intertrochanteric fractures?

Abstract

Background

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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