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Osseointegration of a hydroxyapatite-coated stem in femoral neck fractures in the over-80 s

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

In the over-80 s, femoral bone is often osteoporotic and unlikely to be conducive to periprosthetic bone rehabitation. This observation often leads to cemented fixation for hemiarthroplasty in femoral neck fracture. Hydroxyapatite is a bioactive coating that has already demonstrated its osteoinductive properties. Our hypothesis is that hydroxyapatite enables prosthetic osseointegration in patients over 80, as well as periprosthetic cortical thickening. The objective was to evaluate the osseointegration of a hydroxyapatite-coated femoral stem in femoral neck fractures in the over-80 s, and the evaluation of the periprosthetic bone regeneration permitted by hydroxyapatite.

Methods

This was a retrospective study. Osseointegration and periprosthetic bone regeneration were assessed on pre-operative, immediate post-operative and last follow-up radiographs with Engh score, O-SS score, cortical index, Canal Bone Ration (CBR) and Canal Fill Ratio (CFR).

Results

One hundred and forty-six patients were included. At last follow-up, 99.3% (n = 145) of stems were osseointegrated. The mean Engh score was 19.9 [SD 3.1]. The mean O-SS score was 19.1 [SD 2.4], corresponding to very good osseointegration. The mean CBR at last follow-up was 0.48 [SD 0.07], corresponding to a non-osteoporotic femur. There was a significant difference with pre-operative CBR (p < 0,001). The pre-operative cortical index and the index at the last follow-up were significantly different for all levels of measurement (p < 0,001). The CFR at last follow-up was also significantly different with the post-operative CFR (p < 0,001).

Conclusion

This study shows the value of using a hydroxyapatite-coated stem on senile, osteoporotic bone to improve cortical thickness along the entire length of femoral bone.

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References

  1. Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord. https://doi.org/10.1186/s12891-015-0696-x

    Article  PubMed  PubMed Central  Google Scholar 

  2. Guerado E, Cruz E, Cano JR, Crespo PV, Alaminos M, del Sánchez-Quevedo MC, Campos A (2016) Bone mineral density aspects in the femoral neck of hip fracture patients. Injury 47:S21-24. https://doi.org/10.1016/S0020-1383(16)30005-5

    Article  PubMed  Google Scholar 

  3. Wu Y, Li Q, Xu B, Fu H, Li Y (2021) Nano-hydroxyapatite coated TiO2 nanotubes on Ti-19Zr-10Nb-1Fe alloy promotes osteogenesis in vitro. Colloids Surf B Biointerfaces 207:112019. https://doi.org/10.1016/j.colsurfb.2021.112019

    Article  CAS  PubMed  Google Scholar 

  4. Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop 257:107–128

    Article  Google Scholar 

  5. Roche O, Girard J, Canovas F, Migaud H, Bonnomet F, Goldschild M, Le Béguec P (2016) Assessment of fixation in cementless femoral revision of total hip arthroplasty: comparison of the Engh score versus radiolucent line measurement. Int Orthop 40:907–912. https://doi.org/10.1007/s00264-015-3024-z

    Article  PubMed  Google Scholar 

  6. Gruen T (1997) A simple assessment of bone quality prior to hip arthroplasty: cortical index revisited. Acta Orthop Belg 63:20–27

    PubMed  Google Scholar 

  7. Yeung Y, Chiu KY, Yau WP, Tang WM, Cheung WY, Ng TP (2006) Assessment of the proximal femoral morphology using plain radiograph-can it predict the bone quality? J Arthroplast 21:508–513. https://doi.org/10.1016/j.arth.2005.04.037

    Article  CAS  Google Scholar 

  8. Issa K, Pivec R, Wuestemann T, Tatevossian T, Nevelos J, Mont MA (2014) Radiographic fit and fill analysis of a new second-generation proximally coated cementless stem compared to its predicate design. J Arthroplast 29:192–198. https://doi.org/10.1016/j.arth.2013.04.029

    Article  Google Scholar 

  9. D’Ambrosio A, Peduzzi L, Roche O, Bothorel H, Saffarini M, Bonnomet F (2020) Influence of femoral morphology and canal fill ratio on early radiological and clinical outcomes of uncemented total hip arthroplasty using a fully coated stem. Bone Jt Res 9:182–191. https://doi.org/10.1302/2046-3758.94.BJR-2019-0149.R2

    Article  Google Scholar 

  10. Yeung Y, Chiu KY, Yau WP, Tang WM, Cheung WY, Ng TP (2006) Assessment of the proximal femoral morphology using plain radiograph—can it predict the bone quality? J Arthroplast 21:508–513. https://doi.org/10.1016/j.arth.2005.04.037

    Article  CAS  Google Scholar 

  11. Garcia-Cimbrelo E, Garcia-Rey E, Cruz-Pardos A, Madero R (2010) Stress-shielding of the proximal femur using an extensively porous-coated femoral component without allograft in revision surgery: a 5- to 17-year follow-up study. J Bone Jt Surg Br 92:1363–1369. https://doi.org/10.1302/0301-620X.92B10.24317

    Article  CAS  Google Scholar 

  12. Cordero-Ampuero J, Garcia-Rey E, Garcia-Cimbrelo E (2018) Proximal femoral bone regeneration after an uncemented hydroxyapatite-coated long-stem in revision hip surgery. Open Orthop J 12:125–133. https://doi.org/10.2174/1874325001812010125

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ishii S, Homma Y, Baba T, Ozaki Y, Matsumoto M, Kaneko K (2016) Does the canal fill ratio and femoral morphology of Asian females influence early radiographic outcomes of total hip arthroplasty with an uncemented proximally coated, tapered-wedge stem? J Arthroplast 31:1524–1528. https://doi.org/10.1016/j.arth.2016.01.016

    Article  Google Scholar 

  14. Muir SW, Al-Ahaideb A, Huckell J, Johnson MA, Johnston DBC, Beaupre LA (2011) Radiographic assessment of uncemented total hip arthroplasty: reliability of the Engh Grading Scale. Can J Surg 54:185–188. https://doi.org/10.1503/cjs.002610

    Article  PubMed  PubMed Central  Google Scholar 

  15. Engh CA, Massin P (1989) Cementless total hip arthroplasty using the anatomic medullary locking stem. Results using a survivorship analysis. Clin Orthop 249:141–158

    Article  Google Scholar 

  16. Ruff CB, Hayes WC (1988) Sex differences in age-related remodeling of the femur and tibia. J Orthop Res 6:886–896. https://doi.org/10.1002/jor.1100060613

    Article  CAS  PubMed  Google Scholar 

  17. Spotorno L, Romagnoli S, Ivaldo N, Grappiolo G, Bibbiani E, Blaha DJ, Guen TA (1993) The CLS system. Theoretical concept and results. Acta Orthop Belg 59:144–148

    PubMed  Google Scholar 

  18. Hofmann AA, Bloebaum RD, Bachus KN (1997) Progression of human bone ingrowth into porous-coated implants. Rate of bone ingrowth in humans. Acta Orthop Scand 68:161–166. https://doi.org/10.3109/17453679709004000

    Article  CAS  PubMed  Google Scholar 

  19. Tanaka A, Kaku N, Tabata T, Tagomori H, Tsumura H (2020) Comparison of early femoral bone remodeling and functional outcome after total hip arthroplasty using the SL-PLUS MIA stem with and without hydroxyapatite coating. Musculoskelet Surg 104:313–320. https://doi.org/10.1007/s12306-019-00622-1

    Article  CAS  PubMed  Google Scholar 

  20. Boisgard S, Moreau PE, Tixier H, Levai JP (2001) Bone reconstruction, leg length discrepancy, and dislocation rate in 52 Wagner revision total hip arthroplasties at 44-month follow-up. Rev Chir Orthop Reparatrice Appar Mot 87:147–154

    CAS  PubMed  Google Scholar 

  21. Yli-Kyyny T, Ojanperä J, Venesmaa P, Kettunen J, Miettinen H, Salo J, Kröger H (2013) Perioperative complications after cemented or uncemented hemiarthroplasty in hip fracture patients. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc 102:124–128. https://doi.org/10.1177/1457496913482249

    Article  CAS  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  24. Talsnes O, Vinje T, Gjertsen JE, Dahl OE, Engesæter LB, Baste V, Pripp AH, Reikerås O (2013) Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients. Int Orthop 37:1135–1140. https://doi.org/10.1007/s00264-013-1851-3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Parvizi J, Holiday AD, Ereth MH, Lewallen DG (1999) The Frank Stinchfield Award. Sudden death during primary hip arthroplasty. Clin Orthop. https://doi.org/10.1097/00003086-199912000-00005

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service de Chirurgie Orthopédique Traumatologique et Arthroscopique, CHRU Nancy, Nancy, France

    Mathias Kirsch, Hugo Kremer, Camille Fabbri, Pierre Capdevielle, Florian Collignon & Didier Mainard

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  1. Mathias Kirsch
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  2. Hugo Kremer
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  3. Camille Fabbri
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  4. Pierre Capdevielle
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Correspondence to Mathias Kirsch.

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Kirsch, M., Kremer, H., Fabbri, C. et al. Osseointegration of a hydroxyapatite-coated stem in femoral neck fractures in the over-80 s. Eur J Orthop Surg Traumatol 34, 1535–1541 (2024). https://doi.org/10.1007/s00590-024-03835-8

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