Journal List > Hip Pelvis > v.24(3) > 1081940

Lee, Kim, Hwang, and Kim: Cementless Bipolar Hemiarthroplasty of Hip Fracture in Patients on Hemodialysis

Abstract

Purpose

This study analyzed the clinical and radiologic results and complications in patients with chronic renal failure who underwent cementless bipolar hemiarthroplasty for treatment of hip fractures.

Materials and Methods

Between January 2003 and February 2010, we performed 36 consecutive cementless bipolar hemiarthroplasty procedures in 35 patients with hip fracture who were on hemodialysis for chronic renal failure. Clinically, postoperative Harris hip score, inguinal and thigh pain, and orthopaedic and medical complications were investigated. Radiologically, we examined bone ingrowth, osteolysis, loosening, and nonunion.

Results

According to the Harris hip score grading system, the average postoperative score was 85.7 and the function before the injury was restored in 29 cases. Postoperatively, four patients experienced mild inguinal pain and four patients experienced mild thigh pain. One patient experienced severe thigh pain. Orthopaedic complications(6 cases, 16.7%) included mild hematoma(3 cases), superficial wound infection(2 cases), and dislocation(1 case). Medical complications(10 cases, 27.8%) included sepsis(5 cases), multiple organ failure due to aggravation of underlying diseases(2 cases), ulcer perforation(2 cases), and aspiration pneumonia(1 case). Five patients had died within one year (mortality, 13.9%). Except for loosening of the femoral stem in one case, bone ingrowth was observed in all cases. None of the patients had osteolysis and nonunion.

Conclusion

Although cementless bipolar hemiarthroplasty was considered as an effective treatment in patients with hip fractureon hemodialysis due to favorable results at midterm follow-up, close attention for the postoperative medical complications due to poor general condition is needed.

Figures and Tables

Fig. 1
(A) Preoperative radiograph showed insufficiency fracture of the right femoral neck. (B) Radiograph showed stable fixation after 1 year 3 months using cementless bipolar hemiarthroplasty of the right hip. (C) After 1 year 6 months of operation, loosening of femoral stem had occurred.
hp-24-200-g001
Table 1
Patients Demography
hp-24-200-i001
Table 2
Overall Incidence of Complications of Patients Undergoing Hemodialysis after Cementless Bipolar Hemiarthroplasty
hp-24-200-i002

References

1. Lieberman JR, Fuchs MD, Haas SB, et al. Hip arthroplasty in patients with chronic renal failure. J Arthroplasty. 1995. 10:191–195.
crossref
2. Toomey HE, Toomey SD. Hip arthroplasty in chronic dialysis patients. J Arthroplasty. 1998. 13:647–652.
crossref
3. Sakalkale DP, Hozack WJ, Rothman RH. Total hip arthroplasty in patients on long-term renal dialysis. J Arthroplasty. 1999. 14:571–575.
crossref
4. Alem AM, Sherrad DJ, Gillen DL, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int. 2000. 58:396–399.
crossref
5. García-Ramiro S, Cofán F, Esteban PL, et al. Total hip arthroplasty in hemodialysis and renal transplant patients. Hip Int. 2008. 18:51–57.
crossref
6. Abbott KC, Bucci JR, Agodoa LY. Total hip arthroplasty in chronic dialysis patients in the United States. J Nephrol. 2003. 16:34–39.
7. Sunday JM, Guille JT, Torg JS. Complications of joint arthroplasty in patients with end-stage renal disease on hemodialysis. Clin Orthop Relat Res. 2002. (397):350–355.
crossref
8. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am. 2004. 86-A:1711–1716.
crossref
9. Rödén M, Schön M, Fredin H. Treatment of displaced femoral neck fractures: a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients. Acta Orthop Scand. 2003. 74:42–44.
crossref
10. Karaeminogullari O, Demirors H, Sahin O, Ozalay M, Ozdemir N, Tandogan RN. Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis. J Bone Joint Surg Am. 2007. 89:324–331.
crossref
11. Naito M, Ogata K, Shiota E, Nakamoto M, Goya T. Hip arthroplasty in haemodialysis patients. J Bone Joint Surg Br. 1994. 76:428–431.
crossref
12. Fukunishi S, Fukui T, Nishio S, Imamura F, Yoh K, Yoshiya S. Results of total hip arthroplasty for dialysis arthropathy in long-term hemodialysis patients. J Orthop Sci. 2009. 14:285–291.
crossref
13. Nagoya S, Nagao M, Takada J, Kuwabara H, Kaya M, Yamashita T. Efficacy of cementless total hip arthroplasty in patients on long-term hemodialysis. J Arthroplasty. 2005. 20:66–71.
crossref
14. Li WC, Shih CH, Ueng SW, Shih HN, Lee MS, Hsieh PH. Uncemented total hip arthroplasty in chronic hemodialysis patients. Acta Orthop. 2010. 81:178–182.
crossref
15. Coco M, Rush H. Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis. 2000. 36:1115–1121.
crossref
16. Stehman-Breen CO, Sherrad DJ, Alem AM, et al. Risk factors for hip fracture among patients with end-stage renal disease. Kidney Int. 2000. 58:2200–2205.
crossref
17. Aveline C, Leroux A, Vautier P, Cognet F, Le Hetet H, Bonnet F. Risk factors for renal dysfunction after total hip arthroplasty. Ann Fr Anesth Reanim. 2009. 28:728–734.
18. Shrader MW, Schall D, Parvizi J, McCarthy JT, Lewallen DG. Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients. J Arthroplasty. 2006. 21:324–329.
19. Creighton MG, Callaghan JJ, Olejniczak JP, Johnston RC. Total hip arthroplasty with cement in patients who have rheumatoid arthritis. A minimum ten-year follow-up study. J Bone Joint Surg Am. 1998. 80:1439–1446.
crossref
20. Goldberg BA, al-Habbal G, Noble PC, Paravic M, Liebs TR, Tullos HS. Proximal and distal femoral centralizers in modern cemented hip arthroplasty. Clin Orthop Relat Res. 1998. (349):163–173.
crossref
21. Crawford R, Athanasou NA. Beta 2-microglobulin amyloid deposition in hip revision arthroplasty tissues. Histopathology. 1998. 33:479–484.
crossref
22. Schmalzried TP, Callaghan JJ. Wear in total hip and knee replacements. J Bone Joint Surg Am. 1999. 81:115–136.
crossref
23. Blacha J, Kolodziej R, Karwanski M. Bipolar cemented hip hemiarthroplasty in patients with femoral neck fracture who are on hemodialysis is associated with risk of stem migration. Acta Orthop. 2009. 80:174–178.
crossref
24. Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg Am. 2012. 94:577–583.
crossref
25. Khanuja HS, Vakil JJ, Goddard MS, Mont MA. Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am. 2011. 93:500–509.
crossref
26. Sakabe T, Imai R, Murata H, et al. Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients. J Orthop Trauma. 2006. 20:330–336.
crossref
27. Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis. 2004. 44:672–679.
crossref
28. Klein DM, Tornetta P 3rd, Barbera C, Neuman D. Operative treatment of hip fractures in patients with renal failure. Clin Orthop Relat Res. 1998. (350):174–178.
crossref
29. Kalra S, McBryde CW, Lawrence T. Intracapsular hip fractures in end-stage renal failure. Injury. 2006. 37:175–184.
crossref
30. Tierney GS, Goulet JA, Greenfield ML, Port FK. Mortality after fracture of the hip in patients who have end-stage renal disease. J Bone Joint Surg Am. 1994. 76:709–712.
crossref
TOOLS
Similar articles