Cemented Calcar Replacement versus Long Stem Cemented Hemiarthroplasty in Unstable Intertrochanteric Fractures in Octogenarians

Khatri, Kavin; Banga, Ravinder Kumar; Malhotra, Neeraj; Bansal, Deepak

doi:10.1055/s-0041-1732392

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. bras. ortop. 57 (3) • 2022 • https://doi.org/10.1055/s-0041-1732392 copy

Cemented Calcar Replacement versus Long Stem Cemented Hemiarthroplasty in Unstable Intertrochanteric Fractures in Octogenarians

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The aim of the present study was to compare functional results after Cemented Calcar replacement vis-a-vis Long stem Cemented hemiarthroplasty in patients aged more than 80 years with unstable intertrochanteric fractures.

Methods

The present prospective, randomized trial included 140 patients with AO/OTA type 31-A2, A3 intertrochanteric femur fracture, randomized into 2 treatment groups and followed-up for a minimum of 2 years. Sixty-seven patients in group A were treated with a cemented calcar replacing prosthesis, and 65 patients in group B were treated with a cemented long stem femoral stem prosthesis. The primary end points were hip functions at 2 years. The secondary end points were the complications encountered, mortality, surgical time, reoperation, blood loss, and activities of daily living.

Results

There were no major differences between the groups in terms of hip function, quality of life (health related), reoperation, mortality, and blood loss. However, the function in hip joint and activities of daily living deteriorated in both groups in comparison with prefracture levels.

Conclusion

In octogenarians with an unstable intertrochanteric fracture, cemented calcar replacing prosthesis has similar clinical results in comparison with long stem cemented hemiarthroplasty. Hemiarthroplasty with either implant is a good option in this subset of patients. Level of evidence: I

Keywords
hemiarthroplasty; hip fractures; arthroplasty, replacement, hip; hip prosthesis

	Group A (n = 70) ^{^*}	Group B (n = 70)
Age (years old)^#	83 ± 3.7	82 ± 3.4
Gender
Male	48	48
Female	12	12
Body Mass Index (kg/m²)^#	21 ± 3.2	22 ± 2.4
Singh osteoporosis Index	2.7 ± 0.6	2.6 ± 0.7
Charnley functional classification (number of patients)
A	58	56
B	7	11
C	5	3
ASA classification (number of patients)
1-2	43	38
3-4	27	32

	Intent to Treat			Per Protocol
Outcome measure	Calcar replacement hemiarthroplasty (n = 70)	Long stem hemiarthroplasty (n = 70)	Mean difference or relative risk (95%CI)^#	Calcar replacement hemiarthroplasty (n = 67)	Long stem hemiarthroplasty (n = 65)	Mean difference or relative risk (95%CI)^#
Harris Hip Score
Baseline	83.4 ± 8.6^* * values are expressed as mean with standard deviation in parentheses. (n = 69)	82.4 ± 11.2 (n = 70)	1.0 (-5.7373-3.7373)	83.4 ± 8.6 (n = 69)	82.4 ± 11.2 (n = 65)	1.0 (-5.7373-3.7373)
4 months	80.4 ± 9.4 (n = 64)	77.5 ± 8.1 (n = 62)	2.9 (7.0953-1.2953)	80.4 ± 9.4 (n = 64)	77.5 ± 8.3 (n = 58)	3.9 (8.0953-1.2953)
12 months	78.4 ± 8.7 (n = 59)	75.4 ± 9.6 (n = 60)	3.0 (-7.3414-1.3414)	78.4 ± 8.7 (n = 59)	75.4 ± 9.6 (n = 55)	3.0 (-7.3414-1.3414)
24 months	74.5 ± 9.6 (n = 53)	73.8 ± 7.8 (n = 55)	0.7 (-6.78-2.348)	74.5 ± 9.6 (n = 53)	73.5 ± 7.8 (n = 51)	1.0 (-6.78-2.348)
Barthel Index
Baseline	18 (51%)	17 (49%)	1.04 (0.7888-1.3734)	18 (51%)	17 (49%)	1.04 (0.876-1.4573)
4 months	16 (46%)	16 (46%)	0.9409 (0.6974-1.2695)	16 (46%)	14 (43%)	0.8409 (0.7074-1.256)
12 months	15 (43%)	14 (41%)	1.0238 (0.7416-1.4134)	15 (44%)	13 (42%)	1.0238 (0.7416-1.4134)
24 months	12 (38%)	13 (39%)	1.3214 (0.7653-1.3675)	12 (38%)	11 (36%)	1.1214 (0.8765-1.4675)
EQ-5D
Baseline	0.63 ± 0.29 (n = 69)	0.62 ± 0.31 (n = 70)	0.01 (-0.18-0.02)	0.63 ± 0.29 (n = 69)	0.62 ± 0.31 (n = 65)	0.01 (-0.18-0.02)
4 months	0.63 ± 0.27 (n = 64)	0.62 ± 0.25 (n = 62)	0.01 (-0.06-0.11)	0.63 ± 0.27 (n = 64)	0.59 ± 0.25 (n = 58)	0.04 (-0.08-0.12)
12 months	0.61 ± 0.25 (n = 59)	0.63 ± 0.23 (n = 60)	0.02 (-0.18-0.02)	0.61 ± 0.25 (n = 59)	0.62 ± 0.23 (n = 55)	0.01 (-0.18-0.02)
24 months	0.54 ± 0.26 (n = 53)	0.57 ± 0.30 (n = 55)	0.03 (-0.18-0.02)	0.54 ± 0.26 (n = 53)	0.56 ± 0.30 (n = 51)	0.02 (-0.16-0.01)
Pain Rating Scale
Baseline	0.5 ± 1.3 (n = 69)	0.43 ± 1.7 (n = 70)	0.02 (0.4-0.6)	0.5 ± 1.3 (n = 69)	0.41 ± 1.7 (n = 65)	0.19 (0.3-0.6)
4 months	2.1 ± 1.8 (n = 64)	2.0 ± 1.5 (n = 62)	0.1 (0.4-1)	2.1 ± 1.8 (n = 64)	2.0 ± 1.5 (n = 58)	0.1 (0.4-1)
12 months	1.5 ± 1.6 (n = 59)	1.3 ± 1.2 (n = 60)	0.02 (0.6-0.9)	1.5 ± 1.6 (n = 59)	1.4 ± 1.2 (n = 55)	0.1 (0.6-0.9)
24 months	1.4 ± 1.9 (n = 53)	1.5 ± 1.6 (n = 55)	0.2 (0.8-0.6)	1.5 ± 1.9 (n = 53)	1.2 ± 1.6 (n = 51)	0.3 (0.8-0.6)
Ability to walk with aid
Baseline	33 (94%)	32 (88%)	1.0682 (0.9785-1.1661)	31 (91%)	32 (88%)	1.2422 (0.7895-1.4325)
4 months	27 (78%)	29 (80%)	0.9750 (0.8451-1.1248)	27 (78%)	29 (80%)	0.8897 (0.8456-1.1248)
12 months	30 (85%)	30 (84%)	0.9882 (0.8776-1.1128)	30 (85%)	27 (81%)	0.7654 (0.8965-1.5643)
24 months	28 (79%)	27 (78%)	0.8977 (0.7894-1.2314)	26 (74%)	25 (75%)	0.9875 (0.6754-1.3345)

Parameter	Calcar replaced (n = 67)	Long Stem (n = 65)	Mean Difference	95%CI	p-value
Operative time (minutes)	109 ± 20^* * values are expressed as mean with standard deviation in parentheses,	104 ± 23	- 5.000	-15.2166-5.2166	0.3323
Blood loss (ml)	730 ± 112	745 ± 109	15.000	-37.3229-67.3229	0.5692
Blood transfused (units)	2.3 ± 0.6	2.5 ± 0.7	0.200	-0.1091-0.5091	0.2010

	Calcar replacement (n = 67) group	Long stem (n = 65) group
Immediate postoperative
a. Cardiovascular events	4	2
b. Urinary tract infection	2	0
c. Neurologic complications	0	1
d. Deep vein thrombosis	1	0
e. Respiratory complications	2	3
f. Superficial infection	3	4
g. Deep infection	1	0
h. Mortality in hospital	1	0
i. Nerve injury	0	1
Late postoperative complications
a. Mortality within one year	3	2
b. Mortality after one year	8	6
c. Dislocation	2	0
d. Trochanteric nonunion	0	2

Actual number of patients underwent allocation
	Calcar replaced (n = 48) hemiarthroplasty	Long stem (n = 57) hemiarthroplasty
In which you were allocated?
Calcar replacing hemiarthroplasty	12 (25%)	16 (28%)
Long stem hemiarthroplasty	13 (27%)	11 (19%)
Don’t know	23 (48%)	30 (53%)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Kavin Khatri, MS, DNB, FACS, Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, India (e-mail: kavinkhatri84@gmail.com).