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Outcomes of cerclage wiring to manage intra-operative femoral fracture occurring during cementless hemiarthroplasty in older patients with femoral neck fractures

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Abstract

Background

Cementless hemiarthroplasty is a widely used treatment for femoral neck fractures. Intra-operative femoral fracture occasionally occurs during the procedure, and the use of cerclage wire has been proposed to stabilize both the prosthesis and the bone. This study aimed to investigate the outcomes of cerclage wiring to manage intra-operative fractures occurring during cementless hemiarthroplasty in older patients with a femoral neck fracture.

Methods

Medical records and radiographs of older patients with femoral neck fractures who underwent hemiarthroplasty during 2009 to 2015 were retrospectively reviewed. Patients who received cerclage wiring were matched with a demographically matched control group that did not. Patients were followed for at least 12 months. Functional outcomes and health-related quality of life were evaluated by determining the distance of distal stem migration, Barthel Index, EuroQol-visual analog scale (VAS), and pain-VAS.

Results

Eighty-one patients were included, comprising 27 study group and 54 control group patients. A tapered wedge-shaped femoral prosthesis was implanted in all cases. No significant differences in distance of distal stem migration or rate of stem subsidence > 2 mm were observed between the case and control groups (subsidence rate 11.1 vs. 14.8%, respectively). There was also no significant difference in functional outcomes between groups.

Conclusion

Our results revealed a low mean distance of distal stem migration and a low subsidence rate. Functional outcomes and quality of life were similar between the two groups. Cerclage wiring technique is safe, and it should be routinely performed when intra-operative femoral fracture occurs during cementless hemiarthroplasty.

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References

  1. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141. https://doi.org/10.1002/jbmr.5650090802

    Article  CAS  PubMed  Google Scholar 

  2. Millar WJ, Hill GB (1994) Hip fractures: mortality, morbidity and surgical treatment. Health Rep 6(3):323–337

    CAS  PubMed  Google Scholar 

  3. Civinini R, Paoli T, Cianferotti L, Cartei A, Boccaccini A, Peris A et al (2018) Functional outcomes and mortality in geriatric and fragility hip fractures-results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”. Int Orthop. https://doi.org/10.1007/s00264-018-4132-3

    Article  PubMed  Google Scholar 

  4. Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289. https://doi.org/10.1007/BF01623184

    Article  CAS  PubMed  Google Scholar 

  5. Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413. https://doi.org/10.1007/PL00004148

    Article  CAS  PubMed  Google Scholar 

  6. Stone AV, Jinnah A, Wells BJ, Atkinson H, Miller AN, Futrell WM et al (2018) Nutritional markers may identify patients with greater risk of re-admission after geriatric hip fractures. Int Orthop 42(2):231–238. https://doi.org/10.1007/s00264-017-3663-3

    Article  PubMed  Google Scholar 

  7. Wang Z, Bhattacharyya T (2017) Outcomes of hemiarthroplasty and total hip arthroplasty for femoral neck fracture: a Medicare cohort study. J Orthop Trauma 31(5):260–263. https://doi.org/10.1097/BOT.0000000000000814

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sonaje JC, Meena PK, Bansiwal RC, Bobade SS (2018) Comparison of functional outcome of bipolar hip arthroplasty and total hip replacement in displaced femoral neck fractures in elderly in a developing country: a 2-year prospective study. Eur J Orthop Surg Traumatol 28(3):493–498. https://doi.org/10.1007/s00590-017-2057-y

    Article  PubMed  Google Scholar 

  9. He JH, Zhou CP, Zhou ZK, Shen B, Yang J, Kang PD et al (2012) Meta-analysis comparing total hip arthroplasty with hemiarthroplasty in the treatment of displaced femoral neck fractures in patients over 70 years old. Chin J Traumatol 15(4):195–200. https://doi.org/10.3760/cma.j.issn.1008-1275.2012.04.001

    Article  PubMed  Google Scholar 

  10. von Roth P, Abdel MP, Harmsen WS, Berry DJ (2015) Cemented bipolar hemiarthroplasty provides definitive treatment for femoral neck fractures at 20 years and beyond. Clin Orthop Relat Res 473(11):3595–3599. https://doi.org/10.1007/s11999-015-4462-z

    Article  Google Scholar 

  11. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW (2009) Bone cement implantation syndrome. Br J Anaesth 102(1):12–22. https://doi.org/10.1093/bja/aen328

    Article  CAS  PubMed  Google Scholar 

  12. Yli-Kyyny T, Ojanpera J, Venesmaa P, Kettunen J, Miettinen H, Salo J et al (2013) Perioperative complications after cemented or uncemented hemiarthroplasty in hip fracture patients. Scand J Surg 102(2):124–128. https://doi.org/10.1177/1457496913482249

    Article  CAS  PubMed  Google Scholar 

  13. Olsen F, Kotyra M, Houltz E, Ricksten SE (2014) Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. Br J Anaesth 113(5):800–806. https://doi.org/10.1093/bja/aeu226

    Article  CAS  PubMed  Google Scholar 

  14. Bell KR, Clement ND, Jenkins PJ, Keating JF (2014) 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 96-B(3):299–305. https://doi.org/10.1302/0301-620x.96b3.32271

    Article  CAS  PubMed  Google Scholar 

  15. McGraw IW, Spence SC, Baird EJ, Eckhardt SM, Ayana GE (2013) Incidence of periprosthetic fractures after hip hemiarthroplasty: are uncemented prostheses unsafe? Injury 44(12):1945–1948. https://doi.org/10.1016/j.injury.2013.07.023

    Article  PubMed  Google Scholar 

  16. Ng ZD, Krishna L (2014) Cemented versus cementless hemiarthroplasty for femoral neck fractures in the elderly. J Orthop Surg (Hong Kong) 22(2):186–189. https://doi.org/10.1177/230949901402200214

    Article  Google Scholar 

  17. Morris K, Davies H, Wronka K (2015) Implant-related complications following hip hemiarthroplasty: a comparison of modern cemented and uncemented prostheses. Eur J Orthop Surg Traumatol 25(7):1161–1164. https://doi.org/10.1007/s00590-015-1671-9

    Article  PubMed  Google Scholar 

  18. Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA (2008) Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 90(9):2000–2012. https://doi.org/10.2106/jbjs.h.00331

    Article  PubMed  Google Scholar 

  19. Berend KR, Lombardi AV Jr, Mallory TH, Chonko DJ, Dodds KL, Adams JB (2004) Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2 to 16 years. J Arthroplast 19(7 Suppl 2):17–21. https://doi.org/10.1016/j.arth.2004.06.008

    Article  Google Scholar 

  20. Capello WN, D'Antonio JA, Naughton M (2014) Periprosthetic fractures around a cementless hydroxyapatite-coated implant: a new fracture pattern is described. Clin Orthop Relat Res 472(2):604–610. https://doi.org/10.1007/s11999-013-3137-x

    Article  PubMed  Google Scholar 

  21. Unnanuntana A, Unkanawarapan H (2017) Short-term radiographic result of cementless hemiarthroplasty using taperer wedge-shaped femoral component in older patients with femoral neck fracture. J Med Assoc Thail 100(8):894–900

    Google Scholar 

  22. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH (1993) Structural and cellular assessment of bone quality of proximal femur. Bone 14(3):231–242. https://doi.org/10.3290/j.qi.a39746

    Article  CAS  PubMed  Google Scholar 

  23. Bieger R, Cakir B, Reichel H, Kappe T (2014) Accuracy of hip stem migration measurement on plain radiographs: reliability of bony and prosthetic landmarks Orthopade 43(10): p. 934–939. https://doi.org/10.1007/s00132-014-3014-7

    Article  CAS  PubMed  Google Scholar 

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

  25. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  26. Laohaprasitiporn P, Jarusriwanna A, Unnanuntana A (2017) Validity and reliability of the Thai version of the Barthel Index for elderly patients with femoral neck fracture. J Med Assoc Thail 100(5):539–548

    Google Scholar 

  27. Unnanuntana A, Jarusriwanna A, Nepal S (2018) Validity and responsiveness of Barthel index for measuring functional recovery after hemiarthroplasty for femoral neck fracture. Arch Orthop Trauma Surg:1–7. https://doi.org/10.1007/s00402-018-3020-z

    Article  PubMed  Google Scholar 

  28. Brooks R (1996) EuroQol: the current state of play. Health Policy 37(1):53–72. https://doi.org/10.1016/0168-8510(96)00822-6

    Article  CAS  PubMed  Google Scholar 

  29. Tidermark J, Bergstrom G, Svensson O, Tornkvist H, Ponzer S (2003) Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fractures. Qual Life Res 12(8):1069–1079. https://doi.org/10.1023/A:1026193812514

    Article  CAS  PubMed  Google Scholar 

  30. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL (1998) The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg 86(1):102–106. https://doi.org/10.1213/00000539-199801000-00020

    Article  CAS  PubMed  Google Scholar 

  31. Roberts KC, Brox WT, Jevsevar DS, Sevarino K (2015) Management of hip fractures in the elderly. J Am Acad Orthop Surg 23(2):131–137. https://doi.org/10.5435/jaaos-d-14-00432

    Article  PubMed  Google Scholar 

  32. Figved W, Opland V, Frihagen F, Jervidalo T, Madsen JE, Nordsletten L (2009) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res 467(9):2426–2435. https://doi.org/10.1007/s11999-008-0672-y

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dammerer D, Putzer D, Glodny B, Petersen J, Arrich F, Krismer M et al (2018) Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival. Int Orthop. https://doi.org/10.1007/s00264-018-4084-7

    Article  PubMed  Google Scholar 

  34. Kim SM, Han SB, Rhyu KH, Yoo JJ, Oh KJ, Yoo JH et al (2018) Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty—a multicentric analysis. Int Orthop 42(9):2069–2076. https://doi.org/10.1007/s00264-018-3930-y

    Article  PubMed  Google Scholar 

  35. Barlas KJ, Ajmi QS, Bagga TK, Howell FR, Roberts JA, Eltayeb M (2008) Association of intra-operative metaphyseal fractures with prosthesis size during hemiarthroplasty of the hip. J Orthop Surg (Hong Kong) 16(1):30–34. https://doi.org/10.1177/230949900801600108

    Article  CAS  Google Scholar 

  36. Kuo CL, Tan SH, Lee HC (2015) Intra-operative fractures in cementless bipolar hemiarthroplasty. J Orthop Surg (Hong Kong) 23(2):218–222. https://doi.org/10.1177/230949901502300222

    Article  Google Scholar 

  37. Husmann O, Rubin PJ, Leyvraz PF, de Roguin B, Argenson JN (1997) Three-dimensional morphology of the proximal femur. J Arthroplast 12(4):444–450. https://doi.org/10.1016/S0883-5403(97)90201-1

    Article  CAS  Google Scholar 

  38. Mahaisavariya B, Sitthiseripratip K, Tongdee T, Bohez EL, Vander Sloten J, Oris P (2002) Morphological study of the proximal femur: a new method of geometrical assessment using 3-dimensional reverse engineering. Med Eng Phys 24(9):617–622. https://doi.org/10.1016/S1350-4533(02)00113-3

    Article  PubMed  Google Scholar 

  39. Baharuddin MY, Kadir MRA, Zulkifly AH, Saat A, Aziz AA, Lee MH (2011) Morphology study of the proximal femur in malay population. Int J Morphol 29(4):1321–1325

    Article  Google Scholar 

  40. ACt W, Owen JR, Wayne JS, Hess SR, Golladay GJ, Jiranek WA (2017) The effect of prophylactic cerclage wires in primary total hip arthroplasty: a biomechanical study. J Arthroplast 32(6):2023–2027. https://doi.org/10.1016/j.arth.2017.01.019

    Article  Google Scholar 

  41. Lenz M, Perren SM, Richards RG, Muckley T, Hofmann GO, Gueorguiev B et al (2013) Biomechanical performance of different cable and wire cerclage configurations. Int Orthop 37(1):125–130. https://doi.org/10.1007/s00264-012-1702-7

    Article  PubMed  Google Scholar 

  42. Frisch NB, Charters MA, Sikora-Klak J, Banglmaier RF, Oravec DJ, Silverton CD (2015) Intraoperative periprosthetic femur fracture: a biomechanical analysis of cerclage fixation. J Arthroplast 30(8):1449–1457. https://doi.org/10.1016/j.arth.2015.02.026

    Article  Google Scholar 

  43. Gordon K, Winkler M, Hofstadter T, Dorn U, Augat P (2016) Managing Vancouver B1 fractures by cerclage system compared to locking plate fixation—a biomechanical study. Injury 47(Suppl 2):S51–S57. https://doi.org/10.1016/s0020-1383(16)47009-9

    Article  PubMed  Google Scholar 

  44. Falez F, Santori N, Panegrossi G (1998) Intraoperative type 1 proximal femoral fractures: influence on the stability of hydroxyapatite-coated femoral components. J Arthroplast 13(6):653–659. https://doi.org/10.1016/S0883-5403(98)80009-0

    Article  CAS  Google Scholar 

  45. Schewelov T, Ahlborg H, Sanzen L, Besjakov J, Carlsson A (2012) Fixation of the fully hydroxyapatite-coated Corail stem implanted due to femoral neck fracture: 38 patients followed for 2 years with RSA and DEXA. Acta Orthop 83(2):153–158. https://doi.org/10.3109/17453674.2011.641107

    Article  PubMed  Google Scholar 

  46. Lee YK, Joung HY, Kim SH, Ha YC, Koo KH (2014) Cementless bipolar hemiarthroplasty using a micro-arc oxidation coated stem in patients with displaced femoral neck fractures. J Arthroplast 29(12):2388–2392. https://doi.org/10.1016/j.arth.2014.04.020

    Article  Google Scholar 

  47. Al-Najjim M, Khattak U, Sim J, Chambers I (2016) Differences in subsidence rate between alternative designs of a commonly used uncemented femoral stem. J Orthop 13(4):322–326. https://doi.org/10.1016/j.jor.2016.06.026

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kabelitz M, Fritz Y, Grueninger P, Meier C, Fries P, Dietrich M (2018) Cementless stem for femoral neck fractures in a patient’s 10th decade of life: high rate of periprosthetic fractures. Geriatr Orthop Surg Rehabil 9:2151459318765381. https://doi.org/10.1177/2151459318765381

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ries C, Boese CK, Dietrich F, Miehlke W, Heisel C (2018) Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study. Int Orthop. https://doi.org/10.1007/s00264-018-4020-x

    Article  PubMed  Google Scholar 

  50. Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 420:80–95. https://doi.org/10.1097/00003086-200403000-00012

    Article  Google Scholar 

  51. Pioli G, Barone A, Giusti A, Oliveri M, Pizzonia M, Razzano M et al (2006) Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res 18(5):381–387

    Article  CAS  PubMed  Google Scholar 

  52. Franzo A, Francescutti C, Simon G (2005) Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 20(12):985–991. https://doi.org/10.1007/s10654-005-4280-9

    Article  PubMed  Google Scholar 

  53. Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J, Otto DD et al (2005) Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Miner Res 20(3):494–500. https://doi.org/10.1359/jbmr.041133

    Article  CAS  PubMed  Google Scholar 

  54. Carow J, Carow JB, Coburn M, Kim BS, Bucking B, Bliemel C et al (2017) Mortality and cardiorespiratory complications in trochanteric femoral fractures: a ten year retrospective analysis. Int Orthop 41(11):2371–2380. https://doi.org/10.1007/s00264-017-3639-3

    Article  PubMed  Google Scholar 

  55. Forni C, Gazineo D, D'Alessandro F, Fiorani A, Morri M, Sabattini T et al (2018) Predictive factors for thirty day mortality in geriatric patients with hip fractures: a prospective study. Int Orthop. https://doi.org/10.1007/s00264-018-4057-x

    Article  PubMed  Google Scholar 

  56. Bliemel C, Buecking B, Oberkircher L, Knobe M, Ruchholtz S, Eschbach D (2017) The impact of pre-existing conditions on functional outcome and mortality in geriatric hip fracture patients. Int Orthop 41(10):1995–2000. https://doi.org/10.1007/s00264-017-3591-2

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge Ms. Wachirapan Narktang of the Department of Orthopaedic Surgery for assistance with data collection, and Mr. Sutthipol Udompunthurak of the Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University for assistance with statistical analysis.

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  1. Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand

    Aasis Unnanuntana & Nakarin Saiyudthong

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Correspondence to Aasis Unnanuntana.

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Unnanuntana, A., Saiyudthong, N. Outcomes of cerclage wiring to manage intra-operative femoral fracture occurring during cementless hemiarthroplasty in older patients with femoral neck fractures. International Orthopaedics (SICOT) 43, 2637–2647 (2019). https://doi.org/10.1007/s00264-019-04327-9

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