The suitability of an uncemented hydroxyapatite coated HAC hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal index, a solution to preventing intra-operReportar como inadecuado




The suitability of an uncemented hydroxyapatite coated HAC hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal index, a solution to preventing intra-oper - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Journal of Orthopaedic Surgery and Research

, 6:59

First Online: 18 November 2011Received: 30 March 2011Accepted: 18 November 2011

Abstract

This study will seek to identify a measurable radiographic index, the Metaphyseal-Diaphyseal Index MDI score to determine whether intra-operative fracture in osteoporotic bone can be predicted.

A 5 year prospective cohort of 560 consecutive patients, undergoing hemiarthroplasty cemented or uncemented, was evaluated. A nested case-control study to determine risk factors affecting intra-operative fracture was carried out.

The Vancouver Classification was used to classify periprosthetic fracture.

The MDI score was calculated using radiographs from the uncemented group. As a control gold standard, Yeung et al-s Canal Bone Ratio CBR score was also calculated. From this, a receiver operating characteristic ROC curve was formulated for both scores and area under the curve AUC compared. Intra and inter-observer correlations were determined.

Cost analysis was also worked out for adverse outcomes.

Four hundred and seven uncemented and one hundred and fifty-three cemented stems were implanted. The use of uncemented implants was the main risk factor for intra-operative periprosthetic fracture.

Sixty-two periprosthetic fractures occurred in the uncemented group 15.2%, nine occurred in the cemented group 5.9%, P < 0.001. The revision rate for sustaining a periprosthetic fracture uncemented group was 17.7%, P < 0.001 and 90 day mortality 19.7%, P < 0.03.

MDI-s AUC was 0.985 compared to CBR-s 0.948, P < 0.001. The MDI score cut-off to predict fracture was 21, sensitivity 98.3%, specificity 99.8%, positive predictive value 90.5% and negative predictive value 98%. Multivariate regression analysis ruled out any other confounding factors as being significant.

The intra and inter-observer Pearson correlation scores were r = 0.99, P < 0.001.

JRI uncemented hemiarthroplasty has a significantly higher intra-operative fracture rate. We recommend cemented arthroplasty for hip fractures. We propose a radiographic system that may allow surgeons to select patients who are good candidates for uncemented arthroplasty, but it needs prospective validation.

KeywordsHip fracture Uncemented hemiarthroplasty peri-prosthetic fracture osteoporosis Electronic supplementary materialThe online version of this article doi:10.1186-1749-799X-6-59 contains supplementary material, which is available to authorized users.

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Autor: Rishi Chana - Reza Mansouri - Chris Jack - Max R Edwards - Ravi Singh - Carmel Keller - Farid Khan

Fuente: https://link.springer.com/







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