Intraoperative Femurfrakturen bei der Implantation des zementfreien BiCONTACT-Schaftes: eine Matched-Pair-Analyse von 84 Patienten

Zusammenfassung

Studienziel: Da das Problem intraoperativer periprothetischer Femurfrakturen (PFF) an Bedeutung gewinnt, war die Fragestellung dieser Studie, inwieweit das postoperative Ergebnis zementfreier Hüfttotalendoprothesen (Hüft-TEP) durch intraoperative PFFs mit Berücksichtigung der subjektiven körperbezogenen Patientenzufriedenheit beeinflusst wird. Methode: Von insgesamt 1216 primären Hüft-TEP-Implantationen mit dem zementfreien BiCONTACT-Primärschaft wurden 42 intraoperative PFFs (Typ Vancouver A und B1) anhand einer Matched-Pair-Analyse mit 42 Patienten ohne Frakturkomplikationen verglichen. Präoperativ und nach 2,2 Jahren (0,8 - 3,2 Jahre) wurden die Patienten klinisch und radiologisch untersucht. Klinische Parameter waren: Harris-Hip-Score, SF-36 Health Score, Bewegungs- und Schmerzscore, Hinken sowie postoperative Komplikationen. Radiologische Parameter waren: Knochenheilung sowie Trochanter- und Schaftmigration. Die Frakturen wurden nach der Vancouver-Klassifikation eingeteilt. Ergebnisse: Der Harris-Hip-Score und Bewegungsscore stiegen in beiden Gruppen signifikant an (p < 0,001), während der Schmerzscore in beiden Gruppen signifikant abfiel (p < 0,001). Der SF-36 Health Score stieg bei beiden Gruppen in fast allen Dimensionen signifikant an. Bis auf 2 Patienten mit Trochantermigration von 25 bzw. 20 mm heilten alle Frakturen knöchern aus. Bei 3 Patienten sinterten die Prothesen um 4,7 ± 2,9 mm ein, jedoch waren die Schäfte stabil und zeigten keine weitere Migration. 2 Schäfte in der Kontrollgruppe wurden gewechselt. Alle Unterschiede in den Häufigkeiten der postoperativen Komplikationen sowie der Scores waren zwischen den Gruppen nicht signifikant. Schlussfolgerung: Der zementfreie BiCONTACT-Primärschaft scheint trotz intraoperativer Vancouver-A- oder -B1-Fraktur mittelfristig zu vergleichbaren postoperativen Ergebnissen zu führen wie bei Implantationen ohne Frakturkomplikationen.

Abstract

Aim: Intraoperative periprosthetic femoral fractures (PFF) during the implantation of primary non-cemented total hip arthroplasties (THA) are an increasing problem. Thus, the goal of this study was to analyse the postoperative performance of primary non-cemented THA in patients with intraoperative PFFs, with respect to the patient's subjective health-related satisfaction. Method: 42 PFFs in 1216 primary THAs using the non-cemented BiCONTACT stem were monitored. Patients were compared to a control group of 42 non-cemented THA patients without intraoperative fracture complications, using the matched-pair analysis. Preoperative and after 2.2 years (0.8 - 3.2 years), patients were followed-up clinically and radiographically. Clinical parameters were Harris hip score, SF-36 health score, function and pain score and postoperative complications. Radiographic parameters were bone union, stem and trochanter migration. Fractures were graded using the Vancouver classification. Results: Results showed a significant increase in both Harris hip score and motion score and a significant decrease in pain score in both groups (p < 0.001). The SF-36 health score increased significantly in nearly every dimension in both groups. Except for 2 patients with trochanter migrations of 25 and 20 mm, all fractures showed bony union. In 3 patients the stems subsided by 4.7 ± 2.9 mm. The stems showed no further migration at final follow-up. 2 patients without intraoperative fractures underwent stem revision. Overall increases and postoperative complication rates were not significantly different between the groups. Conclusion: Mid-term THA performance and patient satisfaction are not influenced by intraoperative Vancouver A and B1 fractures during implantation of the non-cemented BiCONTACT stem compared to a collective without intraoperative fractures during implantation.

zementfreie Hüft‐TEP - BiCONTACT - intraoperative periprothetische Femurfraktur - Patientenzufriedenheit

cementless total hip arthroplasty - BiCONTACT - intraoperative periprosthetic femoral fracture - patient satisfaction

Literatur

• 1 Sharkey P F, Hozack W J, Booth Jr R E, Rothman R H. Intraoperative femoral fractures in cementless total hip arthroplasty.  Orthop Rev. 1992;  21 337-342
• 2 Stuchin S A. Femoral shaft fracture in porous and press-fit total hip arthroplasty.  Orthop Rev. 1990;  19 153-159
• 3 Toni A, Ciaroni D, Sudanese A, Femino F, Marraro M D, Bueno Lozano A L, Giunti A. Incidence of intraoperative femoral fracture. Straight-stemmed versus anatomic cementless total hip arthroplasty.  Acta Orthop Belg. 1994;  60 43-54
• 4 Mallory T H, Kraus T J, Vaughn B K. Intraoperative femoral fractures associated with cementless total hip arthroplasty.  Orthopedics. 1989;  12 231-239
• 5 Schutzer S F, Grady-Benson J, Jasty M, O'Connor D O, Bragdon C, Harris W H. Influence of intraoperative femoral fractures and cerclage wiring on bone ingrowth into canine porous-coated femoral components.  J Arthroplasty. 1995;  10 823-829
• 6 Berend K R, Lombardi Jr A V, Mallory T H, Chonko D J, Dodds K L, Adams J B. Cerclage wires or cables for the management of intraoperative fracture associated with a cementless, tapered femoral prosthesis: results at 2 to 16 years.  J Arthroplasty. 2004;  19 17-21
• 7 Berry D J. Management of periprosthetic fractures: the hip.  J Arthroplasty. 2002;  17 11-13
• 8 Flamme C H, Wirth C J, Stukenborg C. [Characteristics of the learning curve in total hip endoprosthesis exemplified by the BiContact prosthesis].  Z Orthop Ihre Grenzgeb. 2001;  139 189-193
• 9 Tsiridis E, Haddad F S, Gie G A. The management of periprosthetic femoral fractures around hip replacements.  Injury. 2003;  34 95-105
• 10 Blatter G, Fiechter T, Magerl F. [Peri-prosthesis fractures in total hip endoprostheses].  Orthopäde. 1989;  18 545-551
• 11 Duncan C P, Masri B A. Fractures of the femur after hip replacement.  Instr Course Lect. 1995;  44 293-304
• 12 Garcia-Cimbrelo E, Munuera L, Gil-Garay E. Femoral shaft fractures after cemented total hip arthroplasty.  Int Orthop. 1992;  16 97-100
• 13 Kyle R F, Crickard III G E. Periprosthetic fractures associated with total hip arthroplasty.  Orthopedics. 1998;  21 982-984
• 14 Moroni A, Faldini C, Piras F, Giannini S. Risk factors for intraoperative femoral fractures during total hip replacement.  Ann Chir Gynaecol. 2000;  89 113-118
• 15 Schmidt A H, Kyle R F. Periprosthetic fractures of the femur.  Orthop Clin North Am. 2002;  33 143-152
• 16 Bethea I IIJS, DeAndrade J R, Fleming L L, Lindenbaum S D, Welch R B. Proximal femoral fractures following total hip arthroplasty.  Clin Orthop Relat Res. 1982;  170 95-106
• 17 Masri B A, Meek R M, Duncan C P. Periprosthetic fractures evaluation and treatment.  Clin Orthop Relat Res. 2004;  420 80-95
• 18 Ware Jr J E, Sherbourne C D. The MOS 36-item short-form health survey (SF‐36). I. Conceptual framework and item selection.  Med Care. 1992;  30 473-483
• 19 Bullinger M, Morfeld M, Kohlmann T, Nantke J, van den Bussche H, Dodt B, Dunkelberg S, Kirchberger I, Kruger-Bodecker A, Lachmann A, Lang K, Mathis C, Mittag O, Peters A, Raspe H H, Schulz H. [SF‐36 Health survey in rehabilitation research. Findings from the North German Network for Rehabilitation Research, NVRF, within the rehabilitation research funding program].  Rehabilitation (Stuttg). 2003;  42 218-225
• 20 Kavanagh B F. Femoral fractures associated with total hip arthroplasty.  Orthop Clin North Am. 1992;  23 249-257
• 21 Jasty M, Bragdon C R, Rubash H, Schutzer S F, Haire T, Harris W. Unrecognized femoral fractures during cementless total hip arthroplasty in the dog and their effect on bone ingrowth.  J Arthroplasty. 1992;  7 501-508
• 22 Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention.  J Bone Joint Surg [Br]. 1972;  54 61-76
• 23 Simank H G, Chatzipanagiotis C, Kaps H P. [Complication rate following trochanteric osteotomy in total hip endoprosthesis. A retrospective study with failure analysis].  Z Orthop Ihre Grenzgeb. 1996;  134 457-464
• 24 Nutton R W, Checketts R G. The effects of trochanteric osteotomy on abductor power.  J Bone Joint Surg [Br]. 1984;  66 180-183
• 25 Long W T, Dorr L D, Healy B, Perry J. Functional recovery of noncemented total hip arthroplasty.  Clin Orthop Relat Res. 1993;  288 73-77
• 26 Amstutz H C, Maki S. Complications of trochanteric osteotomy in total hip replacement.  J Bone Joint Surg [Am]. 1978;  60 214-216
• 27 Nicholson P, Mulcahy D, Fenelon G. Trochanteric union in revision hip arthroplasty.  J Arthroplasty. 2001;  16 65-69
• 28 Greidanus N V, Mitchell P A, Masri B A, Garbuz D S, Duncan C P. Principles of management and results of treating the fractured femur during and after total hip arthroplasty.  Instr Course Lect. 2003;  52 309-322
• 29 Johansson J E, McBroom R, Barrington T W, Hunter G A. Fracture of the ipsilateral femur in patients wih total hip replacement.  J Bone Joint Surg [Am]. 1981;  63 1435-1442
• 30 Taylor M M, Meyers M H, Harvey Jr J P. Intraoperative femur fractures during total hip replacement.  Clin Orthop Relat Res. 1978;  137 96-103