Document Type : Original Article
Authors
- Seyed Alireza Aminjavaheri
- Seyed Hossein Shafiei
- Mohammad Ali Ghasemi
- Alireza Moharrami
- Mir Mansour Moazen Jamshidi
- Seyed Mohammad Javad Mortazavi
Orthopedic Ward, Imam Khomeini Hospital, Tehran- Joint Reconstruction research center, Tehran University of Medical Sciences.
Abstract
Introduction: The risk of femoral neck fracture increases in the End Stage Renal Disease (ESRD) patients who underge hemodialysis. The aim of this study was to describe our experience with the treatment of femoral neck fracture in this particular group of patients.
Method: In a retrospective study, between January 2010 to December 2015, there were 16 displaced femoral neck fracture in 12 haemodialytic ESRD patient. All patients underwent total hip arthroplasty via direct anterior approach (three cementless and 9 cemented). No closed suction drain was used. Follow up regime was at 3,6 and 12 month and annually thereafter.
Result: All patients were satisfied with the results of total hip arthroplasty. At the time of the final follow-up of 22 months (2-47) months, all the hips in the 12 haemodialytic patients functioned well without any loosening, and with a Harris hip score (HHS) of 90(82–100). Of those patients who received cementless components: one patient showed loosening of femoral component on the right and then left hip one year after surgery. He underwent revision of femoral component to a cemented one. The other complications include one greater trochanteric fracture, one intraoperative distal femoral fracture, one postoperative hematoma formation and one superficial surgical site infection.
Conclusion: In this small series, relatively high complication rate is observable in cases of ESRD with femoral neck fracture treated by hip Arthroplasty. The use of cemented femoral sterns is preferred and extra caution is advised to avoid fracture in such osteoporotic bones.
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- Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, et al. Increased risk of hip fracture among patients with end-stage renal disease. Kidney international. 2000;58(1):396-9.
- Ball AM, Gillen DL, Sherrard D, Weiss NS, Emerson SS, Seliger SL, et al. Risk of hip fracture among dialysis and renal transplant recipients. Jama. 2002;288(23):3014-8.
- Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated with hip fracture in the dialysis population. American Journal of Kidney Diseases. 2004;44(4):672-9.
- Ellis H, Pierides A, Feest T, Ward M, Kerr D. HISTOPATHOLOGY OF RENAL OSTEODYSTROPHY WITH PARTICULAR REFERENCE TO THE EFFECTS OF lα‐HYDROXYVITAMIN D3 IN PATIENTS TREATED BY LONG‐TERM HAEMODIALYSIS. Clinical endocrinology. 1977;7:31s-8s.
- Kaneko TM, Foley RN, Gilbertson DT, Collins AJ. Clinical epidemiology of long-bone fractures in patients receiving hemodialysis. Clinical Orthopaedics and Related Research®. 2007;457:188-93.
- Karapinar H, Ozdemir M, Akyol S, Ulku O. Spontaneous bilateral femoral neck fractures in a young adult with chronic renal failure. Acta orthopaedica belgica. 2003;69(1):82-5.
- Elder G. Pathophysiology and recent advances in the management of renal osteodystrophy. Journal of Bone and Mineral Research. 2002;17(12):2094-105.
- Tarr R, Kaye J, Nance JE. Insufficiency fractures of the femoral neck in association with chronic renal failure. Southern medical journal. 1988;81(7):863-6.
- Schaab PC, Murphy G, Tzamaloukas AH, Hays MB, Merlin TL, Eisenberg B, et al. Femoral neck fractures in patients receiving long-term dialysis. Clinical orthopaedics and related research. 1990(260):224-31.
- Hardy P, Benoit J, Donneaud B, Jehanno P, Lortat-Jacob A. Pathological fractures of the femoral neck in hemodialyzed patients. Apropos of 26 cases. Revue de chirurgie orthopedique et reparatrice de l'appareil moteur. 1994;80(8):702-10.
- Kalra S, McBryde C, Lawrence T. Intracapsular hip fractures in end-stage renal failure. Injury. 2006;37(2):175-84.
- Karaeminogullari O, Demirors H, Sahin O, Ozalay M, Ozdemir N, Tandogan RN. Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis. JBJS. 2007;89(2):324-31.
- Bednarek-Skublewska A, Kolodziej R, Baranowicz-Gaszczyk I, Ksiazek A. [Femoral neck fractures in hemodialysis patients]. Przeglad lekarski. 2003;60(11):682-5.
- HODSMAN AB, SHERRARD DJ, ALFREY AC, OTT S, BRICKMAN AS, MILLER NL, et al. Bone aluminum and histomorphometric features of renal osteodystrophy. The Journal of Clinical Endocrinology & Metabolism. 1982;54(3):539-46.
- Gruen TA, McNeice GM, Amstutz HC. " Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clinical orthopaedics and related research. 1979(141):17-27.
- Stanbury SW, Lumb GA, Mawer EB. Osteodystrophy developing spontaneously in the course of chronic renal failure. Archives of internal medicine. 1969;124(3):274-81.
- Akçalı Ö, Ko¸ say C, Günal I, Alıcı E. Bilateral trochanteric fractures of the femur in a patient with chronic renal failure. International orthopaedics. 2000;24(3):179-80.
- Piraino B, Chen T, Cooperstein L, Segre G, Puschett J. Fractures and vertebral bone mineral density in patients with renal osteodystrophy. Clinical nephrology. 1988;30(2):57-62.
- Tzamaloukas A, Murphy G, Schaab P, Worrel R. Conservative versus operative management of femoral neck fractures in patients on long-term dialysis. Nephron. 1990;55(2):229.
- Crawford R, Athanasou N. β2‐microglobulin amyloid deposition in hip revision arthroplasty tissues. Histopathology. 1998;33(5):479-84.
- Klein DM, Tornetta P, 3rd, Barbera C, Neuman D. Operative treatment of hip fractures in patients with renal failure. Clinical orthopaedics and related research. 1998(350):174-8.
- Sakabe T, Imai R, Murata H, Fujioka M, Iwamoto N, Ono T, et al. Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients. Journal of orthopaedic trauma. 2006;20(5):330-6.
- Lieberman JR, Fuchs MD, Haas SB, Garvin KL, Goldstock L, Gupta R, et al. Hip arthroplasty in patients with chronic renal failure. J Arthroplasty. 1995;10(2):191-5.
- Sakalkale DP, Hozack WJ, Rothman RH. Total hip arthroplasty in patients on long-term renal dialysis. The Journal of arthroplasty. 1999;14(5):571-5.
- Nagoya S, Nagao M, Takada J, Kuwabara H, Kaya M, Yamashita T. Efficacy of cementless total hip arthroplasty in patients on long-term hemodialysis. The Journal of arthroplasty. 2005;20(1):66-71.
- Naito M, Ogata K, Shiota E, Nakamoto M, Goya T. Hip arthroplasty in haemodialysis patients. The Journal of bone and joint surgery British volume. 1994;76(3):428-31.
- Blacha J, Kolodziej R, Karwanski M. Bipolar cemented hip hemiarthroplasty in patients with femoral neck fracture who are on hemodialysis is associated with risk of stem migration. Acta orthopaedica. 2009;80(2):174-8.
- Toomey HE, Toomey SD. Hip arthroplasty in chronic dialysis patients. J Arthroplasty. 1998;13(6):647-52.
- Gualtieri G, Vellani G, Dallari D, Catamo L, Gualtieri I, Fatone F, et al. Total hip arthroplasty in patients dialyzed or with renal transplants. La Chirurgia degli organi di movimento. 1995;80(2):139-45.
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