Abstract:
BACKGROUND:The use of an anatomic cementless stem in hemiarthroplasties for femoral intracapsular proximal fracture has been debated, notably because of bone weakness and/or morphological defects related to osteoporosis. We therefore conducted a retrospective study in subjects over 75 years of age who had received an anatomic stem partially coated with hydroxyapatite. The objectives were to determine: 1) the incidence of periprosthetic fractures (PPFs) and, 2) the influence of anatomic factors, including the Cortical Bone Ratio (CBR) (the relation between the endosteal and external diameter of the femoral diaphysis 10cm below the lesser trochanter). HYPOTHESIS:The risk of PPF with an anatomic cementless implant is greater than with cemented stems. MATERIAL AND METHODS:We retrospectively analyzed 233 patients followed up for 5 years after their surgery. The stem used was an anatomic stem with a modular neck partially coated with hydroxyapatite. The risk factors examined were age, gender, history of osteoporotic fractures, diverse causes of secondary osteoporosis, and proximal bone stock according to various referenced radiological indices such as the CBR. RESULTS:Twenty patients (15%) were lost to follow-up, 74 had died (32%) but did not undergo revision for PPF, 15 of the 139 survivors at the last follow-up (10.8%) had had a PPF, five (3.6%; four females, one male) were early fractures (≤2 months after implantation), ten (7.2%; two females, eight males) were late fractures (>2 months). Male gender was protective for PPF occurrence (RR=0.129; 95%CI (0.04-0.39); P=0.0003), whereas secondary factors of osteoporosis (RR=2.035; 95%CI (1.11-3.72); P=0.0211), and CBR>0.49 (RR=227.42; 95%CI (1.072-48,226.76); P=0.0471) were found as risk factors of PPF. DISCUSSION:The PPF rate was greater than that related to cemented stems, requiring that morphological and clinical factors of bone weakness (collected with the patient history and related to osteoporosis) be taken into account. A CBR>0.49 requires caution on the use of this type of stem. LEVEL OF EVIDENCE:Level 4. Retrospective study.
journal_name
Orthop Traumatol Surg Resjournal_title
Orthopaedics & traumatology, surgery & research : OTSRauthors
Kouyoumdjian P,Dhenin A,Dupeyron A,Coulomb R,Asencio Gdoi
10.1016/j.otsr.2016.05.013subject
Has Abstractpub_date
2016-10-01 00:00:00pages
701-5issue
6issn
1877-0568pii
S1877-0568(16)30074-3journal_volume
102pub_type
杂志文章abstract::Chronic patellar tendon ruptures are somewhat rare, thus little work has been done in this area and their true incidence is not known. The management of a neglected, chronic patellar tendon rupture must address three difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, th...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2011.01.015
更新日期:2011-06-01 00:00:00
abstract::Early-onset scoliosis, which appears before the age of 10, can be due to congenital vertebral anomalies, neuromuscular diseases, scoliosis-associated syndromes, or idiopathic causes. It can have serious consequences for lung development and significantly reduce the life expectancy compared to adolescent scoliosis. Ext...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2016.09.013
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,多中心研究
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abstract::The medial approach to the hip via the adductors, as described by Ludloff or Ferguson, provides restricted visualization and incurs a risk of neurovascular lesion. We describe a minimally invasive medial hip approach providing broader exposure of extra- and intra-articular elements in a space free of neurovascular str...
journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2014.06.009
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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doi:10.1016/j.rcot.2010.02.001
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2013.03.010
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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更新日期:2019-09-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2015.03.005
更新日期:2015-06-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
doi:10.1016/j.otsr.2019.10.029
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章,评审
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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更新日期:2019-04-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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更新日期:2009-11-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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更新日期:2009-06-01 00:00:00
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
pub_type: 杂志文章
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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journal_title:Orthopaedics & traumatology, surgery & research : OTSR
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pub_type: 杂志文章,多中心研究
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