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. 2020 Apr 30;54(6):868-878.
doi: 10.1007/s43465-020-00115-5. eCollection 2020 Nov.

Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shorter Femoral Stem and Standard Femoral Stem

Jae-Young Lim  1 , Hyeong-Jun Park  2 , Young-Kyun Lee  3 , Yong-Chan Ha  2 , Kyung-Hoi Koo  3
Affiliations

Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shorter Femoral Stem and Standard Femoral Stem

Jae-Young Lim et al. Indian J Orthop. .

Abstract

Background: This randomized control study was designed to compare the clinical and radiological outcomes, including periprosthetic bone mineral density (BMD) changes, between the short and standard stems after using cementless hemiarthroplasty in elderly patients with femur neck fractures.

Materials and methods: From January 2013 to May 2017, 151 patients (aged ≥ 65 years) underwent hemiarthroplasties due to femoral neck fractures. Patients were randomized into two groups; 77 patients in Group A implanting the short femoral stem and 74 patients in Group B implanting the standard femoral stem. Clinical and radiographic evaluations were performed in all patients.

Results: 75 patients (40 patients in Group A and 35 patients in Group B) completed routine follow-up for a minimum of 2 years. The clinical outcomes, including ambulatory functions and thigh pain, were similar in both groups. All the femoral stems acquired radiologic stability. At postoperative one year, BMD values in Gruen zone (G) seven on the standard stem side were significantly lower than those on the short stem side (P = 0.038). At the second year of follow-up, the BMD values of Group A in G1, G3, G4, and G7 were significantly greater than those of Group B (P = 0.007, 0.032, 0.026, and P < 0.000, respectively).

Conclusions: Both the clinical outcomes and radiologic stability in both group demonstrated similar results in elderly patients with femoral neck fracture at the latest follow-up. In addition, the periprosthetic BMD of the short femoral stems demonstrated better periprosthetic bone preservation at a minimum of 2 years of follow-up.

Level of evidences: Therapeutic Level II.

Keywords: Elderly; Femoral neck fracture; Hemiarthroplasty; Periprosthetic bone preservation; Short stem.

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Conflict of interest statement

Conflict of interestNo benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Fig. 1
Fig. 1
The CONSORT (Consolidated Standards of Reporting Trials) diagram of the study
Fig. 2
Fig. 2
Graph showing dichotomized walking ability according to Koval’s categories during the follow-up (the thick black lines and asterisks represent statistically significant differences)
Fig. 3
Fig. 3
a At the 1st year, in Gruen zone 7, the BMD of Group A was statistically better. b At the 2nd year, in Gruen zones 1, 3, 4, and 7, the statistical differences had become apparent
Fig. 4
Fig. 4
a Preoperative X-ray of an 80-year-old woman (Group A; short stem group). b Immediate postoperative image after hemiarthroplasty with Bencox M stem (Corentec®, South Korea). c, d Follow-up X-ray and Dual-energy X-ray absorptiometry images at postoperative 1st and 2nd years
Fig. 5
Fig. 5
a Preoperative X-ray of an 82-year-old woman (Group B; standard stem group). b Immediate postoperative image after hemiarthroplasty with Bencox ID stem (Corentec®, South Korea). c, d Follow-up X-ray and Dual-energy X-ray absorptiometry images at postoperative 1st and 2nd years
See this image and copyright information in PMC

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