Article

Periprosthetic fractures of the greater trochanter through osteolytic cysts with uncemented MicroStructured Omnifit prosthesis: retrospective analyses of 23 fractures in 887 hips after 5-14 yrs. Acta Orthop

Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Acta Orthopaedica (Impact Factor: 2.77). 09/2005; 76(4):538-43. DOI: 10.1080/17453670510041538
Source: PubMed

ABSTRACT

Periprosthetic fractures of the greater trochanter through osteolytic cysts are rare. The proper treatment and its influence on the prosthetic survival remains unknown.
We retrospectively evaluated 887 hips with uncemented MicroStructured Omnifit total hip prostheses at a mean follow-up time of 11 (5-14) years. We found 23 (2.6%) fractures of the greater trochanter through a cystic lesion, occurring 4-11 years postoperatively.
Nonoperative treatment healed 15 of the 17 fractures that were minimally displaced. At a mean follow-up of 3 (2-5) years after the fracture, 16 had had revision of the components because of excessive wear, loosening, or nonunion.
We conclude that a periprosthetic fracture of the greater trochanter through an osteolytic lesion is usually stable and heals without treatment. However, it is associated with poor prosthetic survival because of excessive polyethylene wear.

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    • "This indicates that early osseointegration can be achieved in osteoporotic bone and that immediate weight bearing is well tolerated postoperatively . Disuse-periprosthetic-proximal atrophy of the femur, also known as stress-shielding, is a well-documented phenomenon (Kilgus et al. 1993, Ang et al. 1997, Boden et al. 2006) but to date there have been few reported clinical consequences (Hsieh et al. 2005). This periprosthetic bone loss may be one possible explanation for the increased risk of periprosthetic fractures found in patients who have undergone surgery for FNF with uncemented implants (Leonardsson et al. 2012), particularly as we found the BMD loss to be more pronounced in those who later sustained a periprosthetic fracture (Figure 4). "
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    ABSTRACT: Background and purpose We previously evaluated a new uncemented femoral stem designed for elderly patients with a femoral neck fracture and found stable implant fixation and good clinical results up to 2 years postoperatively, despite substantial periprosthetic bone mineral loss. We now present the medium-term follow-up results from this study. Patients and methods In this observational prospective cohort study, we included 50 patients (mean age 81 (70–92) years) with a femoral neck fracture. All patients underwent surgery with a cemented cup and an uncemented stem specifically designed for fracture treatment. Outcome variables were migration of the stem measured with radiostereometry (RSA) and periprosthetic change in bone mineral density (BMD), measured with dual-energy X-ray absorptiometry (DXA). Hip function and health-related quality of life were assessed using the Harris hip score (HHS) and the EuroQol-5D (EQ-5D). DXA and RSA data were collected at regular intervals up to 4 years, and data concerning reoperations and hip-related complications were collected during a mean follow-up time of 5 (0.2–7.5) years. Results At 5 years, 19 patients had either passed away or were unavailable for further participation and 31 could be followed up. Of the original 50 patients, 6 patients had suffered a periprosthetic fracture, all of them sustained after the 2-year follow-up. In 19 patients, we obtained complete RSA and DXA data and no component had migrated after the 2-year follow-up. We also found a continuous total periprosthetic bone loss amounting to a median of –19% (–39 to 2). No changes in HHS or EQ-5D were observed during the follow-up period. Interpretation In this medium-term follow-up, the stem remained firmly fixed in bone despite considerable periprosthetic bone mineral loss. However, this bone loss might explain the high number of late-occurring periprosthetic fractures. Based on these results, we would not recommend uncemented femoral stems for the treatment of femoral neck fractures in the elderly.
    Full-text · Article · Jun 2014 · Acta Orthopaedica
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    • "Polyethylene wear was documented by assessing the eccentricity of the femoral head on the postoperative radiographs using a custom-made computer-aided digitizer (Shih et al. 1997). Osteolysis was defined as a lytic lesion of more than 5 mm in its largest diameter that was not seen on the initial postoperative radiographs (Hsieh et al. 2005). "
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    ABSTRACT: Background and purpose Whether or not uncemented total hip arthroplasty (THA) can achieve durable fixation of implants to bone in patients on chronic hemodialysis is unknown. We analyzed the 2–13-year clinical outcomes of cementless THA in patients with end-stage renal diseases who were maintained on long-term hemodialysis. Patients and methods We reviewed the outcome of 23 consecutive uncemented THAs undertaken between 1993 and 2004, in patients with chronic renal failure who had been on long-term hemodialysis (2–18 years). 1 patient died and 2 patients were lost to follow-up within 2 years, leaving 20 hips (20 patients, median age 66 (38–81) years at the time of THA, 11 females) that were reviewed at median 7 (2–13) years postoperatively. Results Radiographic bone-ingrowth fixation of the components was found in 19 patients. 1 patient had aseptic loosening requiring revision surgery. The median d'Aubigne and Postel score was 10 (8–14) preoperatively and 15 (12–18) at final review. No prosthetic infections were found in any of the patients. Interpretation Uncemented THA shows promising medium-term results in patients receiving long-term hemodialysis.
    Full-text · Article · Jun 2010
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    • "Polyethylene wear was documented by assessing the eccentricity of the femoral head on the postoperative radiographs using a custom-made computer-aided digitizer (Shih et al. 1997). Osteolysis was defined as a lytic lesion of more than 5 mm in its largest diameter that was not seen on the initial postoperative radiographs (Hsieh et al. 2005). "
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    ABSTRACT: Whether or not uncemented total hip arthroplasty (THA) can achieve durable fixation of implants to bone in patients on chronic hemodialysis is unknown. We analyzed the 2-13-year clinical outcomes of cementless THA in patients with end-stage renal diseases who were maintained on long-term hemodialysis. We reviewed the outcome of 23 consecutive uncemented THAs undertaken between 1993 and 2004, in patients with chronic renal failure who had been on long-term hemodialysis (2-18 years). 1 patient died and 2 patients were lost to follow-up within 2 years, leaving 20 hips (20 patients, median age 66 (38-81) years at the time of THA, 11 females) that were reviewed at median 7 (2-13) years postoperatively. Radiographic bone-ingrowth fixation of the components was found in 19 patients. 1 patient had aseptic loosening requiring revision surgery. The median d'Aubigne and Postel score was 10 (8-14) preoperatively and 15 (12-18) at final review. No prosthetic infections were found in any of the patients. Uncemented THA shows promising medium-term results in patients receiving long-term hemodialysis.
    Full-text · Article · Feb 2010 · Acta Orthopaedica
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