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báo cáo hóa học:" The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intracapsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal index, a solution to preventing intra-operative periprosthetic fracture"

Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học quốc tế đề tài : The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intracapsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal index, a solution to preventing intra-operative periprosthetic fracture | Chana et al. Journal of Orthopaedic Surgery and Research 2011 6 59 http www.josr-online.eom content 6 1 59 JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH RESEARCH ARTICLE Open Access The suitability of an uncemented hydroxyapatite coated HAC hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients the Metaphyseal-Diaphyseal index a solution to preventing intra-operative periprosthetic fracture Rishi Chana1 Reza Mansouri1 Chris Jack1 Max R Edwards2 Ravi Singh3 Carmel Keller4 and Farid Khan1 Abstract This study will seek to identify a measurable radiographic index the Metaphyseal-Diaphyseal Index MDI score to determine whether intra-operative fracture in osteoporotic bone can be predicted. A 5 year prospective cohort of 560 consecutive patients undergoing hemiarthroplasty cemented or uncemented was evaluated. A nested case-control study to determine risk factors affecting intra-operative fracture was carried out. The Vancouver Classification was used to classify periprosthetic fracture. The MDI score was calculated using radiographs from the uncemented group. As a control gold standard Yeung et al s Canal Bone Ratio CBR score was also calculated. From this a receiver operating characteristic ROC curve was formulated for both scores and area under the curve AUC compared. Intra and inter-observer correlations were determined. Cost analysis was also worked out for adverse outcomes. Four hundred and seven uncemented and one hundred and fifty-three cemented stems were implanted. The use of uncemented implants was the main risk factor for intra-operative periprosthetic fracture. Sixty-two periprosthetic fractures occurred in the uncemented group 15.2 nine occurred in the cemented group 5.9 P 0.001. The revision rate for sustaining a periprosthetic fracture uncemented group was 17.7 P 0.001 and 90 day mortality 19.7 P 0.03. MDI s AUC was 0.985 compared to CBR s 0.948 P 0.001. The MDI score cut-off to predict fracture was 21 .