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Cement augmentation of the proximal femur nail antirotation: is it safe?

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Cement augmentation of the proximal femur nail antirotation (PFNA; Fa. DePuy Synthes) showed good biomechanical and clinical results regarding increased stability and functional outcome [Linden et al. in J Orthop Res 24:2230–2237, 2006;Kammerlander et al. in Injury 49:1436–1444, 2018;]. Cement-associated complications are well known in orthopedic procedures like hip arthroplasty, vertebra- and kyphoplasty. This study investigates outcome and safety of augmentation of the proximal femur nail blade.

Materials and methods

The retrospective review of the 299 patients (mean age 80 ± 13 years; 205 women and 94 men) focused on perioperative complications after augmentation which was performed with Traumacem V+ Cement (Fa. DePuy Synthes) in 152 cases. The decision for augmentation of the blade was made by the attending surgeon and based on the factors age, bone quality, and fracture pattern. Primary outcome measures were changes in blood pressure, heart rate or oxygen saturation, and the number of needed vasoactive drugs during augmentation. Secondary outcome measures where the rate of cement leakage into the joint, mechanical failure, and perioperative complications like pulmonary embolism, stroke, or heart attack.

Results

In 152 augmented cases, no leakage of cement into the joint could be detected. No signs of mechanical failure like cut-out of the blade were seen after 6 weeks and 3 months. Also, augmentation did not show a higher rate of mortality or postoperative complications like stroke, heart attack, embolism, or infection. 57 of 152 augmented cases received an intraoperative intervention with vasoactive medication at the time of augmentation either prophylactically or because of a blood pressure fall. Out of the non-augmented cases, 21 of 147 needed vasoactive medication in the second half of the operation. The difference between these groups was significant (p < 0.05). In the cases without an intervention, there was a significant blood pressure fall of about 8 ± 7.4 mmHg during the augmentation (p < 0.001). Still, none of the augmented cases showed a change in heart rate or oxygen saturation.

Conclusion

The augmentation of the PFNA blade proved to be a safe procedure. Cement augmentation will not increase postoperative complications or mortality. The risk for leakage of cement into the joint is low and mechanical cut-out might be prevented. The decision for augmentation should be made carefully and always be declared loud and in advance to allow the anesthetist to prepare, because blood pressure changes can occur.

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Funding

No author is affiliated to any of the supporting companies or received or will receive any form of payment related to this study.

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Authors and Affiliations

  1. Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Konrad Schuetze, A. Eickhoff, C. Dehner, F. Gebhard & P. H. Richter

  2. Department of Anesthesiology, University Hospital Ulm, Ulm, Germany

    S. Ehinger

Authors
  1. Konrad Schuetze
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  2. S. Ehinger
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  3. A. Eickhoff
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  4. C. Dehner
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We affirm that this manuscript is original, has not been published before, and is not currently being considered for publication elsewhere. All authors have contributed equally to this work.

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Correspondence to Konrad Schuetze.

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The authors declare that there is no conflict of interest. No company had influence in the collection of data or contributed to or had influence on the conception, design, analysis, and writing of the study. No further funding was received.

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All procedures followed were in accordance with the ethical standards of the responsible ethics committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Schuetze, K., Ehinger, S., Eickhoff, A. et al. Cement augmentation of the proximal femur nail antirotation: is it safe?. Arch Orthop Trauma Surg 141, 803–811 (2021). https://doi.org/10.1007/s00402-020-03531-2

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  • DOI: https://doi.org/10.1007/s00402-020-03531-2

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