gms | German Medical Science

Objectives: Bone cement implantation syndrome (BCIS) is known to be responsible for intraoperative cardiac or pulmonary complications especially in nonagenarians. Besides the cardio-pulmonary complications during the operation itself, it may also lead to an elevated perioper-ative morbidity and mortality. In addition, many orthopaedic trauma surgeons are concerned about the possible subsidence and increased fracture rate especially in the osteoporotic bone when using cementless femoral stems.

It was the goal of this study to analyze subsidence and intraoperative fracture complications in a cohort of very old fracture patients.

Methods: Retrospective analyze of a consecutive cohort of patients older than ninety years of age, all treated with an uncemented Quadra-stem^® (Medacta^®), AMIS-approach, due to a fracture of the femoral neck. Full weight bearing was allowed the first day after operation.

Systemic or surgery associated complications were documented. The anterior-posterior radi-ographs of the pelvis, postoperatively and in early follow-up were examined, paying especial attention on the subsidence of the stem. These examinations were performed and interpret-ed by 3 different examiners. Subsidence was suspected if a difference of more than 2 mm in the two consecutive radiologic examinations was documented.

Result: From 3/2010 until 7/2014 we treated 82 patients (66 women (80%)), which fulfilled the inclu-sion criteria by hemiarthroplasty of the hip. Median age was 92 years (90-102). An early mor-tality of 2.3% and a one-year mortality of 27.3% were documented. Early systemic morbidity was 27.3%. Time until first follow-up was 43 days.

We counted 8 (9.7%) intraoperative fractures (fx): 2 fx of the greater trochanter, 6 fx of the proximal femur. Nevertheless only two patients were obliged to a partial weight bearing post-operatively. In 7 patients we documented subsidence of more than 2 mm (median 4.5mm, range 2.5-9.5mm). Besides these measurements, the price difference of the procedure using cemented or uncemented stems differed by only 11% in favour of the cemented stem.

Conclusion: In this retrospective study we could not demonstrate an elevated rate of early subsidence in this clearly geriatric cohort of fracture patients. The prevention of BCIS, the shorter operation time, the small price difference are all in favour of the uncemented implants. On the opposite, the possible elevated risk for an intraoperative fx is an argument for the use of a cemented stem.