Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture

Sang-Eun Park; Young-Yul Kim; Jae-Jung Jeong; Seung-Gyun Choi; Dong-Seok Jeong; Weon-Yoo Kim

doi:10.5371/hp.2013.25.1.37

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Park, Kim, Jeong, Choi, Jeong, and Kim: Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture

Original Article

Hip & Pelvis

Hip & Pelvis 2013; 25(1): 37-43.

Published online: 31 March 2013

DOI: https://doi.org/10.5371/hp.2013.25.1.37

Comparison of Postoperative Bleeding and Complications between Cemented and Non-cemented Bipolar Hemiarthroplasty in Treatment of Unstable Pertrochanteric Fracture

Sang-Eun Park, MD, Young-Yul Kim, MD, Jae-Jung Jeong, MD, Seung-Gyun Choi, MD, Dong-Seok Jeong, MD, Weon-Yoo Kim, MD

Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

Address reprint request to Weon-Yoo Kim, MD. Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2 Daehung-dong, Jung-gu, Daejeon 301-723, Korea. TEL: +82-42-220-9530, FAX: +82-42-221-0429, weonkim@hotmail.com

Received 17 October 2012 Revised 18 March 2013 Accepted 18 March 2013

(open-access):

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.

Abstract

Purpose

In cases of patients who underwent bipolar hemiarthroplasty (BPHA) for treatment of a pertrochanteric fracture, we compared and analyzed the amount of blood loss and complications between a group using the cemented stem and a group using the cementless stem.

Materials and Methods

A total of 104 patients who underwent BPHA for treatment of a pertrochanteric fracture in our hospital for three years and 10 months (From January 2008 to October 2011) were included in this study. Among the 104 patients, 64 patients with a cemented stem were categorized into group 1, and the other 40 patients with an uncemented stem were categorized into group 2. Before surgery, the type of stem was determined by the bone quality of the proximal femur, which had been evaluated with a simple X-ray. Then, after surgery, the amount of blood loss and complications were compared between the two groups.

Results

Expected blood loss during the operation was 389.8 cc in group 1, and 395.3 cc in group 2(P=0.88). Postoperatively, average drained blood loss was 219.6 cc in group 1, and 338.1 cc in group 2. Cemented stem was associated with significantly less blood loss (P=0.004). The average operation time in group 1 and in group 2 was 96 minutes and 72 minutes. There was no significant difference in operating time (P=0.85). In addition, there was no difference in INR (International Normalized Ratio) and BMI (Body Mass Index) (P=0.28 and 0.08) regarding total amount of postoperatively drained blood loss. There was no occurrence of hypotensive shock or fatal pulmonary embolism in either group. Three cases of periprosthetic fracture occurred in group 2.

Conclusion

Fewer occurrences of postoperative blood loss and fewer complications were observed in the cemented stem group than in the cementless stem group. Preoperative evaluation of bone quality and use of the cement stem for patients with poor bone quality may be a good treatment method that can help to reduce complications.

Keywords: Pertrochanteric fracture, Bipolar hemiarthroplasty, Blood loss, Cementless stem, Cemented stem

Figures and Tables

Fig. 1

A 80-year-old female with right hip pain. (A) Radiograph of initial evaluation show comminuted intertrochanteric fracture with underlying osteoporotic change. Cortical bone of the proximal femur is thin and the medullary canal is wide. (B) Bipolar hemiarthroplasty using cement stem was done with additional fixation.

Fig. 2

A 85-year-old female with right hip pain. (A) Radiograph of intraoperative scanning of bipolar hemiarthroplasty using cementless stem for intertrochanteric fracture. During press-fitting, a periprosthetic fracture occurred. (B) Additional fixation with multiple wirings was done for long oblique periprosthetic fracture.

Table 1

Patients

^*PAD: Post Accidental Day, ^†BMI: Body Mass Index, ^‡INR: International Normalized Ratio

Table 2

Clinical Results: Comparison of the Two Groups According to the Stem Type

^*EBL: Expected Blood Loss.

Table 3

Clinical Results: Comparison of Normal & High INR^* Groups

^*INR: International Normalized Ratio.

Table 4

Clinical Results: Comparison of Normal & High BMI Groups

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