Clinical Interventions in Aging (Oct 2021)
The Outcomes of Cemented Femoral Revisions for Periprosthetic Femoral Fractures in the Elderly: Comparison with Cementless Stems
Abstract
Pavel Sponer,1,2 Martin Korbel,1,2 Michal Grinac,1,2 Libor Prokes,1,2 Ales Bezrouk,3 Tomas Kucera1,2 1Department of Orthopedic Surgery, University Hospital in Hradec Králové, Hradec Králové, Czech Republic; 2Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic; 3Department of Medical Biophysics, Charles University in Prague, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech RepublicCorrespondence: Pavel Sponer Tel +420 495 833 566Email [email protected]: The present study compares the outcome of the long cemented stem and the revision uncemented stem used in periprosthetic femoral fractures. We propose that the revision with a long stem cemented prosthesis does not compromise fracture healing.Patients and Methods: A consecutive series of 37 patients, operated between 2010 and 2017, were enrolled in a retrospective analysis. A long cemented stem was implanted in 21 patients (study group; age at operation: 63 to 89 years). A distally tapered fluted uncemented stem was used in 16 patients (control group; age at operation: 35 to 77 years). The clinical outcome was evaluated with Merle d’Aubigné and Postel scoring system. Standard radiographs were taken before surgery, at 3, 6, and 12 months postoperatively, and last follow-up. Any and all complications during the follow-up period were recorded.Results: Although a significant difference (P = 0.006) was observed in the post-operative Merle d´Aubigné score over the 12-month follow-up period, no significant difference (P = 0.066) was found in the post-operative pain score between the study and control groups. Periodic radiographic assessments showed the disappearance of radiolucent lines and the diaphyseal part of the fracture was healed in all 34 followed-up cases during the first annual follow-up. Early surgical complications were seen in both groups, the medical complications were observed only in the study group.Conclusion: Based on our results, periprosthetic fractures of the femur after a total hip arthroplasty were associated with significant morbidity and increased mortality in elderly patients. Revision with a long-stem cemented prosthesis provided early pain-free weight-bearing without compromising the healing of femoral fractures in elderly patients with osteoporotic bone, altered mobility, poor balance, and reduced cognitive capacity.Keywords: revision total hip arthroplasty, periprosthetic hip fractures, cemented stem
