Use of Double Bone Graft to Stabilize Prosthesis in Uncemented Partial Hip Replacement in Elderly Patients with Fracture Neck of Femur

  • Varma H S Department of Orthopaedics, NSCB Medical College, Jabalpur, Madhya Pradesh, India
  • Pandey K K Department of Orthopaedics, NSCB Medical College, Jabalpur, Madhya Pradesh, India
  • Peepra D Department of Orthopaedics, NSCB Medical College, Jabalpur, Madhya Pradesh, India
  • Rajpoot Manish S. Department of Orthopaedics, NSCB Medical College, Jabalpur, Madhya Pradesh, India
DOI: https://doi.org/10.5281/zenodo.3970728
Keywords: Uncemented Bipolar prosthesis, uncemented Austin Moore Prosthesis, Double Bone graft

Abstract

Background: Partial hip replacement (cemented or uncemented) is the frequently done surgery in elderly patients with fracture neck of femur. Problems with cementing techniques are reported like increased infection rate and cardiac problems particularly in elderly patients with compromised cardiopulmonary reserve. Austin Moore prosthesis has its own complication like femoral loosening and frequent revision.

Material& Methods: We analysed results of 30 patients of fracture neck femur with Dorr type A and B proximal femoral morphology, treated by uncemented partial hip replacement (20 patients with Austin Moore prosthesis,10 patients with bipolar prosthesis) in elderly age group ( range 60 to 75 years) where double bone graft were used for additional stabilization of the stem of prosthesis in femoral canal which included transverse peg grafts in fenestrations and conical graft over the tip of the stem of prosthesis to centralise the stem.

Results: The mean follow up was 9.3 years (range from 2 to 15 years). According to Harris Hip score, final outcome was excellent in 21 hips, good in 7 hips and poor in 2 hips.Prosthesis subsidence was found in uncemented partial hip replacement with mean of 2.5 mm (range from 0 mm to 3.5 mm ) which was well tolerated due to bone plugs formed around the tip and fenestrations of prosthesis except in one patient who had complained of thigh pain which required revision with cemented modular prosthesis subsequently. Groin pain was reported in another one patient due to acetabular erosion which required cemented total hip replacement subsequently. There was no incidence of hip dislocation.

Conclusions: Our study shows that in addition to the transverse bar by fenestration grafts, bone block formed around the tip of the stem by conical graft provided strong pillar support and once it is integrated, it prevents excessive subsidence of the prosthesis with excellent result.

Downloads

Download data is not yet available.

References

MaryaSKS,Thukral,SChandeep. Prosthetic replacement in femoral neck fracture in the elderly: Results and review of the literature.Indian J Orthop,2008 Jan-March;42(1):61-67.

Davison JN, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, et al. Treatment for displaced intracapsular fracture of the proximal femur: A prospective, randomized trial in patients aged 65 to 79 years. J Bone Joint Surg Br. 2001;83:206–12.

Parker MJ, Pryor GA. Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: A randomized controlled trial of 208 patients. Acta Orthop Scand. 2000;71:440–6.

Roden M, Schon M, Fredin H. Treatment of displaced femoral neck fractures: A randomized minimum 5-year follow-up study of screws and bipolar hemi prostheses in 100 patients. Acta Orthop Scand. 2003;74:42–4.

Nather A, Seow C, Lau P, Chan A. Mortality and morbidity for elderly patients with fracture neck of femur treated by hemiarthroplasty. Injury . 1995;26:187–190.

MUE DD, Yongu WT, Mohammad H, Kortor JN, Elachi IC, and Donwa JO. Intra –operative implantation errors during hemiarthoplasty. J West AfrColl Surg. 2012 Oct-Dec; 2(4): 79–94.

Drinker H,MurryWR.The universal proximal femoral endoprosthesis. J Bone Joint Surg Am.1979;61(8):1167-74).

Lo WH, Chen WM, Huang CK, Chen TH, Chiu FY, Chen CM. Bateman bipolar hemiarthroplasty for displaced intracapsular femoral neck fractures: Uncemented versus cemented. ClinOrthopRelat Res. 1994;302:75–82

Parvizi J, Holiday AD, Ereth MH, Lewallen DG. Sudden death during primary hip arthroplasty. ClinOrthopRelat Res. 1999;369:39–48.

Byrick RJ. Cement implantation syndrome: A time limited embolic phenomenon. Can J Anaesth. 1997;44:107–11.

Leighton RK, Schmidt AH, Collier P, Trask K. Advances in the treatment of intracapsular hip fractures in the elderly. Injury. 2007;38:S24–34.

Nikolopoulos KE, PapadakisSA,KaterosKT,Themistocleous GS, VlamisJA,Papagelopoupos PJ, Nikiforidid PA. Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures.Injury 2003 Jul;34(7):525-8.

MUE DD, Yongu WT, Mohammad H, Kortor JN, Elachi IC, and Donwa JO. Intra –operative implantation errors during hemiarthoplasty. J West AfrColl Surg. 2012 Oct-Dec; 2(4): 79–94.

Dorr L, Faugere M, Mackel A. Structural and cellular assessment of bone quality of proximal femur. Bone.1993;14:231–242. Majority of our patients were of Dorr type B morphology.

Hudson JI, Kenzora JE, Hebel JR, Gardner JF, Scherlis L, Epstein RS, et al. Eight-year outcome associated with clinical options in the management of femoral neck fractures. ClinOrthopRelat Res. 1998;348:59–66.

Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck: A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am. 1994;76:15–25.

Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, 3rd, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck: A meta-analysis. J Bone Joint Surg Am. 2003;85:1673–81.

Rogmark C, Carlsson Å, Johnell O, Sernbo I. A prospective randomized trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur: Functional outcome for 450 patients at two years. J Bone Joint Surg Br. 2002;84:183–8.

Parker MJ, Gurusamy K. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;3:CD001706.
Use of Double Bone Graft to Stabilize Prosthesis in Uncemented Partial Hip Replacement in Elderly Patients with Fracture Neck of Femur
Published
2016-12-31
CITATION
DOI: 10.5281/zenodo.3970728
Published: 2016-12-31
How to Cite
1.
Varma H S, Pandey K K, Peepra D, Rajpoot Manish S. Use of Double Bone Graft to Stabilize Prosthesis in Uncemented Partial Hip Replacement in Elderly Patients with Fracture Neck of Femur. ojmpc [Internet]. 2016Dec.31 [cited 2024Dec.22];22(2):37-1. Available from: https://ojmpc.com/index.php/ojmpc/article/view/37
Issue
Vol 22 No 2 (2016): JUL-DEC
Section
Original Article

The entire contents of the Orthopaedic Journal of Madhya Pradesh Chapter are protected under Indian and International copyrights. Orthopaedic Journal of Madhya Pradesh Chapter allow authors to retain the copyrights of their papers without restrictions, Authors grant the publisher the right of exclusive publication. The Journal then grants to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, perform and display the work publicly and to make and distribute derivative works in any digital medium for any reasonable non-commercial purpose, subject to proper attribution of authorship. The journal also grants the right to make numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Non-commercial share alike 4.0 International Public License.