J Korean Orthop Assoc.  2008 Dec;43(6):703-709.

Cementless Bipolar Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients

• Choy WS
• Ahn JH
• Jeong HJ
• Lee SH
• Yang DH
• Kam BS
• Koo JY

Abstract

PURPOSE: The purpose of this study was to evaluate clinicoradiological outcomes after cementless bipolar hemiarthroplasty in elderly patients with femoral neck fractures.
MATERIALS AND METHODS
Eighty hips-all in patients greater than 70 years of age-were followed for more than 2 years after undergoing cementless bipolar hemiarthroplasty with a tapered cementless stem (Lima SPH-C2(R)). The mean age was 76 years, and the mean follow-up period was 37 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices.
RESULTS
At last follow-up, the mean Harris hip score was 80.2 points. There was one case of significant hip pain. Fifty-five cases (68.7%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 47 cases (58.7%) of bone ingrowth and 33 cases (41.3%) of stable fibrous fixation. There were no cases of osteolysis, and 30 cases (37.5%) exhibited new bone formation around the stem. All stems were stable without significant alignment change or progressive subsidence.
CONCLUSION
Short-term outcomes proved to be satisfactory in elderly patients undergoing cementless bipolar hemiarthroplasty for femoral neck fractures.

Keyword

Old age; Femoral neck fracture; Cementless bipolar hemiarthroplasty

MeSH Terms

Aged
Femoral Neck Fractures
Femur Neck
Follow-Up Studies
Hemiarthroplasty
Hip
Humans
Osteogenesis
Osteolysis
Walking

Figure

• 

  Fig. 1 (A) A 75-year-old woman had a femoral neck fracture in type B proximal femur. (B) The postoperative radiograph shows excellent metaphyseal fit of cementless tapered femoral stem. (C) At postoperative 37 months, the radiograph shows stable fixation of femoral component without subsidence or changes in alignment.

Reference

1. Berend KR, Lombardi AV, Mallory TH, Dodds KL, Adams JB. Cementless double-tapered total hip arthroplasty in patients 75 years of age and older. J Arthroplasty. 2004. 19:288–295.

2. Chang JD, Yoo JH, Chang KY, Park BM. Cementless Zweymuller stem for the treatment of the hip fracture in patients older than 80 with severe osteoporosis - case control study with cemented stem -. J Korean Hip Soc. 2006. 18:447–453.

3. Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of transartrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg Br. 1994. 76:409–412.

4. Cuckler JM, Tamarapalli JR. An algorithm for the management of femoral neck fractures. Orthopedics. 1994. 17:789–792.

5. Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993. 14:231–242.

6. Emery RJ, Broughton NS, Desai K, Bulstrode CJ, Thomas TL. Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomized trial of cemented Thompson and uncemented Moore stems. J Bone Joint Surg Br. 1991. 73:322–324.

7. Engh CA, Bobyn JD. Engh CA, Bobyn JD, editors. Clinical evaluation of biological fixation. Biological fixation in total hip arthroplasty. 1985. Thorofare, NJ: Slack Inc;219–240.

8. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding and clinical results. J Bone Joint Surg Br. 1987. 69:45–55.

9. Engh CA, Massin P, Suther KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990. 257:107–128.

10. Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA. 1994. 271:128–133.

11. Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979. 141:17–27.

12. Hearly WL. Hip implant selection for total hip arthroplasty in elderly patients. Clin Orthop Relat Res. 2002. 405:54–64.

13. Hungerford DS, Jones LC. The rationale for cementless total hip replacement. Orthop Clin North Am. 1993. 24:617–626.

14. Katz S, Jackson BA, Jaffe MW, Littell AS, Turk CE. Multidisciplinary studies of illness in aged persons VI. Comparison study of rehabilitated and nonrehabilitated patients with fracture of the hip. J Chronic Dis. 1962. 15:979–984.

15. Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg Am. 2001. 83:1333–1338.

16. Khan RJ, MacDowell A, Crossman P, et al. Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures. Int Orthop. 2002. 26:229–232.

17. Kim YH, Kim VE. Uncemented porous-coated anatomic total hip replacement. Results at six years in a consecutive series. J Bone Joint Surg Br. 1993. 75:6–13.

18. Kim YH, Kim JS, Cho SH. Primary total hip arthroplasty with the AML total hip prosthesis. Clin Orthop Relat Res. 1999. 360:147–158.

19. Kim YM, Kim HJ, Ahn JH, Kim KH, Kang SB. Early postoperative periprosthetic radiological findings in cementless THRA: comparison between porous-coated implant and HA-coated implant. J Korean Orthop Assoc. 1997. 32:1005–1014.

20. Konstantoulakis C, Anastopoulos G, Papaeliou A, Tsoutsanis A, Asimakopoulos A. Uncemented total hip arthroplasty in the elderly. Int orthop. 1999. 23:334–336.

21. Lettich T, Tierney MG, Parvizi J, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: two- to seven-year results. J Arthroplasty. 2007. 22:7 Suppl 3. S43–S46.

22. Maloney WJ, editor. Femoral fixation in older patients: uncemented is reasonable in many patients. Program and abstracts of the 74^th annual meeting of the American Acadamy of Orthopaedic Surgeons. 2007. February 14-18.

23. McAuley JP, Moore D, Culpepper WJ 2nd, Engh CA. Total hip arthroplasty with porous-coated prostheses fixed without cement in patients who are sixty-five years of age or older. J Bone Joint Surg Am. 1998. 80:1648–1655.

24. Mulliken BD, Bourne RB, Rorabeck CH, Nayak N. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Joint Surg Am. 1996. 78:1214–1225.

25. Overgaard S, Jensen TT, Bonde G, Mossing NB. The uncemented bipolar hemiarthroplasty for displaced femoral neck fractures. 6-year follow-up 171 cases. Acta Orthop Scand. 1991. 62:115–120.

26. Parvizi J, Holiday AD, Ereth MH, Lewallen DG. The frank stinchfield award. Sudden death during primary hip arthroplasty. Clin Orthop Relat Res. 1999. 369:39–48.

27. Rothman RH, Cohn JC. Cemented versus cementless total hip arthroplasty. A critical review. Clin Orthop Relat Res. 1990. 254:153–169.

28. Shon WY, Lee SH, Suh SW, Jeon SJ. The evaluation of proximal femur classification by Dorr as preoperative radiographic evaluation. J Korean Hip Soc. 1995. 7:79–86.

29. Singh M, Nagrath AR, Maini PS. Change in the trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970. 52:457–467.