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      Relationships between Femoral Offset Change and Clinical Score following Bipolar Hip Arthroplasty in Femoral Neck Fractures

      research-article
      Author(s): , MD, , MD , , MD
      Publication date (Electronic):
      Journal: Hip & Pelvis
      Publisher: Korean Hip Society
      Keywords: Femoral neck fractures, Hemiarthroplasty, Offset

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          Abstract

          Purpose

          This study aimed to investigate the relationship between femoral offset (FO) and clinical outcomes of patients with femoral neck fracture following bipolar hip arthroplasty (BHA).

          Materials and Methods

          Records for a total of 520 patients who underwent BHA for a femoral neck fracture between December 1, 2003, and September 30, 2018, were reviewed retrospectively. Patients with unclear medical records, a congenital deformity and preoperative trauma history of the hip, high-energy multiple trauma, or a history of neurodegenerative disease or cerebrovascular disease were excluded. The remaining 77 patients included in the analysis had a minimum follow-up period of one year. For clinical assessment, the postoperative pain visual analogue scale (VAS) and Harris hip score (HHS) were analyzed at each follow-up period. For radiological assessment, the difference in leg length discrepancy (LLD) and FO were measured.

          Results

          The difference in mean FO postoperatively was 6.7±4.8 mm, and the difference in mean postoperative LLD was 4.9±3.4 mm. The mean HHS was 77.1±7.7, 82.3±8.6, 83.4±7.7, and 86.4±6.7 at 1, 3, 6, and 12 months postoperative, respectively. The correlation coefficient between FO and HHS in 1-year follow-up was −0.38, and a statistically significant outcome was found ( P=0.001). For the HHS domain, the correlation coefficient for function at 1-year follow-up was −0.42, revealing a statistically significant outcome ( P=0.0001).

          Conclusion

          There was a statistically significant correlation between clinical outcomes and FO difference at 1 year after BHA in patients over 65 years of age with femoral neck fractures.

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          Most cited references24

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          A systematic review of hip fracture incidence and probability of fracture worldwide

          J Kanis, Thomas A. Odén, E. McCloskey … (2012)
          Summary The country-specific risk of hip fracture and the 10-year probability of a major osteoporotic fracture were determined on a worldwide basis from a systematic review of literature. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. Introduction The present study aimed to update the available information base available on the heterogeneity in the risk of hip fracture on a worldwide basis. An additional aim was to document variations in major fracture probability as determined from the available FRAX models. Methods Studies on hip fracture risk were identified from 1950 to November 2011 by a Medline OVID search. Evaluable studies in each country were reviewed for quality and representativeness and a study (studies) chosen to represent that country. Age-specific incidence rates were age-standardised to the world population in 2010 in men, women and both sexes combined. The 10-year probability of a major osteoporotic fracture for a specific clinical scenario was computed in those countries for which a FRAX model was available. Results Following quality evaluation, age-standardised rates of hip fracture were available for 63 countries and 45 FRAX models available in 40 countries to determine fracture probability. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. Conclusions Worldwide, there are marked variations in hip fracture rates and in the 10-year probability of major osteoporotic fractures. The variation is sufficiently large that these cannot be explained by the often multiple sources of error in the ascertainment of cases or the catchment population. Understanding the reasons for this heterogeneity may lead to global strategies for the prevention of fractures.
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            Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials

            Paul T. P. W. Burgers, Arnoud R. Van Geene, Michel Van Den Bekerom … (2012)
            Purpose Displaced femoral neck fractures in healthy elderly patients have traditionally been managed with hemiarthroplasty (HA). Recent data suggest that total hip arthroplasty (THA) may be a better alternative. Methods A systematic review of the English literature was conducted. Randomized controlled trials comparing all forms of THA with HA were included. Three authors independently extracted articles and predefined data. Results were pooled using a random effects model. Results Eight trials totalling 986 patients were retrieved. After THA 4 % underwent revision surgery versus 7 % after HA. The one-year mortality was equal in both groups: 13 % (THA) versus 15 % (HA). Dislocation rates were 9 % after THA versus 3 % after HA. Equal rates were found for major (25 % in THA versus 24 % in HA) and minor complications (13 % THA versus 14 % HA). The weighted mean of the Harris hip score was 81 points after THA versus 77 after HA. The subdomain pain of the HHS (weighted mean score after THA was 42 versus 39 points for HA), the rate of patients reporting mild to no pain (75 % after THA versus 56 % after HA) and the score of WOMAC (94 points for THA versus 78 for HA) all favored THA. Quality of life measured with the EQ-5D favored THA (0.69 versus 0.57). Conclusions Total hip arthroplasty for displaced femoral neck fractures in the fit elderly may lead to higher patient-based outcomes but has higher dislocation rates compared with hemiarthroplasty. Further high-quality randomized clinical trails are needed to provide robust evidence and to definitively answer this clinical question.
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              Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty.

              G Lecerf, M.H. Fessy, R. Philippot … (2009)
              BACKGROUND OBJECTIVE: Femoral offset is supposed to influence the results of hip replacement but little is known about the accurate method of measure and the true effect of offset modifications. This article is a collection of independent anatomic, radiological and clinical works, which purpose is to assess knowledge of the implications of femoral offset for preoperative templating and total hip arthroplasty. There is a strong correlation between femoral offset, abductors lever arm and hip abductor strength. Hip lateralization is independent of the femoral endomedullary characteristics. The abductors lever arm is highly correlated to the gluteus medius activation angle. There were correlations between femoral offset and endomedullary shape. The hip center was high and medial for stovepipe metaphysis while it was lower and lateralized for champagne - flute upper femur. A study was performed to compare the femoral offset measured by X-ray and CT-scan in 50 patients, demonstrated that plain radiography underestimates offset measurement. The 2D templating cannot appreciate the rotation of the lower limb. Taking into account the horizontal plane is essential to obtain proper 3D planning of the femoral offset. A randomized study was designed to compare femoral offset measurements after hip resurfacing and total hip arthroplasty. This study underlined hip resurfacing reduced the femoral offset, while hip replacement increased offset. However, the reduction of femoral offset after hip resurfacing does not affect the function. A pilot study was designed to assess the results of 120 hip arthroplasties with a modular femoral neck. This study showed that the use of a modular collar ensures an easier restoration of the femoral offset. A cohort of high offset stems (Lubinus 117 degrees) was retrospectively assessed. The survival rate was slightly lower that the standard design reported in the Swedish register. Finally, the measurement of offset and leg length was assessed with the help of computer assistance. The software changed the initial schedule (obtained by templating) in 29%. Therefore, femoral offset restoration is essential to improve function and longevity of hip arthroplasty. CT-scan is more accurate than plain radiography to assess femoral offset. Hip resurfacing decreases offset without effect on function. Modular neck and computer assistance may improve intraoperative calculation and reproduction of femoral offset. Increasing offset with a standard cemented design may decrease long-term fixation. Level IV: Retrospective or historical series.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Hip Pelvis
                Journal ID (iso-abbrev): Hip Pelvis
                Journal ID (publisher-id): HP
                Title: Hip & Pelvis
                Publisher: Korean Hip Society
                ISSN (Print): 2287-3260
                ISSN (Electronic): 2287-3279
                Publication date (Print): June 2021
                Publication date (Electronic): 04 June 2021
                Volume: 33
                Issue: 2
                Pages: 78-86
                Affiliations
                Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea.
                Author notes
                Address reprint request to Hyeon Jun Kim, MD. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea. TEL: +82-51-240-2757, FAX: +82-51-254-6757, hyeonjun@ 123456dau.ac.kr
                Author information
                https://orcid.org/0000-0002-3775-6421
                Article
                DOI: 10.5371/hp.2021.33.2.78
                PMC ID: 8190501
                PubMed ID: 34141694
                SO-VID: 7a418318-f6e6-4713-98d3-389f06b3107c
                Copyright © Copyright © 2021 by Korean Hip Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 November 2020
                Date revision received : 08 January 2021
                Date accepted : 09 January 2021
                Categories
                Subject: Original Article

                Keywords: femoral neck fractures,hemiarthroplasty,offset
                Data availability:
                Keywords: femoral neck fractures, hemiarthroplasty, offset

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