Hip Pelvis.  2015 Dec;27(4):232-240. 10.5371/hp.2015.27.4.232.

Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture

• Kang JH
• Lee SH
• Jung S

• KMID: 2150511
• DOI: http://doi.org/10.5371/hp.2015.27.4.232

Abstract

PURPOSE
The current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry.
MATERIALS AND METHODS
Seventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis.
RESULTS
At the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C.
CONCLUSION
Bipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture.

Keyword

Bipolar hemiarthroplasty; Cone stem; Femoral neck fractures

MeSH Terms

Dislocations
Femoral Neck Fractures*
Femur
Femur Neck*
Follow-Up Studies
Hemiarthroplasty
Hip
Ossification, Heterotopic
Prostheses and Implants
Venous Thrombosis
Walking

Figure

• 

  Fig. 1 Hip anteroposterior and lateral radiograph of a 75 year-old female patient shows thin cortical bone thickness and widened of medullary cavity.

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  Fig. 2 Wagner Cone Stem (Zimmer, Warsaw, IN, USA). The titanium implant has a cone stem with a tapered angle of 5°. Eight sharp longitudinal ridges are evenly distributed over the entire circumference of the prosthetic stem. The titanium surface is coarse blasted for osseointegration. The round stem facilitates unimpeded rotation during implantation to adjust the anteversion angle.

• 

  Fig. 3 Stem subsidence was calculated by following method. Line a was drawn along the center of the long axis of the stem. Lines perpendicular to the line a at the level of the greater trochanteric tip (line b) and the superolateral shoulder of the stem (line c) was drawn. The change of distance between line b and c (both side arrow) since the immediate post-operative radiograph was measured.

• 

  Fig. 4 (A) Radiograph of a 75-year-old female with right femoral neck fracture in Dorr type B. (B) Postoperative anteroposterior (AP) hip radiograph. (C, D) Hip AP and lateral radiograph shows stable bony fixation without no subsidence or osteolysis at 7 years after the operation.

• 

  Fig. 5 (A) Radiograph of a 78-year-old female with left femoral neck fracture in Dorr type C. (B) Postoperative anteroposterior (AP) hip radiograph. (C, D) Hip AP and lateral radiograph shows stable bony fixation without no subsidence or osteolysis at 5.5 years after the operation.

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