Skip to main content

Advertisement

SpringerLink
Log in

Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shorter Femoral Stem and Standard Femoral Stem

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

This randomized control study was designed to compare the clinical and radiological outcomes, including periprosthetic bone mineral density (BMD) changes, between the short and standard stems after using cementless hemiarthroplasty in elderly patients with femur neck fractures.

Materials and Methods

From January 2013 to May 2017, 151 patients (aged ≥ 65 years) underwent hemiarthroplasties due to femoral neck fractures. Patients were randomized into two groups; 77 patients in Group A implanting the short femoral stem and 74 patients in Group B implanting the standard femoral stem. Clinical and radiographic evaluations were performed in all patients.

Results

75 patients (40 patients in Group A and 35 patients in Group B) completed routine follow-up for a minimum of 2 years. The clinical outcomes, including ambulatory functions and thigh pain, were similar in both groups. All the femoral stems acquired radiologic stability. At postoperative one year, BMD values in Gruen zone (G) seven on the standard stem side were significantly lower than those on the short stem side (P = 0.038). At the second year of follow-up, the BMD values of Group A in G1, G3, G4, and G7 were significantly greater than those of Group B (P = 0.007, 0.032, 0.026, and P < 0.000, respectively).

Conclusions

Both the clinical outcomes and radiologic stability in both group demonstrated similar results in elderly patients with femoral neck fracture at the latest follow-up. In addition, the periprosthetic BMD of the short femoral stems demonstrated better periprosthetic bone preservation at a minimum of 2 years of follow-up.

Level of Evidences

Therapeutic Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jiang, J., Yang, C. H., Lin, Q., Yun, X. D., & Xia, Y. Y. (2015). Does arthroplasty provide better outcomes than internal fixation at mid- and long-term followup? A Meta-analysis. Clinical Orthopaedics and Related Research, 473, 2672–2679.

    Article  Google Scholar 

  2. Burgers, P. T., Van Geene, A. R., Van den Bekerom, M. P., et al. (2012). Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. International Orthopaedics, 36, 1549–1560.

    Article  Google Scholar 

  3. Luo, X., He, S., Li, Z., & Huang, D. (2012). Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Archives of Orthopaedic and Trauma Surgery, 132, 455–463.

    Article  Google Scholar 

  4. Taylor, F., Wright, M., & Zhu, M. (2012). Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. Journal of Bone and Joint Surgery, 94, 577–583.

    Article  Google Scholar 

  5. Morrey, B. F. (1989). Short-stemmed uncemented femoral component for primary hip arthroplasty. Clinical Orthopaedics and Related Research, 249, 169–175.

    Google Scholar 

  6. Yu, H., Liu, H., Jia, M., Hu, Y., & Zhang, Y. (2016). A comparison of a short versus a conventional femoral cementless stem in total hip arthroplasty in patients 70 years and older. Journal of Orthopaedic Surgery and Research, 11, 33.

    Article  Google Scholar 

  7. Salemyr, M., Muren, O., Ahl, T., et al. (2015). Lower periprosthetic bone loss and good fixation of an ultra-short stem compared to a conventional stem in uncemented total hip arthroplasty. Acta Orthopaedica, 86, 659–666.

    Article  Google Scholar 

  8. Sluimer, J. C., Hoefnagels, N. H., Emans, P. J., Kuijer, R., & Geesink, R. G. (2006). Comparison of two hydroxyapatite-coated femoral stems: clinical, functional, and bone densitometry evaluation of patients randomized to a regular or modified hydroxyapatite-coated stem aimed at proximal fixation. Journal of Arthroplasty, 21, 344–352.

    Article  Google Scholar 

  9. Koyano, G., Jinno, T., Koga, D., Yamauchi, Y., Muneta, T., & Okawa, A. (2017). Comparison of bone remodeling between an anatomic short stem and a straight stem in 1-stage bilateral total hip arthroplasty. Journal of Arthroplasty, 32, 594–600.

    Article  Google Scholar 

  10. Garden, R. S. (1964). Stability and union in subcapital fractures of the femur. Journal of Bone and Joint Surgery. British Volume, 46, 630–647.

    Article  CAS  Google Scholar 

  11. Ji, H. M., Kim, K. C., Lee, Y. K., Ha, Y. C., & Koo, K. H. (2012). Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. Journal of Arthroplasty, 27, 378–385.

    Article  Google Scholar 

  12. Koval, K. J., Skovron, M. L., Aharonoff, G. B., Meadows, S. E., & Zuckerman, J. D. (1995). Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clinical Orthopaedics and Related Research, 310, 150–159.

    Google Scholar 

  13. Barrack, R. L., Paprosky, W., Butler, R. A., Palafox, A., Szuszczewicz, E., & Myers, L. (2000). Patients' perception of pain after total hip arthroplasty. Journal of Arthroplasty, 15, 590–596.

    Article  CAS  Google Scholar 

  14. Heekin, R. D., Callaghan, J. J., Hopkinson, W. J., Savory, C. G., & Xenos, J. S. (1993). The porous-coated anatomic total hip prosthesis, inserted without cement. Results after five to seven years in a prospective study. The Journal of Bone and Joint Surgery., 75, 77–91.

    Article  CAS  Google Scholar 

  15. Callaghan, J. J., Dysart, S. H., & Savory, C. G. (1988). The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. The Journal of Bone and Joint Surgery., 70, 337–346.

    Article  CAS  Google Scholar 

  16. Engh, C. A., Glassman, A. H., & Suthers, K. E. (1990). The case for porous-coated hip implants. The femoral side. Clinical Orthopaedics and Related Research, 261, 63–81.

    Google Scholar 

  17. Meijerink, H.J., Gardeniers, J.W., Buma, P., Lemmens, J.A., Schreurs, B.W. (2004) Hydroxyapatite does not improve the outcome of a bipolar hemiarthroplasty. Clinical Orthopaedics and Related Research, 143–150.

  18. Engh, C. A., Bobyn, J. D., & Glassman, A. H. (1987). Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. The Journal of Bone and Joint Surgery. British Volume, 69, 45–55.

    Article  CAS  Google Scholar 

  19. Engh, C.A., Bobyn, J.D. (1988). The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clinical Orthopaedics and Related Research, 231, 7–28.

  20. Gruen, T.A., McNeice, G.M., Amstutz, H.C. (1979). "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clinical Orthopaedics and Related Research, 17–27.

  21. Kido, K., Fujioka, M., Takahashi, K., Ueshima, K., Goto, T., & Kubo, T. (2009). Short-term results of the S-ROM-A femoral prosthesis operative strategies for Asian patients with osteoarthritis. Journal of Arthroplasty, 24, 1193–1199.

    Article  Google Scholar 

  22. Capello, W. N., D'Antonio, J. A., Geesink, R. G., Feinberg, J. R., & Naughton, M. (2009). Late remodeling around a proximally HA-coated tapered titanium femoral component. Clinical Orthopaedics and Related Research, 467, 155–165.

    Article  Google Scholar 

  23. Woolson, S. T., Hartford, J. M., & Sawyer, A. (1999). Results of a method of leg-length equalization for patients undergoing primary total hip replacement. Journal of Arthroplasty, 14, 159–164.

    Article  CAS  Google Scholar 

  24. Brooker, A. F., Bowerman, J. W., Robinson, R. A., & Riley, L. H., Jr. (1973). Ectopic ossification following total hip replacement. Incidence and a method of classification. Journal of Bone and Joint Surgery, 55, 1629–1632.

    Article  CAS  Google Scholar 

  25. Lee, S. J., & Yoon, K. S. (2019). favorable functional recovery and stem stability after hip arthroplasty with a short metaphyseal stem in elderly patients with osteoporotic femoral neck fractures. Hip & Pelvis., 31, 11–17.

    Article  Google Scholar 

  26. Ferguson, R. J., Broomfield, J. A., Malak, T. T., et al. (2018). Primary stability of a short bone-conserving femoral stem: a two-year randomized controlled trial using radiostereometric analysis. The Bone & Joint Journal, 100-B, 1148–1156.

    Article  CAS  Google Scholar 

  27. Yan, S. G., Li, D., Yin, S., Hua, X., Tang, J., & Schmidutz, F. (2017). Periprosthetic bone remodeling of short cementless femoral stems in primary total hip arthroplasty: A systematic review and meta-analysis of randomized-controlled trials. Medicine (Baltimore)., 96, e8806.

    Article  Google Scholar 

  28. Liang, H. D., Yang, W. Y., Pan, J. K., et al. (2018). Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials. British Medical Journal Open, 8, e021649.

    Google Scholar 

  29. Knutsen, A. R., Lau, N., Longjohn, D. B., Ebramzadeh, E., & Sangiorgio, S. N. (2017). Periprosthetic femoral bone loss in total hip arthroplasty: systematic analysis of the effect of stem design. Hip International, 27, 26–34.

    Article  Google Scholar 

  30. Nkanang, B., Parker, M., Parker, E., & Griffiths, R. (2017). Perioperative mortality for patients with a hip fracture. Injury, 48, 2180–2183.

    Article  Google Scholar 

  31. Tran, P., Zhang, B. X., Lade, J. A., Pianta, R. M., Unni, R. P., & Haw, C. S. (2016). Periprosthetic bone remodeling after novel short-stem neck-sparing total hip arthroplasty. Journal of Arthroplasty, 31, 2530–2535.

    Article  Google Scholar 

  32. Wixson, R. L., Stulberg, S. D., Van Flandern, G. J., & Puri, L. (1997). Maintenance of proximal bone mass with an uncemented femoral stem analysis with dual-energy X-ray absorptiometry. Journal of Arthroplasty, 12, 365–372.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

No benefits in any form have been received or will be received from any commercial party related directly or indirectly to the subject of this article.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inje University College of Medicine and Inje University Haeundae Paik Hospital, Busan, South Korea

    Jae-Young Lim

  2. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine and Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea

    Hyeong-Jun Park & Yong-Chan Ha

  3. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea

    Young-Kyun Lee & Kyung-Hoi Koo

Authors
  1. Jae-Young Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyeong-Jun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young-Kyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yong-Chan Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyung-Hoi Koo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong-Chan Ha.

Ethics declarations

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lim, JY., Park, HJ., Lee, YK. et al. Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shorter Femoral Stem and Standard Femoral Stem. JOIO 54, 868–878 (2020). https://doi.org/10.1007/s43465-020-00115-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-020-00115-5

Keywords

Search

Navigation