Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shor
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ORIGINAL ARTICLE
Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shorter Femoral Stem and Standard Femoral Stem Jae‑Young Lim1 · Hyeong‑Jun Park2 · Young‑Kyun Lee3 · Yong‑Chan Ha2 · Kyung‑Hoi Koo3 Received: 19 February 2020 / Accepted: 10 April 2020 / Published online: 30 April 2020 © Indian Orthopaedics Association 2020
Abstract Background This randomized control study was designed to compare the clinical and radiological outcomes, including periprosthetic bone mineral density (BMD) changes, between the short and standard stems after using cementless hemiarthroplasty in elderly patients with femur neck fractures. Materials and Methods From January 2013 to May 2017, 151 patients (aged ≥ 65 years) underwent hemiarthroplasties due to femoral neck fractures. Patients were randomized into two groups; 77 patients in Group A implanting the short femoral stem and 74 patients in Group B implanting the standard femoral stem. Clinical and radiographic evaluations were performed in all patients. Results 75 patients (40 patients in Group A and 35 patients in Group B) completed routine follow-up for a minimum of 2 years. The clinical outcomes, including ambulatory functions and thigh pain, were similar in both groups. All the femoral stems acquired radiologic stability. At postoperative one year, BMD values in Gruen zone (G) seven on the standard stem side were significantly lower than those on the short stem side (P = 0.038). At the second year of follow-up, the BMD values of Group A in G1, G3, G4, and G7 were significantly greater than those of Group B (P = 0.007, 0.032, 0.026, and P grade 2 was determined to have clinical significance. Lesions were recorded according to the seven zones described by Gruen et al. [20]. Evidence of spot welding, pedestal formation, and reactive lines in each Gruen zone was also documented. Spot welds were defined as bone densification and trabecular streaming between the cortex and the implant [21]. Cortical porosis was considered as bone loss associated with normal aging, and was defined as a loss of endosteal definition and a decrease in bone mineralization resulting in a homogeneous but somewhat sparse (washedout) appearance of the remaining cortex [22].To evaluate leg-length discrepancy, the distance between the interteardrop line and the lower margin of the lesser trochanter was measured on each leg. A difference > 2 cm was defined as a failure of leg-length equalization [23]. Heterotopic ossification was classified according to the system of Brooker et al. [24].
BMD Assessment BMD was measured using dual-energy X-ray absorptiometry (DXA; Lunar Prodigy advance devices, GE Healthcare, Madison, WI, USA) on the admission day or before surgery and at the 12-month and 24-month postoperative followup. Patients were positioned supine with knee and foot support to ensure a neutral femur position. The Orthopaedic Software Package (GE Healthcare) was used to measure the BMD preoperatively in the femoral neck, and postoperativel
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