Abstract
Background: Cemented hip arthroplasty is an established treatment for femoral neck fracture in the mobile elderly. Cement pressurization raises intramedullary pressure and may lead to fat embolization, resulting in fatal bone cement implantation syndrome, particularly in patients with multiple comorbidities. The cementless stem technique may reduce this mortality risk but it is technically demanding and needs precise planning and execution. We report the perioperative mortality and morbidity of cementless bipolar hemiarthroplasty in a series of mobile elderly patients (age >70 years) with femoral neck fractures.
Materials and Methods: Twenty-nine elderly patients with mean age of 83 years (range:71–102 years) with femoral neck fractures (23 neck of femur and 6 intertrochanteric) were operated over a 2-year period (Nov 2005–Oct 2007). All were treated with cementless bipolar hemiarthroplasty. Clinical and radiological follow-up was done at 3 months, 6 months, 12 months, and then yearly. Results: The average follow-up was 36 months (range 26–49 months). The average duration of surgery and blood loss was 28 min from skin to skin (range, 20–50 min) and 260 ml (range, 95–535 ml), respectively. Average blood transfusion was 1.4 units (range, 0 to 4 units) Mean duration of hospital stay was 11.9 days (7–26 days). We had no perioperative mortality or serious morbidity. We lost two patients to follow-up after 12 months, while three others died due to medical conditions (10–16 months post surgery). Twenty-four patients were followed to final follow-up (average 36 months; range: 26–49 months). All were ambulatory and had painless hips; the mean Harris hip score was 85 (range: 69–96).
Conclusion: Cementless bipolar hemiarthroplasty for femoral neck fractures in the very elderly permits early return to premorbid life and is not associated with any untoward cardiac event in the perioperative period. It can be considered a treatment option in this select group.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parker MJ, Gurusamy K. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 2006;3:CD001706.
Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty 1986;1:21–8.
Leighton RK, Schmidt AH, Collier P, Trask K. Advances in the treatment of intracapsular hip fractures in the elderly. Injury 2007;38:S24–34.
Geiger F, Zimmermann-Stenzel M, Heisel C, Lehner B, Daecke W. Trochanteric fractures in the elderly: The influence of primary hip arthroplasty on 1-year mortality. Arch Orthop Trauma Surg 2007;127:959–66.
Lo WH, Chen WM, Huang CK, Chen TH, Chiu FY, Chen CM. Bateman bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures: Uncemented versus cemented. Clin Orthop Relat Res 1994;302:75–82.
Ozturkmen Y, Karamehmetoglu M, Caniklioglu M, Ince Y, Azboy Y. Cementless hemiarthroplasty for femoral neck fractures in elderly patients. ArchJ Orthop 2008; 42:56–60.
Parvizi J, Holiday AD, Ereth MH, Lewallen DG. Sudden death during primary hip arthroplasty. Clin Orthop Relat Res 1999;369:39–48.
Byrick RJ. Cement implantation syndrome: A time limited embolic phenomenon. Can J Anaesth 1997;44:107–11.
Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth 2009;102:12–22.
Parvizi J, Ereth MH, Lewallen DG. The role of methyl-methacrylate monomer in the formation of haemodynamic outcome of pulmonary fat emboli. J Bone Joint Surg Br 1999;81:369–70.
Christie J, Burnett R, Potts HR, Pell AC. Echocardiography of transatrial embolism during cemented and uncemented hemiarthroplasty of the hip. J Bone Joint Surg Br 1994; 76:409–12.
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.
Bezwada HP, Shah AR, Harding SH, Baker J, Johanson NA, Mont MA. Cementless bipolar hemiarthroplasty for displaced femoral neck fractures in the elderly. J Arthroplasty 2004;19:73–7.
Rodop O, Kiral A, Kaplan H, Akmaz I. Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop 2002;26:233–7.
Lu-Yao GL, Baron JA, Barrett JA, Fisher ES. Treatment and survival among elderly Americans with hip fractures: A population-based study. Am J Public Health 1994;84:1287–91.
Haentjens P, Casteleyn PP, Opdecam P. Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg 1994;60:124–8.
Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005;87:2186–92.
Konstantoulakis C, Anastopoulos G, Papaeliou A, Tsoutsanis A, Asimakopoulus A. Uncemented total hip arthroplasty in the elderly. Int Orthop 1999;23:334–6.
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;19:288–95.
Ahn J, Man LX, Park S, Sodl JF, Esterhai JL. Systematic review of cemented and uncemented hemiarthroplasty outcomes for femoral neck fractures. Clin Orthop Relat Res 2008;466:2513–8.
Pieringer H, Labek G, Auersperg V, Bohler N. Cementless total hip arthroplasty in patients older than 80 years of age. J Bone Joint Surg Br 2003;85:641–5.
Klestil T, Biedermann R, Krüger A, Gfoller P, Schmoelz W, Rangger C, et al. Cementless hemiarthroplasty in femoral neck fractures: Evaluation of clinical results and measurement of migration by EBRA-FCA. Arch Orthop Trauma Surg 2006;126:380–6.
Ogino D, Kawaji H, Konttinen L, Lehto M, Rantanen P, Malmivaara A, et al. Total hip replacement in patients eighty years of age and older. J Bone Joint Surg Am 2008;90:1884–90.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Marya, S.K.S., Thukral, R., Hasan, R. et al. Cementless bipolar hemiarthroplasty in femoral neck fractures in elderly. IJOO 45, 236–242 (2011). https://doi.org/10.4103/0019-5413.80042
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.80042