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Bipolar Hemiarthroplasty and Parathyroidectomy at the Same Setting for Fragility Fractures Secondary to Renal Bone Disease

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Abstract

Background

From 1980s to the new millennium, the number of patients surviving with end stage renal disease (ESRD) has increased by 3 fold. This is driven by early detection of primordial and primary risk factors, state of the art renal replacement therapy and ease of public access to healthcare. Renal osteodystrophy (RO) is a metabolic bone disease causing significant morbidity in patients with ESRD, in particular fragility fractures. In this case series, we present the surgical management of 3 ESRD patients with pathological fractures of the neck of femur (NOF) and surgical treatment (parathyroidectomy) of tertiary hyperparathyroidism of ESRD patients in the same surgical setting. Up to date there has been no reports on bipolar hemiarthroplasty and total parathyroidectomy implemented in the same operative setting.

Methods

We present 3 cases, 2 males and a female with an average age of 48 years. All patients presented with no trauma or minimal trauma. With high index of suspicion and after confirming the diagnosis with advanced imaging, the patients underwent cemented modular hemiarthroplasty with posterior approach. Parathyroidectomy was sequentially performed to address the tertiary hyperparathyroidism at the same setting. We followed them for 48 months.

Results

At 48-month follow up, all the patients were at their pre-morbid ambulatory status and there were no major complications. They did not need any revision surgery or re-operation either for the hemiarthroplasty surgery or the parathyroidectomy during the follow up period.

Conclusion

To avoid diagnostic pitfalls in this group of patients we recommend MRIs of both hips in patients complaining of unilateral hip pain even when the roentgenograms are clear of fractures. Total parathyroidectomy at the same setting with the bipolar hemi-arthroplasty is a safe combination. This reduces the anaesthesia risk, the recovery time as well as the equilibrium time for calcium homeostasis.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Outram Road, Academia, Level 4, Singapore, 169856, Singapore

    Amila Silva, Adriel You Wei Tay & Tet Sen Howe

  2. Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Chung Fai Jeremy Ng

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  1. Amila Silva
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  2. Adriel You Wei Tay
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Correspondence to Adriel You Wei Tay.

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This study was performed in accordance with the ethical standards of our institutional review board (IRB) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Silva, A., Tay, A.Y.W., Ng, C.F.J. et al. Bipolar Hemiarthroplasty and Parathyroidectomy at the Same Setting for Fragility Fractures Secondary to Renal Bone Disease. JOIO 54 (Suppl 1), 81–86 (2020). https://doi.org/10.1007/s43465-020-00153-z

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