Hip Pelvis.  2012 Sep;24(3):200-205. 10.5371/hp.2012.24.3.200.

Cementless Bipolar Hemiarthroplasty of Hip Fracture in Patients on Hemodialysis

• Lee JH
• Kim YS
• Hwang KT
• Kim YH

• KMID: 2054133
• DOI: http://doi.org/10.5371/hp.2012.24.3.200

Abstract

PURPOSE
This study analyzed the clinical and radiologic results and complications in patients with chronic renal failure who underwent cementless bipolar hemiarthroplasty for treatment of hip fractures.
MATERIALS AND METHODS
Between January 2003 and February 2010, we performed 36 consecutive cementless bipolar hemiarthroplasty procedures in 35 patients with hip fracture who were on hemodialysis for chronic renal failure. Clinically, postoperative Harris hip score, inguinal and thigh pain, and orthopaedic and medical complications were investigated. Radiologically, we examined bone ingrowth, osteolysis, loosening, and nonunion.
RESULTS
According to the Harris hip score grading system, the average postoperative score was 85.7 and the function before the injury was restored in 29 cases. Postoperatively, four patients experienced mild inguinal pain and four patients experienced mild thigh pain. One patient experienced severe thigh pain. Orthopaedic complications(6 cases, 16.7%) included mild hematoma(3 cases), superficial wound infection(2 cases), and dislocation(1 case). Medical complications(10 cases, 27.8%) included sepsis(5 cases), multiple organ failure due to aggravation of underlying diseases(2 cases), ulcer perforation(2 cases), and aspiration pneumonia(1 case). Five patients had died within one year (mortality, 13.9%). Except for loosening of the femoral stem in one case, bone ingrowth was observed in all cases. None of the patients had osteolysis and nonunion.
CONCLUSION
Although cementless bipolar hemiarthroplasty was considered as an effective treatment in patients with hip fractureon hemodialysis due to favorable results at midterm follow-up, close attention for the postoperative medical complications due to poor general condition is needed.

Keyword

Hemodialysis; Hip fracture; Cementless bipolar hemiarthroplasty

MeSH Terms

Follow-Up Studies
Hemiarthroplasty
Hip
Humans
Kidney Failure, Chronic
Multiple Organ Failure
Osteolysis
Renal Dialysis
Thigh
Ulcer

Figure

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  Fig. 1 (A) Preoperative radiograph showed insufficiency fracture of the right femoral neck. (B) Radiograph showed stable fixation after 1 year 3 months using cementless bipolar hemiarthroplasty of the right hip. (C) After 1 year 6 months of operation, loosening of femoral stem had occurred.

Reference

1. Lieberman JR, Fuchs MD, Haas SB, et al. Hip arthroplasty in patients with chronic renal failure. J Arthroplasty. 1995. 10:191–195.

2. Toomey HE, Toomey SD. Hip arthroplasty in chronic dialysis patients. J Arthroplasty. 1998. 13:647–652.

3. Sakalkale DP, Hozack WJ, Rothman RH. Total hip arthroplasty in patients on long-term renal dialysis. J Arthroplasty. 1999. 14:571–575.

4. Alem AM, Sherrad DJ, Gillen DL, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000. 58:396–399.

5. García-Ramiro S, Cofán F, Esteban PL, et al. Total hip arthroplasty in hemodialysis and renal transplant patients. Hip Int. 2008. 18:51–57.

6. Abbott KC, Bucci JR, Agodoa LY. Total hip arthroplasty in chronic dialysis patients in the United States. J Nephrol. 2003. 16:34–39.

7. Sunday JM, Guille JT, Torg JS. Complications of joint arthroplasty in patients with end-stage renal disease on hemodialysis. Clin Orthop Relat Res. 2002. (397):350–355.

8. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am. 2004. 86-A:1711–1716.

9. Rödén M, Schön M, Fredin H. Treatment of displaced femoral neck fractures: a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients. Acta Orthop Scand. 2003. 74:42–44.

10. Karaeminogullari O, Demirors H, Sahin O, Ozalay M, Ozdemir N, Tandogan RN. Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis. J Bone Joint Surg Am. 2007. 89:324–331.

11. Naito M, Ogata K, Shiota E, Nakamoto M, Goya T. Hip arthroplasty in haemodialysis patients. J Bone Joint Surg Br. 1994. 76:428–431.

12. Fukunishi S, Fukui T, Nishio S, Imamura F, Yoh K, Yoshiya S. Results of total hip arthroplasty for dialysis arthropathy in long-term hemodialysis patients. J Orthop Sci. 2009. 14:285–291.

13. Nagoya S, Nagao M, Takada J, Kuwabara H, Kaya M, Yamashita T. Efficacy of cementless total hip arthroplasty in patients on long-term hemodialysis. J Arthroplasty. 2005. 20:66–71.

14. Li WC, Shih CH, Ueng SW, Shih HN, Lee MS, Hsieh PH. Uncemented total hip arthroplasty in chronic hemodialysis patients. Acta Orthop. 2010. 81:178–182.

15. Coco M, Rush H. Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis. 2000. 36:1115–1121.

16. Stehman-Breen CO, Sherrad DJ, Alem AM, et al. Risk factors for hip fracture among patients with end-stage renal disease. Kidney Int. 2000. 58:2200–2205.

17. Aveline C, Leroux A, Vautier P, Cognet F, Le Hetet H, Bonnet F. Risk factors for renal dysfunction after total hip arthroplasty. Ann Fr Anesth Reanim. 2009. 28:728–734.

18. Shrader MW, Schall D, Parvizi J, McCarthy JT, Lewallen DG. Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients. J Arthroplasty. 2006. 21:324–329.

19. Creighton MG, Callaghan JJ, Olejniczak JP, Johnston RC. Total hip arthroplasty with cement in patients who have rheumatoid arthritis. A minimum ten-year follow-up study. J Bone Joint Surg Am. 1998. 80:1439–1446.

20. Goldberg BA, al-Habbal G, Noble PC, Paravic M, Liebs TR, Tullos HS. Proximal and distal femoral centralizers in modern cemented hip arthroplasty. Clin Orthop Relat Res. 1998. (349):163–173.

21. Crawford R, Athanasou NA. Beta 2-microglobulin amyloid deposition in hip revision arthroplasty tissues. Histopathology. 1998. 33:479–484.

22. Schmalzried TP, Callaghan JJ. Wear in total hip and knee replacements. J Bone Joint Surg Am. 1999. 81:115–136.

23. Blacha J, Kolodziej R, Karwanski M. Bipolar cemented hip hemiarthroplasty in patients with femoral neck fracture who are on hemodialysis is associated with risk of stem migration. Acta Orthop. 2009. 80:174–178.

24. Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012. 94:577–583.

25. Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011. 93:500–509.

26. Sakabe T, Imai R, Murata H, et al. Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients. J Orthop Trauma. 2006. 20:330–336.

27. Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis. 2004. 44:672–679.

28. Klein DM, Tornetta P 3rd, Barbera C, Neuman D. Operative treatment of hip fractures in patients with renal failure. Clin Orthop Relat Res. 1998. (350):174–178.

29. Kalra S, McBryde CW, Lawrence T. Intracapsular hip fractures in end-stage renal failure. Injury. 2006. 37:175–184.

30. Tierney GS, Goulet JA, Greenfield ML, Port FK. Mortality after fracture of the hip in patients who have end-stage renal disease. J Bone Joint Surg Am. 1994. 76:709–712.