Clin Orthop Surg.  2018 Mar;10(1):14-19. 10.4055/cios.2018.10.1.14.

Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures

Affiliations
  • 1Department of Orthopaedics and Trauma Surgery, Hull Royal Infirmary, Hull, UK.
  • 2Department of Orthopaedics and Trauma Surgery, Leeds General Infirmary, Leeds, UK. osmanriaz@doctors.org.uk
  • 3Department of Orthopaedics and Trauma Surgery, University College London, London, UK.

Abstract

BACKGROUND
The aim of our study was to determine the rate and preoperative predictors of intraoperative fracture (IOF) during hip hemiarthroplasty (HA) in patients who have sustained a fragility hip fracture injury.
METHODS
We reviewed 626 patients who underwent HA at our institution using the National Hip Fracture Database. Various patient- and surgery-related data including demographic information, cement usage, surgeon grade, time to surgery, and operative duration were collected. The metaphyseal diaphyseal index and modified canal bone ratio were measured on preoperative radiographs. We compared patients with and without IOF with respect to all variables collected. Multivariate regression modeling was used to identify significant preoperative risk factors for IOF.
RESULTS
There was a 7% incidence of IOF in our cohort exclusively comprising of Vancouver A fractures. The majority of these complications were treated nonoperatively (52%). There was no statistically significant difference with respect to cement usage, surgeon grade, operative duration, time to surgery, and radiographic parameters collected. Increasing age was found to be the most significant preoperative risk factor for predicting IOF (p = 0.024, overall relative risk = 1.06).
CONCLUSIONS
Our identified predictor of increasing age is nonmodifiable and illustrates the importance of meticulous surgical technique in older patients. Furthermore, its independence from fixation methods or prosthesis design as a predictor of IOF may support using an uncemented prosthesis in patients at risk from cement implantation.

Keyword

Hemiarthroplasty; Hip fractures; Femur neck fracture; Intraoperative fracture

MeSH Terms

Cohort Studies
Femoral Neck Fractures
Hemiarthroplasty*
Hip Fractures*
Hip*
Humans
Incidence
Prostheses and Implants
Prosthesis Design
Risk Factors

Figure

  • Fig. 1 Description of calculation of metaphyseal diaphyseal index (MDI) score (A) and modified canal bone ratio (CBR) (B).

  • Fig. 2 Treatment for intraoperative fractures in the cohort (n = 33). VAG: Vancouver A greater trochanter fracture, VAL: Vancouver A lesser trochanter fracture.


Cited by  1 articles

Comparison of the Incidence of Intra-operative Fractures in Hip Hemi-arthroplasty Performed in Supine and Lateral Positions
Kenta Kamo, Hidehiko Kido, Satoshi Kido
Hip Pelvis. 2019;31(1):33-39.    doi: 10.5371/hp.2019.31.1.33.


Reference

1. Bhandari M, Devereaux PJ, Tornetta P 3rd, et al. Operative management of displaced femoral neck fractures in elderly patients: an international survey. J Bone Joint Surg Am. 2005; 87(9):2122–2130. PMID: 16140828.
2. Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res. 2009; 467(9):2426–2435. PMID: 19130162.
Article
3. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010; (6):CD001706. PMID: 20556753.
Article
4. Bhattacharyya T, Chang D, Meigs JB, Estok DM 2nd, Malchau H. Mortality after periprosthetic fracture of the femur. J Bone Joint Surg Am. 2007; 89(12):2658–2662. PMID: 18056498.
Article
5. Lindahl H. Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007; 38(6):651–654. PMID: 17477925.
Article
6. Mayle RE, Della Valle CJ. Intra-operative fractures during THA: see it before it sees us. J Bone Joint Surg Br. 2012; 94(11 Suppl A):26–31. PMID: 23118376.
7. Sheth NP, Brown NM, Moric M, Berger RA, Della Valle CJ. Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty. J Arthroplasty. 2013; 28(2):286–291. PMID: 22868075.
Article
8. Metcalfe D. The pathophysiology of osteoporotic hip fracture. Mcgill J Med. 2008; 11(1):51–57.
Article
9. Neander G, Adolphson P, Hedstrom M, von Sivers K, Dahlborn M, Dalen N. Decrease in bone mineral density and muscle mass after femoral neck fracture: a quantitative computed tomography study in 25 patients. Acta Orthop Scand. 1997; 68(5):451–455. PMID: 9385245.
Article
10. Yeung Y, Chiu KY, Yau WP, Tang WM, Cheung WY, Ng TP. Assessment of the proximal femoral morphology using plain radiograph-can it predict the bone quality? J Arthroplasty. 2006; 21(4):508–513. PMID: 16781402.
Article
11. Chana R, Mansouri R, Jack C, et al. The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal Index, a solution to preventing intra-operative periprosthetic fracture. J Orthop Surg Res. 2011; 6:59. PMID: 22099169.
Article
12. Bell KR, Clement ND, Jenkins PJ, Keating JF. A comparison of the use of uncemented hydroxyapatite-coated bipolar and cemented femoral stems in the treatment of femoral neck fractures: a case-control study. Bone Joint J. 2014; 96(3):299–305. PMID: 24589782.
13. Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012; 94(7):577–583. PMID: 22488613.
Article
14. Brady OH, Garbuz DS, Masri BA, Duncan CP. Classification of the hip. Orthop Clin North Am. 1999; 30(2):215–220. PMID: 10196423.
Article
15. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008; 3:17. PMID: 19087314.
Article
16. Deangelis JP, Ademi A, Staff I, Lewis CG. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up. J Orthop Trauma. 2012; 26(3):135–140. PMID: 22198652.
17. Barlas KJ, Ajmi QS, Bagga TK, Howell FR, Roberts JA, Eltayeb M. Association of intra-operative metaphyseal fractures with prosthesis size during hemiarthroplasty of the hip. J Orthop Surg (Hong Kong). 2008; 16(1):30–34. PMID: 18453655.
Article
18. Livesley PJ, Srivastiva VM, Needoff M, Prince HG, Moulton AM. Use of a hydroxyapatite-coated hemiarthroplasty in the management of subcapital fractures of the femur. Injury. 1993; 24(4):236–240. PMID: 8392032.
Article
19. Greidanus NV, Mitchell PA, Masri BA, Garbuz DS, Duncan CP. Principles of management and results of treating the fractured femur during and after total hip arthroplasty. Instr Course Lect. 2003; 52:309–322. PMID: 12690859.
20. Royal College of Physicians. National Hip Fracture Database annual report 2014. London: Royal College of Physicians;2014.
21. Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M. Epidemiology of hip fractures. Bone. 1996; 18(1 Suppl):57S–63S. PMID: 8717549.
Article
22. Lena T, Dzupa V, Lunacek L, Fric V, Kostal R, Krbec M. Intra-operative periprosthetic fractures during THA in the period 1995-2009. Acta Chir Orthop Traumatol Cech. 2013; 80(5):341–345. PMID: 25105675.
23. Enocson A, Hedbeck CJ, Tidermark J, Pettersson H, Ponzer S, Lapidus LJ. Dislocation of total hip replacement in patients with fractures of the femoral neck. Acta Orthop. 2009; 80(2):184–189. PMID: 19404800.
Article
24. Kendrick BJ, Wilson HA, Lippett JE, McAndrew AR, Andrade AJ. Corail uncemented hemiarthroplasty with a Cathcart head for intracapsular hip fractures. Bone Joint J. 2013; 95(11):1538–1543. PMID: 24151276.
Article
25. National Institute for Health and Care Excellence. Hip fracture: the management of hip fracture in adults CG124 [Internet]. London: National Institute for Health and Care Excellence;2011. cited 2018 Jan 5. Available from: https://www.nice.org.uk/guidance/cg124.
26. Nash W, Harris A. The Dorr type and cortical thickness index of the proximal femur for predicting peri-operative complications during hemiarthroplasty. J Orthop Surg (Hong Kong). 2014; 22(1):92–95. PMID: 24781623.
Article
27. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993; 14(3):231–242. PMID: 8363862.
Article
28. Jasty M, O'Connor DO, Henshaw RM, Harrigan TP, Harris WH. Fit of the uncemented femoral component and the use of cement influence the strain transfer the femoral cortex. J Orthop Res. 1994; 12(5):648–656. PMID: 7931781.
29. Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br. 2011; 93(1):96–101. PMID: 21196551.
Article
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