Impact of the Origin of Surgical Cement in Patients with Hip Fractures Treated with Arthroplasty. Comparative Study on 153 Patients
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Published:
Oct 17, 2024
Keywords:
Hip fracture, hip arthroplasty, bipolar hemiarthroplasty, surgical bone cement
Main Article Content
Abstract
Introduction: The objective of this study was to determine whether the use of national or imported cement has an impact on the clinical and radiological outcomes of a series of hip fracture patients treated with arthroplasty.
Materials and Methods: We retrospectively analyzed 153 patients with hip fractures who were treated consecutively with arthroplasty (total or partial) between 2017 and 2019 at our center, with a minimum follow-up of 24 months. The patients were divided into two groups based on the origin of the cement, and we compared preoperative characteristics, functional outcomes (Parker index and Harris Hip Score - HHS), complications, mechanical loosening, and prosthetic survival.
Results: In 99 cases (64.7%), national cement was used, and in 54 cases (35.3%), imported cement was used. There were 96 total hip arthroplasties (81 cemented and 15 hybrid) and 57 bipolar hemiarthroplasties. The mean follow-up was 47 ± 1.1 months. No significant differences were found between the groups in functional outcomes (Parker: 5.3 ± 0.4 vs. 5.5 ± 0.6; p = 0.88; HHS: 84.5 ± 6.6 vs. 85.9 ± 7.5; p = 0.28), complication rates (6% vs. 5.5%; p = 0.99), revisions (2.6% vs. 1.9%; p = 0.69), or prosthetic survival (96% vs. 94.5%; p = 0.69).
Conclusion: The results of this study suggest that the origin of surgical cement does not significantly affect clinical or radiological outcomes in patients undergoing total or partial hip arthroplasty for hip fracture.
Materials and Methods: We retrospectively analyzed 153 patients with hip fractures who were treated consecutively with arthroplasty (total or partial) between 2017 and 2019 at our center, with a minimum follow-up of 24 months. The patients were divided into two groups based on the origin of the cement, and we compared preoperative characteristics, functional outcomes (Parker index and Harris Hip Score - HHS), complications, mechanical loosening, and prosthetic survival.
Results: In 99 cases (64.7%), national cement was used, and in 54 cases (35.3%), imported cement was used. There were 96 total hip arthroplasties (81 cemented and 15 hybrid) and 57 bipolar hemiarthroplasties. The mean follow-up was 47 ± 1.1 months. No significant differences were found between the groups in functional outcomes (Parker: 5.3 ± 0.4 vs. 5.5 ± 0.6; p = 0.88; HHS: 84.5 ± 6.6 vs. 85.9 ± 7.5; p = 0.28), complication rates (6% vs. 5.5%; p = 0.99), revisions (2.6% vs. 1.9%; p = 0.69), or prosthetic survival (96% vs. 94.5%; p = 0.69).
Conclusion: The results of this study suggest that the origin of surgical cement does not significantly affect clinical or radiological outcomes in patients undergoing total or partial hip arthroplasty for hip fracture.
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Garabano, G., Pérez Alamino, L., Juri, A., Maya Nieto, A. X., & Pesciallo, C. Á. (2024). Impact of the Origin of Surgical Cement in Patients with Hip Fractures Treated with Arthroplasty. Comparative Study on 153 Patients. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 470-478. https://doi.org/10.15417/issn.1852-7434.2024.89.5.1869
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Clinical Research
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References
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https://doi.org/10.1016/j.injury.2018.04.015
2. Pech-Ciau BA, Lima-Martínez EA, Espinosa-Cruz GA, Pacho-Aguilar CR, Huchim-Lara O, Alejos-Gómez RA.
Hip fracture in the elderly: epidemiology and costs of care. Acta Ortop Mex 2021;35(4):341-7. PMID: 35139593
3. Garabano G, Cubecino A, Simesen de Bielke H, Robador N, Olivetto JM, Sierto M, et al. Epidemiología de la
fractura de cadera en la Argentina. Rev Asoc Arg Ortop Traumatol 2020;85(4):437-46.
https://doi.org/10.15417/issn.1852-7434.2020.85.4.1113
4. Clark P, Chico G, Carlos F, Zamudio F, Pereira RM, Zanchetta J, et al. Osteoporosis en América Latina: revisión de panel de expertos. Medwave 2013;13(8):e5791. https://doi.org/10.5867/medwave.2013.08.5791
5. Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, et al. Global epidemiology of hip fractures: a
study protocol using a common analytical platform among multiple countries. BMJ Open 2021;11(7):e047258.
https://doi.org/10.1136/bmjopen-2020-047258
6. Lewis SR, Macey R, Parker MJ, Cook JA, Griffin XL. Arthroplasties for hip fracture in adults. Cochrane Database
Syst Rev 2022;2(2):CD013410. https://doi.org/10.1002/14651858.CD013410.pub2
7. Antapur P, Mahomed N, Gandhi R. Fractures in the elderly: when is hip replacement a necessity? Clin Interv Aging 2011;6:1-7. https://doi.org/10.2147/CIA.S10204
8. Kim YY, Kim BJ, Ko HS, Sung YB, Kim SK, Shim JC. Total hip reconstruction in the anatomically distorted hip.
Cemented versus hybrid total hip arthroplasty. Arch Orthop Trauma Surg 1998;117(1-2):8-14.
https://doi.org/10.1007/BF00703431
9. Lindberg-Larsen M, Petersen PB, Jørgensen CC, Overgaard S, Kehlet H; Lundbeck Foundation Center for Fasttrack Hip and Knee Arthroplasty Collaborating Group. Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients >70 years. Acta Orthop 2020;91(3):286-92. https://doi.org/10.1080/17453674.2020.1745420
10. Blankstein M, Lentine B, Nelms NJ. The use of cement in hip arthroplasty: A contemporary perspective. J Am Acad Orthop Surg 2020;28(14):e586-e594. https://doi.org/10.5435/JAAOS-D-19-00604
11. Bedard NA, Callaghan JJ, Stefl MD, Liu SS. Systematic review of literature of cemented femoral components: What is the durability at minimum 20 years followup? Clin Orthop Relat Res 2015;473:563-71.
https://doi.org/10.1007/s11999-014-3876-3
12. Kropivšek L, Roškar S, Zore LA, Antolič V, Mavčič B. Cohort analysis of two thousand nine hundred forty-three
Link Lubinus SP II cemented total hip arthroplasties from a single hospital with surgeon stratification and twenty
six thousand, nine hundred and eighty one component-years of follow-up. Int Orthop 2022;46(4):797-804.
https://doi.org/10.1007/s00264-022-05315-2
13. Buckwalter AE, Callaghan JJ, Liu SS, Pedersen DR, Goetz DD, Sullivan PM, et al. Results of Charnley total hip
arthroplasty with use of improved femoral cementing techniques. A concise follow-up, at a minimum of twenty-five years, of a previous report. J Bone Joint Surg Am 2006;88(7):1481-5. https://doi.org/10.2106/JBJS.E.00818
14. Dienstknecht T, Lüring C, Tingart M, Grifka J, Sendtner E. Total hip arthroplasty through the mini-incision (Microhip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg (Hong Kong) 2014;22(2):168-72. https://doi.org/10.1177/230949901402200210
15. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993;75(5):797-8. https://doi.org/10.1302/0301-620X.75B5.8376443
16. Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis
Care Res (Hoboken) 2011;63(Suppl 11):S200-7. https://doi.org/10.1002/acr.20549
17. Al-Ahaideb A, Muir SW, Huckell J, Alsaleh KA, Johnson MA, Johnston DW, et al. Interobserver reliability of the
radiographic assessment of cement fixation in total hip arthroplasty. Eur J Orthop Surg Traumatol 2013;23(8):889-94. https://doi.org/10.1007/s00590-012-1108-7
18. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;(121):20-32. PMID: 991504
19. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 477100
20. Yoo JI, Cha YH, Kim JT, Park CH. Clinical outcomes of bipolar hemiarthroplasty versus total hip arthroplasty:
Assessing the potential impact of cement use and pre-injury activity levels in elderly patients with femoral neck
fractures. Hip Pelvis 2019;31(2):63-74. https://doi.org/10.5371/hp.2019.31.2.63
21. Behairy YM, Harris WH. Mode of loosening of matt-finished femoral stems in primary total hip replacement. Saudi Med J 2022;23(10):1187-94. PMID: 12436120
22. Liu T, Hua X, Yu W, Lin J, Zhao M, Liu J, et al. Long-term follow-up outcomes for patients undergoing primary
total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up. J Orthop Surg Res 2019;14(1):371. https://doi.org/10.1186/s13018-019-1415-3
23. Mao S, Chen B, Zhu Y, Qian L, Lin J, Zhang X, et al. Cemented versus uncemented total hip replacement for
femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up. J Orthop Surg Res 2020;15(1):447. https://doi.org/10.1186/s13018-020-01980-4
24. Ritter MA, Zhou H, Keating CM, Keating EM, Faris PM, Meding JB, et al. Radiological factors influencing femoral and acetabular failure in cemented Charnley total hip arthroplasties. J Bone Joint Surg Br 1999;81(6):982-6. https://doi.org/10.1302/0301-620x.81b6.9634
25. Takaoka Y, Goto K, Tamura J, Okuzu Y, Kawai T, Kuroda Y, et al. Radiolucent lines do not affect the longevity of
highly cross-linked polyethylene cemented components in total hip arthroplasty. Bone Joint J 2021;103-B(10):1604-10. https://doi.org/10.1302/0301-620X.103B10.BJJ-2020-2298.R2
26. Barrack R, Mulroy R, Harris H. Improved cementing techniques and femoral component loosening in young
patients with hip arthroplasty: A 12-year radiographic review. J Bone Joint Surg Br 1992;74-B(3):385-9.
https://doi.org/10.1302/0301-620X.74B3.1587883
27. Beckenbaugh R, Ilstrup D. Total hip arthroplasty: A review of three hundred and thirty-three cases with long followup. J Bone Joint Surg Am 1978;60:306-13. PMID: 649633
28. Dunbar MJ. Cemented femoral fixation: the North Atlantic divide. Orthopedics 2009;32(9):662-5.
https://doi.org/doi.org/10.3928/01477447-20090728-07
29. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth
2009;102(1):12-22. https://doi.org/10.1093/bja/aen328
30. Garabano G, Pesciallo CA, Perez Alamino L, Ernst G, Del Sel H. Bipolar hemiarthroplasty in unstable
intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year
mortality. J Clin Orthop Trauma 2021;25:101743. https://doi.org/10.1016/j.jcot.2021.101743
31. Garabano G, Perez Alamino L, Rodriguez J, Del Sel H, Lopreite F, Pesciallo CA. Pre-fracture ambulation capacity, Charlson comorbidity index, and dementia as predictors of functional impairment after bipolar hemiarthroplasty for unstable intertrochanteric fracture. A retrospective analysis in 158 octogenarian patients. J Clin Orthop Trauma 2023;40:102163. https://doi.org/10.1016/j.jcot.2023.102163
32. Espehaug B, Furnes O, Havelin LI, Engesaeter LB, Vollset SE. The type of cement and failure of total hip
replacements. J Bone Joint Surg Br 2002;84(6):832-8. https://doi.org/10.1302/0301-620x.84b6.12776
33. Hailer NP, Garellick G, Kärrholm J. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Acta Orthop 2010;81(1):34-41. https://doi.org/10.3109/17453671003685400
34. Kam DC, Gardeniers JW, Veth RP, Schreurs BW. Good results with cemented total hip arthroplasty in patients
between 40 and 50 years of age. Acta Orthop 2010;81(2):165-70. https://doi.org/10.3109/17453671003717831
https://doi.org/10.1016/j.injury.2018.04.015
2. Pech-Ciau BA, Lima-Martínez EA, Espinosa-Cruz GA, Pacho-Aguilar CR, Huchim-Lara O, Alejos-Gómez RA.
Hip fracture in the elderly: epidemiology and costs of care. Acta Ortop Mex 2021;35(4):341-7. PMID: 35139593
3. Garabano G, Cubecino A, Simesen de Bielke H, Robador N, Olivetto JM, Sierto M, et al. Epidemiología de la
fractura de cadera en la Argentina. Rev Asoc Arg Ortop Traumatol 2020;85(4):437-46.
https://doi.org/10.15417/issn.1852-7434.2020.85.4.1113
4. Clark P, Chico G, Carlos F, Zamudio F, Pereira RM, Zanchetta J, et al. Osteoporosis en América Latina: revisión de panel de expertos. Medwave 2013;13(8):e5791. https://doi.org/10.5867/medwave.2013.08.5791
5. Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, et al. Global epidemiology of hip fractures: a
study protocol using a common analytical platform among multiple countries. BMJ Open 2021;11(7):e047258.
https://doi.org/10.1136/bmjopen-2020-047258
6. Lewis SR, Macey R, Parker MJ, Cook JA, Griffin XL. Arthroplasties for hip fracture in adults. Cochrane Database
Syst Rev 2022;2(2):CD013410. https://doi.org/10.1002/14651858.CD013410.pub2
7. Antapur P, Mahomed N, Gandhi R. Fractures in the elderly: when is hip replacement a necessity? Clin Interv Aging 2011;6:1-7. https://doi.org/10.2147/CIA.S10204
8. Kim YY, Kim BJ, Ko HS, Sung YB, Kim SK, Shim JC. Total hip reconstruction in the anatomically distorted hip.
Cemented versus hybrid total hip arthroplasty. Arch Orthop Trauma Surg 1998;117(1-2):8-14.
https://doi.org/10.1007/BF00703431
9. Lindberg-Larsen M, Petersen PB, Jørgensen CC, Overgaard S, Kehlet H; Lundbeck Foundation Center for Fasttrack Hip and Knee Arthroplasty Collaborating Group. Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients >70 years. Acta Orthop 2020;91(3):286-92. https://doi.org/10.1080/17453674.2020.1745420
10. Blankstein M, Lentine B, Nelms NJ. The use of cement in hip arthroplasty: A contemporary perspective. J Am Acad Orthop Surg 2020;28(14):e586-e594. https://doi.org/10.5435/JAAOS-D-19-00604
11. Bedard NA, Callaghan JJ, Stefl MD, Liu SS. Systematic review of literature of cemented femoral components: What is the durability at minimum 20 years followup? Clin Orthop Relat Res 2015;473:563-71.
https://doi.org/10.1007/s11999-014-3876-3
12. Kropivšek L, Roškar S, Zore LA, Antolič V, Mavčič B. Cohort analysis of two thousand nine hundred forty-three
Link Lubinus SP II cemented total hip arthroplasties from a single hospital with surgeon stratification and twenty
six thousand, nine hundred and eighty one component-years of follow-up. Int Orthop 2022;46(4):797-804.
https://doi.org/10.1007/s00264-022-05315-2
13. Buckwalter AE, Callaghan JJ, Liu SS, Pedersen DR, Goetz DD, Sullivan PM, et al. Results of Charnley total hip
arthroplasty with use of improved femoral cementing techniques. A concise follow-up, at a minimum of twenty-five years, of a previous report. J Bone Joint Surg Am 2006;88(7):1481-5. https://doi.org/10.2106/JBJS.E.00818
14. Dienstknecht T, Lüring C, Tingart M, Grifka J, Sendtner E. Total hip arthroplasty through the mini-incision (Microhip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg (Hong Kong) 2014;22(2):168-72. https://doi.org/10.1177/230949901402200210
15. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993;75(5):797-8. https://doi.org/10.1302/0301-620X.75B5.8376443
16. Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis
Care Res (Hoboken) 2011;63(Suppl 11):S200-7. https://doi.org/10.1002/acr.20549
17. Al-Ahaideb A, Muir SW, Huckell J, Alsaleh KA, Johnson MA, Johnston DW, et al. Interobserver reliability of the
radiographic assessment of cement fixation in total hip arthroplasty. Eur J Orthop Surg Traumatol 2013;23(8):889-94. https://doi.org/10.1007/s00590-012-1108-7
18. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;(121):20-32. PMID: 991504
19. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a
radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27. PMID: 477100
20. Yoo JI, Cha YH, Kim JT, Park CH. Clinical outcomes of bipolar hemiarthroplasty versus total hip arthroplasty:
Assessing the potential impact of cement use and pre-injury activity levels in elderly patients with femoral neck
fractures. Hip Pelvis 2019;31(2):63-74. https://doi.org/10.5371/hp.2019.31.2.63
21. Behairy YM, Harris WH. Mode of loosening of matt-finished femoral stems in primary total hip replacement. Saudi Med J 2022;23(10):1187-94. PMID: 12436120
22. Liu T, Hua X, Yu W, Lin J, Zhao M, Liu J, et al. Long-term follow-up outcomes for patients undergoing primary
total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up. J Orthop Surg Res 2019;14(1):371. https://doi.org/10.1186/s13018-019-1415-3
23. Mao S, Chen B, Zhu Y, Qian L, Lin J, Zhang X, et al. Cemented versus uncemented total hip replacement for
femoral neck fractures in elderly patients: a retrospective, multicentre study with a mean 5-year follow-up. J Orthop Surg Res 2020;15(1):447. https://doi.org/10.1186/s13018-020-01980-4
24. Ritter MA, Zhou H, Keating CM, Keating EM, Faris PM, Meding JB, et al. Radiological factors influencing femoral and acetabular failure in cemented Charnley total hip arthroplasties. J Bone Joint Surg Br 1999;81(6):982-6. https://doi.org/10.1302/0301-620x.81b6.9634
25. Takaoka Y, Goto K, Tamura J, Okuzu Y, Kawai T, Kuroda Y, et al. Radiolucent lines do not affect the longevity of
highly cross-linked polyethylene cemented components in total hip arthroplasty. Bone Joint J 2021;103-B(10):1604-10. https://doi.org/10.1302/0301-620X.103B10.BJJ-2020-2298.R2
26. Barrack R, Mulroy R, Harris H. Improved cementing techniques and femoral component loosening in young
patients with hip arthroplasty: A 12-year radiographic review. J Bone Joint Surg Br 1992;74-B(3):385-9.
https://doi.org/10.1302/0301-620X.74B3.1587883
27. Beckenbaugh R, Ilstrup D. Total hip arthroplasty: A review of three hundred and thirty-three cases with long followup. J Bone Joint Surg Am 1978;60:306-13. PMID: 649633
28. Dunbar MJ. Cemented femoral fixation: the North Atlantic divide. Orthopedics 2009;32(9):662-5.
https://doi.org/doi.org/10.3928/01477447-20090728-07
29. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth
2009;102(1):12-22. https://doi.org/10.1093/bja/aen328
30. Garabano G, Pesciallo CA, Perez Alamino L, Ernst G, Del Sel H. Bipolar hemiarthroplasty in unstable
intertrochanteric fractures in elderly patients. The predictive value of the Charlson Comorbidity Index in 1-year
mortality. J Clin Orthop Trauma 2021;25:101743. https://doi.org/10.1016/j.jcot.2021.101743
31. Garabano G, Perez Alamino L, Rodriguez J, Del Sel H, Lopreite F, Pesciallo CA. Pre-fracture ambulation capacity, Charlson comorbidity index, and dementia as predictors of functional impairment after bipolar hemiarthroplasty for unstable intertrochanteric fracture. A retrospective analysis in 158 octogenarian patients. J Clin Orthop Trauma 2023;40:102163. https://doi.org/10.1016/j.jcot.2023.102163
32. Espehaug B, Furnes O, Havelin LI, Engesaeter LB, Vollset SE. The type of cement and failure of total hip
replacements. J Bone Joint Surg Br 2002;84(6):832-8. https://doi.org/10.1302/0301-620x.84b6.12776
33. Hailer NP, Garellick G, Kärrholm J. Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Acta Orthop 2010;81(1):34-41. https://doi.org/10.3109/17453671003685400
34. Kam DC, Gardeniers JW, Veth RP, Schreurs BW. Good results with cemented total hip arthroplasty in patients
between 40 and 50 years of age. Acta Orthop 2010;81(2):165-70. https://doi.org/10.3109/17453671003717831