Bipolar Hemiarthroplasty and Parathyroidectomy at the Same Setting for Fragility Fractures Secondary to Renal Bone Disea
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ORIGINAL ARTICLE
Bipolar Hemiarthroplasty and Parathyroidectomy at the Same Setting for Fragility Fractures Secondary to Renal Bone Disease Amila Silva1 · Adriel You Wei Tay1 · Chung Fai Jeremy Ng2 · Tet Sen Howe1 Received: 7 March 2020 / Accepted: 22 May 2020 / Published online: 3 June 2020 © Indian Orthopaedics Association 2020
Abstract Background From 1980s to the new millennium, the number of patients surviving with end stage renal disease (ESRD) has increased by 3 fold. This is driven by early detection of primordial and primary risk factors, state of the art renal replacement therapy and ease of public access to healthcare. Renal osteodystrophy (RO) is a metabolic bone disease causing significant morbidity in patients with ESRD, in particular fragility fractures. In this case series, we present the surgical management of 3 ESRD patients with pathological fractures of the neck of femur (NOF) and surgical treatment (parathyroidectomy) of tertiary hyperparathyroidism of ESRD patients in the same surgical setting. Up to date there has been no reports on bipolar hemiarthroplasty and total parathyroidectomy implemented in the same operative setting. Methods We present 3 cases, 2 males and a female with an average age of 48 years. All patients presented with no trauma or minimal trauma. With high index of suspicion and after confirming the diagnosis with advanced imaging, the patients underwent cemented modular hemiarthroplasty with posterior approach. Parathyroidectomy was sequentially performed to address the tertiary hyperparathyroidism at the same setting. We followed them for 48 months. Results At 48-month follow up, all the patients were at their pre-morbid ambulatory status and there were no major complications. They did not need any revision surgery or re-operation either for the hemiarthroplasty surgery or the parathyroidectomy during the follow up period. Conclusion To avoid diagnostic pitfalls in this group of patients we recommend MRIs of both hips in patients complaining of unilateral hip pain even when the roentgenograms are clear of fractures. Total parathyroidectomy at the same setting with the bipolar hemi-arthroplasty is a safe combination. This reduces the anaesthesia risk, the recovery time as well as the equilibrium time for calcium homeostasis. Keywords Osteodystrophy · Renal · Hip · Fracture · Parathyroidectomy
Introduction The incidence of Chronic Renal Disease (CKD) is said to be 340–360 per million according to the 2012 reports by the National Kidney foundation in USA [1, 2]. From 1980s to the new millennium, due to early detection of primordial and primary risk factors, state of the art renal replacement
* Adriel You Wei Tay [email protected] 1
Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Outram Road, Academia, Level 4, Singapore 169856, Singapore
Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
2
therapy and improved access to healthcare, the survivability of patients with CKD has
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