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High Incidence of Intraoperative Fractures With a Specific Cemented Stem Following Intracapsular Displaced Hip
Melissa Laflamme1, Michèle Angers1, Jessica Vachon2
1Department of Orthopaedic Surgery, CHU de Québec - Centre Hospitalier de l'Université Laval (CHUL), Québec City, Québec, Canada.
Insights
The Corail cemented stem led to a significantly higher incidence of intraoperative fractures in geriatric hip fracture patients compared to the OmniFit EON stem. Implant design may require reevaluation due to these findings.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Geriatric medicine
Background:
- Standardization of orthopedic implants was implemented to reduce costs in a hospital group.
- A new cemented stem (Corail) replaced the standard stem for intracapsular displaced geriatric hip fractures.
- Increased intraoperative calcar and trochanteric fractures were observed after the implant change.
Purpose of the Study:
- To determine the incidence of intraoperative periprosthetic fractures with the Corail cemented stem.
- To compare fracture rates between the Corail stem and the previous implant (OmniFit EON).
- To investigate potential factors contributing to intraoperative fractures in geriatric hip fracture repair.
Main Methods:
- Retrospective cohort study design.
- Comparison of two groups: historic cohort (OmniFit EON) and new cohort (Corail stem).
- Review of operative reports and radiographs by four orthopedic surgeons.
Main Results:
- The Corail group (348 patients) showed a 15.5% incidence of intraoperative calcar or trochanteric fractures.
- The control group (OmniFit EON, 77 patients) had a 2.7% fracture incidence (P < .05).
- No patient or surgeon factors explained the increased fracture rate in the Corail group.
Conclusions:
- The Corail cemented stem is associated with a high rate of iatrogenic intraoperative fractures in geriatric patients with displaced femoral neck fractures.
- No external factors identified to explain the elevated fracture incidence.
- The design of the Corail implant warrants further investigation regarding its role in these fractures.
Background:
To reduce costs of orthopedic implants, the government decided to standardize implants used across different specialties in a group of hospitals located in the same geographic area. The usual cemented stem used in the context of intracapsular displaced geriatric hip fractures was replaced by another stem. Abnormal intraoperative calcar and trochanteric fractures were noted. The purpose of this study is to determine the incidence of intraoperative periprosthetic fractures following an intracapsular displaced hip fracture treated with this specific cemented stem compared to the previous implant.
Methods:
This is a retrospective cohort study comparing an historic cohort of hip fractures treated with the OmniFit EON (Stryker, Kalamazoo, MI) cemented stem with a new cohort of patients who received the Corail (DePuy Synthes, Warsaw, IN) cemented stem. Four orthopedic surgeons reviewed operative reports and postoperative radiographs.
Results:
The treatment group included 348 patients who received the Corail stem. The control group included 77 patients. The 2 groups had similar baseline characteristics (P > .05) except for the presence of dementia. Incidence of intraoperative calcar or greater trochanteric fracture was 15.5% for the Corail group and 2.7% for the control group (P < .05). No patient-related factors or surgeon-related factors were related to a higher number of fractures in the treatment group (P > .05).
Conclusion:
The Corail cemented stem presents an abnormal number of iatrogenic intraoperative fractures following displaced femoral neck fracture in our geriatric population. No external factor seems to explain this high number of fractures. Implant design should be questioned.
Level Of Evidence:
III.
