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      Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

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          Abstract

          Background

          Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients.

          Methods

          Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat® AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices.

          Results

          At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence.

          Conclusions

          The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

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          Most cited references31

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          Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components.

          Certain roentgenographic signs have value in predicting the fixation of a cementless femoral component to bone by osseointegration. Other signs have value in predicting the gross stability of a cementless femoral component. The authors have determined the specificity and sensitivity of the signs for osseointegration in cases in which the histologic fixation has been confirmed after implant removal. The authors have also determined the specificity and sensitivity of the signs for gross implant stability in cases in which the stability has been confirmed at reoperation. Statistical methods were used to determine a numeric value for each of these roentgenographic signs, and these values were combined into a score. The score was divided into fixation by osseointegration and mechanical implant stability. The two scores were then combined into an overall score. When signs of osseointegration were present, the implant was always stable, and the overall scores were the highest. When signs of osseointegration were absent, the mechanical stability varied, and the scores were lower. A neutral or slightly negative score correlated with failed osseointegration but secondary successful implant stabilization. A very low negative score correlated with gross implant instability. To confirm the validity of the scoring system, the two-year postoperative score was determined for 1005 cases in which the clinical outcome was known. A strong correlation between the presence of symptoms and a low score confirmed the value of the scoring system for diagnosing implant loosening as the cause of symptoms. As a second test, the two-year and five-year postoperative results were compared in the same patients. A high two-year score correlated with durable implant stability through five years. A low two-year score correlated with a higher incidence of late symptomatic loosening.
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            "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening.

            In view of the increasing incidence of stem-type femoral component loosening, a detailed retrospective radiographic zonal analysis of 389 total hip replacements indicated a 19.5% incidence (76 hips) of radiological evidences of mechanical looseness, i.e., fractured acrylic cement and/or a radiolucent gap at the stem-cement or cement-bone interfaces. Detailed serial radiographic examination demonstrated progressive loosening in 56 of the 76 hips and these were categorized into mechanical modes of failure. The 4 modes of failure characterizing stem-type component progressive loosening mechanisms consisted of stem pistoning within the acrylic (3.3%), cement-embedded stem pistoning with the femur (5.1%), medial midstem pivot (2.5%), calcar pivot (0.7%) and bending (fatigue) cantilever (3.3%).
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              • Record: found
              • Abstract: not found
              • Article: not found

              Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis.

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                Author and article information

                Journal
                Clin Orthop Surg
                CIOS
                Clinics in Orthopedic Surgery
                The Korean Orthopaedic Association
                2005-291X
                2005-4408
                December 2010
                05 November 2010
                : 2
                : 4
                : 221-226
                Affiliations
                Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.
                Author notes
                Correspondence to: Jae Hoon Ahn, MD. Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon 302-799, Korea. Tel: +82-42-611-3280, Fax: +82-42-259-1289, jhahn@ 123456eulji.ac.kr
                Article
                10.4055/cios.2010.2.4.221
                2981778
                21119938
                0d85f8ac-1728-4738-960c-878fd2ceeb4b
                Copyright © 2010 by The Korean Orthopaedic Association

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 June 2009
                : 04 December 2009
                Categories
                Original Article

                Surgery
                intertrochanteric fracture,cementless bipolar hemiarthroplasty,old age
                Surgery
                intertrochanteric fracture, cementless bipolar hemiarthroplasty, old age

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