The Impact of Bone Cement on Bone Healing in Revision Hip Arthroplasty for Periprosthetic Femur Fractures and Cortical Osteotomies

Abstract

Background It is widely acknowledged that bone cement may infiltrate the fracture site during the implantation of a cemented hip stem for a periprosthetic fracture, potentially leading to non-union. This study sought to examine this hypothesis through a radiological analysis of patients who underwent cemented femoral stem implantation to stabilize a periprosthetic femur fracture or after a cortical osteotomy for stem extraction. Methodology A retrospective study was conducted from 2015 to 2020 at a specialist center in the United Kingdom. Patients over 18 years old receiving cemented femoral stems for periprosthetic fractures or following cortical osteotomies were included. Bone healing was assessed through serial radiographs. Results The study included 25 patients with a mean age of 82.2 years and a female-to-male ratio of 16:9. Overall, 19 (76%) and 6 (24%) patients, respectively, received cemented femoral stems following a periprosthetic fracture revision or a cortical osteotomy used during revision. No bone grafts were used for any of the patients. Unfortunately, two patients were lost to follow-up, and five patients in the fracture group died before their fractures had united. The remaining 12 fractures healed in an average of 2.2 months, while all six cortical osteotomies healed in an average of 4.2 months. Conclusions Our research findings demonstrate the efficacy of employing a cemented femoral stem in revision hip arthroplasty scenarios involving periprosthetic femur fractures or cortical osteotomies, as it does not adversely affect bone healing.

Keywords: bone cement; bone healing; cortical osteotomy; periprosthetic fractures; revision tha.

Figure 1. Patient distribution for subjects based on the indication of cemented revision hip arthroplasty.