Research progress on treatment of unstable intertrochanteric fractures in elderly patients with bone cement type femoral head replacement_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Shixiong ^1,2,3 , MA Jianxiong ^1,2,3 , LU Bin ^1,2,3 ,  MA Xinlong ^1,2,3

1. Tianjin University Tianjin Hospital (Tianjin Hospital), Tianjin, 300211, P. R. China;
2. Tianjin Institute of Orthopedics, Tianjin, 300050, P. R. China;
3. Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, P. R. China;

Corresponding author：

MA Xinlong, Email: maxinlong8686@sina.com

Keywords：

Intertrochanteric fracture; unstable fracture; bone cement type prosthesis; femoral head replacement; the elderly

DOI：

10.7507/1002-1892.202402067

Video：

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Objective To summarize the latest research progress of bone cement type femoral head replacement in the treatment of unstable intertrochanteric fractures in elderly patients. Methods The literature on the application of bone cement type femoral head replacement for unstable intertrochanteric fractures in elderly patients both domestically and internationally was reviewed, and the findings in aspects of selection of prosthesis types, proximal femoral reconstruction methods, postoperative complications, and rehabilitation were summarized and analyzed. Results The bone cement type femoral head replacement has shown significant effectiveness in the treatment of unstable intertrochanteric fractures in elderly patients. The surgery provides immediate stability, allowing patients to quickly bear weight and regain walking function, thereby reducing the incidences of postoperative complications and mortality. However, due to the generally poor physical condition and low surgical tolerance of elderly patients, the risk of postoperative complications significantly increases, which has a significant impact on patients’ postoperative recovery. Common complications include deep vein thrombosis, bone cement implantation syndrome, joint dislocation, prosthesis loosening, and periprosthetic fractures. Therefore, despite the apparent short-term effectiveness of the surgery, it is crucial to emphasize the prevention and management of postoperative complications to improve the long-term prognosis of elderly patients. Conclusion For unstable intertrochanteric fractures in elderly patients, when choosing bone cement type femoral head replacement, it is necessary to strictly adhere to surgical indications, reduce the occurrence of complications, and improve the patients’ quality of life through refined preoperative evaluation, intraoperative operation, and effective postoperative management.

Citation： ZHANG Shixiong, MA Jianxiong, LU Bin, MA Xinlong. Research progress on treatment of unstable intertrochanteric fractures in elderly patients with bone cement type femoral head replacement. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1143-1148. doi: 10.7507/1002-1892.202402067 Copy

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2.	Heiden JJ, Goodin SR, Mormino MA, et al. Early ambulation after hip fracture surgery is associated with decreased 30-day mortality. J Am Acad Orthop Surg, 2021, 29(5): e238-e242.
3.	赵晓涛, 张殿英, 郁凯, 等. 股骨近端防旋髓内钉固定治疗股骨转子间骨折的失效原因分析. 中华创伤骨科杂志, 2021, 23(3): 202-208.
4.	陆英超, 陈向阳, 袁斌. 两种体位下股骨近端防旋髓内钉治疗股骨转子间骨折的疗效比较. 临床骨科杂志, 2023, 26(2): 255-259.
5.	Hongku N, Woratanarat P, Nitiwarangkul L, et al. Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: A systematic review and network meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res, 2022, 108(1): 102838. doi: 10.1016/j.otsr.2021.102838.
6.	Chowdhury AK, Townsend O, Edwards MR. A comparison of hemiarthroplasty versus dynamic hip screw fixation for intertrochanteric femoral fractures: a systematic review. Hip Int, 2023, 33(4): 752-761.
7.	Tanzer M, Graves SE, Peng A, et al. Is cemented or cementless femoral stem fixation more durable in patients older than 75 years of age? A comparison of the best-performing stems. Clin Orthop Relat Res, 2018, 476(7): 1428-1437.
8.	Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement?. Bone Joint J, 2014, 96-B(4): 442-448.
9.	梁雨田, 唐佩福, 郭义柱, 等. 高龄患者非稳定性股骨粗隆间骨折人工股骨头置换临床研究. 中华医学杂志, 2005, 85(46): 3260-3262.
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12.	Shi T, Fang X, Huang C, et al. Conversion hip arthroplasty using standard and long stems after failed internal fixation of intertrochanteric fractures. Orthop Surg, 2023, 15(1): 124-132.
13.	Dung TT, Hieu ND, Son LM, et al. Primary cementless bipolar long stem hemiarthroplasty for unstable osteoporotic intertrochanteric fracture in the elderly patients. Open Access Maced J Med Sci, 2019, 7(24): 4342-4346.
14.	曹治东, 田开熙, 苟景跃, 等. 骨水泥加长柄人工股骨头置换于高龄股骨粗隆间骨折的临床应用. 创伤外科杂志, 2014, 16(6): 551, 560.
15.	Lee KH, Lee DH, Noh JH, et al. Is rigid fixation of the greater trochanter necessary for arthroplasty of intertrochanteric fractures? Orthop Traumatol Surg Res, 2019, 105(1): 41-45.
16.	Kim KC, Park HG, Park JW. The efficacy of suture fixation of the greater trochanter in unstable intertrochanteric fractures. Clin Orthop Surg, 2021, 13(4): 468-473.
17.	陈涛, 董盼锋, 章晓云, 等. 非骨水泥股骨假体置换联合术中股骨大转子重建对不稳定股骨转子间骨折的疗效分析. 中国现代医学杂志, 2022, 32(18): 70-76.
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22.	Seker A, Baysal G, Bilsel N, et al. Should early weightbearing be allowed after intramedullary fixation of trochanteric femur fractures? A finite element study. J Orthop Sci, 2020, 25(1): 132-138.
23.	许晓沛, 吕欣. 内侧壁破坏老年股骨转子间骨折分型及恢复骨性支撑和骨皮质的连续性. 中国组织工程研究, 2021, 25(14): 2259-2265.
24.	Andriollo L, Sangaletti R, Are L, et al. Uncemented hemiarthroplasty may have a role in the treatment of unstable intertrochanteric fractures in elderly patient. A survival complications and functional outcomes analysis. Int J Burns Trauma, 2023, 13(3): 126-135.
25.	封海, 陈纪伟, 潘阳阳, 等. 人工股骨头置换术与Gamma3型髓内钉内固定选择性治疗老年股骨粗隆间骨折的比较. 中国骨与关节损伤杂志, 2018, 33(12): 1240-1243.
26.	马瑞, 葛莹, 王坤正, 等. 小转子重建人工股骨头置换治疗高龄Evans-Ⅲ型股骨转子间骨折. 中国组织工程研究, 2024, 28(12): 1880-1884.
27.	Hantouly AT, Salameh M, Toubasi AA, et al. The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: a meta-analysis of comparative studies. Eur J Orthop Surg Traumatol, 2023, 33(4): 739-749.
28.	Karayiannis P, James A. The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fractures: a retrospective review of 465 patients. Eur J Trauma Emerg Surg, 2020, 46(5): 969-975.
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1. 李宁, 李新萍, 杨明辉, 等. 老年髋部骨折的骨质疏松症诊疗专家共识. 中华骨与关节外科杂志, 2021, 14(8): 657-663.
2. Heiden JJ, Goodin SR, Mormino MA, et al. Early ambulation after hip fracture surgery is associated with decreased 30-day mortality. J Am Acad Orthop Surg, 2021, 29(5): e238-e242.
3. 赵晓涛, 张殿英, 郁凯, 等. 股骨近端防旋髓内钉固定治疗股骨转子间骨折的失效原因分析. 中华创伤骨科杂志, 2021, 23(3): 202-208.
4. 陆英超, 陈向阳, 袁斌. 两种体位下股骨近端防旋髓内钉治疗股骨转子间骨折的疗效比较. 临床骨科杂志, 2023, 26(2): 255-259.
5. Hongku N, Woratanarat P, Nitiwarangkul L, et al. Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: A systematic review and network meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res, 2022, 108(1): 102838. doi: 10.1016/j.otsr.2021.102838.
6. Chowdhury AK, Townsend O, Edwards MR. A comparison of hemiarthroplasty versus dynamic hip screw fixation for intertrochanteric femoral fractures: a systematic review. Hip Int, 2023, 33(4): 752-761.
7. Tanzer M, Graves SE, Peng A, et al. Is cemented or cementless femoral stem fixation more durable in patients older than 75 years of age? A comparison of the best-performing stems. Clin Orthop Relat Res, 2018, 476(7): 1428-1437.
8. Feyen H, Shimmin AJ. Is the length of the femoral component important in primary total hip replacement?. Bone Joint J, 2014, 96-B(4): 442-448.
9. 梁雨田, 唐佩福, 郭义柱, 等. 高龄患者非稳定性股骨粗隆间骨折人工股骨头置换临床研究. 中华医学杂志, 2005, 85(46): 3260-3262.
10. Liu SH, Liu WG, Yin QF, et al. Finite element analysis of cemented prostheses for hip replacement in elderly patients with comminuted intertrochanteric fracture. Ann Ital Chir, 2020, 91: 679-687.
11. 成世高, 王万春, 蒋栋, 等. 标准柄与加长柄骨水泥型假体置换治疗高龄转子间骨折的比较. 中国组织工程研究, 2021, 25(3): 362-367.
12. Shi T, Fang X, Huang C, et al. Conversion hip arthroplasty using standard and long stems after failed internal fixation of intertrochanteric fractures. Orthop Surg, 2023, 15(1): 124-132.
13. Dung TT, Hieu ND, Son LM, et al. Primary cementless bipolar long stem hemiarthroplasty for unstable osteoporotic intertrochanteric fracture in the elderly patients. Open Access Maced J Med Sci, 2019, 7(24): 4342-4346.
14. 曹治东, 田开熙, 苟景跃, 等. 骨水泥加长柄人工股骨头置换于高龄股骨粗隆间骨折的临床应用. 创伤外科杂志, 2014, 16(6): 551, 560.
15. Lee KH, Lee DH, Noh JH, et al. Is rigid fixation of the greater trochanter necessary for arthroplasty of intertrochanteric fractures? Orthop Traumatol Surg Res, 2019, 105(1): 41-45.
16. Kim KC, Park HG, Park JW. The efficacy of suture fixation of the greater trochanter in unstable intertrochanteric fractures. Clin Orthop Surg, 2021, 13(4): 468-473.
17. 陈涛, 董盼锋, 章晓云, 等. 非骨水泥股骨假体置换联合术中股骨大转子重建对不稳定股骨转子间骨折的疗效分析. 中国现代医学杂志, 2022, 32(18): 70-76.
18. 赵忠全, 陈杰超, 李学福, 等. 加长型股骨柄半髋关节置换术治疗股骨转子间骨折股骨近端重建研究进展. 中国修复重建外科杂志, 2020, 34(4): 536-540.
19. 李青. 人工股骨头置换术结合股骨距重建治疗高龄不稳定性股骨转子间骨折的临床效果分析. 中国实用医药, 2022, 17(18): 24-28.
20. 王攀. 股骨距重建结合锁定钢板固定和股骨近端抗旋髓内钉治疗老年转子间骨折46例分析. 安徽医药, 2021, 25(4): 693-696.
21. 吴贵佑, 于前进, 朱红伟, 等. 股骨头置换与内固定治疗高龄不稳定转子间骨折的比较研究. 中国骨伤, 2021, 34(10): 895-900.
22. Seker A, Baysal G, Bilsel N, et al. Should early weightbearing be allowed after intramedullary fixation of trochanteric femur fractures? A finite element study. J Orthop Sci, 2020, 25(1): 132-138.
23. 许晓沛, 吕欣. 内侧壁破坏老年股骨转子间骨折分型及恢复骨性支撑和骨皮质的连续性. 中国组织工程研究, 2021, 25(14): 2259-2265.
24. Andriollo L, Sangaletti R, Are L, et al. Uncemented hemiarthroplasty may have a role in the treatment of unstable intertrochanteric fractures in elderly patient. A survival complications and functional outcomes analysis. Int J Burns Trauma, 2023, 13(3): 126-135.
25. 封海, 陈纪伟, 潘阳阳, 等. 人工股骨头置换术与Gamma3型髓内钉内固定选择性治疗老年股骨粗隆间骨折的比较. 中国骨与关节损伤杂志, 2018, 33(12): 1240-1243.
26. 马瑞, 葛莹, 王坤正, 等. 小转子重建人工股骨头置换治疗高龄Evans-Ⅲ型股骨转子间骨折. 中国组织工程研究, 2024, 28(12): 1880-1884.
27. Hantouly AT, Salameh M, Toubasi AA, et al. The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: a meta-analysis of comparative studies. Eur J Orthop Surg Traumatol, 2023, 33(4): 739-749.
28. Karayiannis P, James A. The impact of cerclage cabling on unstable intertrochanteric and subtrochanteric femoral fractures: a retrospective review of 465 patients. Eur J Trauma Emerg Surg, 2020, 46(5): 969-975.
29. Zhang H, Xu Z, Zhou A, et al. Efficacy of Kirschner-wires and tension band in hip arthroplasty for aged patients with unstable intertrochanteric osteoporotic fracture: A 2-to-11-year follow-up. Medicine (Baltimore), 2017, 96(1): e5614. doi: 10.1097/MD.0000000000005614.
30. Tetreault AK, McGrory BJ. Use of locking plates for fixation of the greater trochanter in patients with hip replacement. Arthroplast Today, 2016, 2(4): 187-192.
31. Huang G, Zhang M, Qu Z, et al. Fixation options for reconstruction of the greater trochanter in unstable intertrochanteric fracture with arthroplasty. Medicine (Baltimore), 2021, 100(26): e26395. doi: 10.1097/MD.0000000000026395.
32. Schafer P, Sullivan TC, Lambert B, et al. Greater trochanteric fixation using cable plate devices in complex primary and revision total hip arthroplasty. Arthroplast Today, 2023, 20: 101103. doi: 10.1016/j.artd.2023.101103.
33. Cui Q, Liu YS, Li DF, et al. Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies. Eur J Trauma Emerg Surg, 2016, 42(5): 651-656.
34. Zhao K, Zhang J, Li J, et al. Incidence of and risk factors for new-onset deep venous thrombosis after intertrochanteric fracture surgery. Sci Rep, 2021, 11(1): 17319. doi: 10.1038/s41598-021-96937-w.
35. Feng L, Xu L, Yuan W, et al. Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery. BMC Anesthesiol, 2020, 20(1): 72. doi: 10.1186/s12871-020-00983-2.
36. Wong DW, Lee QJ, Lo CK, et al. Incidence of venous thromboembolism after primary total hip arthroplasty with mechanical prophylaxis in Hong Kong Chinese. Hip Pelvis, 2024, 36(2): 108-119.
37. Jo WL, Lee YK, Ha YC, et al. Preventing venous thromboembolism with use of intermittent pneumatic compression after total hip arthroplasty in Korean patients. J Korean Med Sci, 2016, 31(8): 1319-1323.
38. CRISTAL Economic Analysis Study Group. Cost-effectiveness of enoxaparin versus aspirin in the prevention of venous thromboembolism after total hip or knee arthroplasty: an analysis from the CRISTAL cluster-randomized trial. Bone Joint J, 2024, 106-B(6): 589-595.
39. Ferreira GE, Patanwala AE, Turton H, et al. How is postoperative pain after hip and knee replacement managed? An analysis of two large hospitals in Australia. Perioper Med (Lond), 2024, 13(1): 49. doi: 10.1186/s13741-024-00403-w.
40. Li J, Zhang M, Yao J, et al. Risk factors for periprosthetic femoral fractures after cementless total hip arthroplasty. J Arthroplasty, 2024. doi: 10.1016/j.arth.2024.06.005.
41. Layson JT, Hameed D, Dubin JA, et al. Patients with osteoporosis are at higher risk for periprosthetic femoral fractures and aseptic loosening following total hip arthroplasty. Orthop Clin North Am, 2024, 55(3): 311-321.
42. Nantha Kumar N, Kunutsor SK, Fernandez MA, et al. Effectiveness and safety of cemented and uncemented hemiarthroplasty in the treatment of intracapsular hip fractures. Bone Joint J, 2020, 102-B(9): 1113-1121.
43. Agarwal AR, Kinnard MJ, Murdock C, et al. The cost-effectiveness of osteoporosis medications for preventing periprosthetic fractures following femoral neck fracture indicated hip arthroplasty: a break-even analysis. Osteoporos Int, 2024, 35(7): 1223-1229.
44. Lewis SR, Macey R, Parker MJ, et al. Arthroplasties for hip fracture in adults. Cochrane Database Syst Rev, 2022, 2(2): CD13410. doi: 10.1002/14651858.CD013410.pub2.
45. Weingärtner K, Störmann P, Schramm D, et al. Bone cement implantation syndrome in cemented hip hemiarthroplasty—A persistent risk. Eur J Trauma Emerg Surg, 2022, 48(2): 721-729.
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Chinese Journal of Reparative and Reconstructive Surgery

Research progress on treatment of unstable intertrochanteric fractures in elderly patients with bone cement type femoral head replacement

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