SpringerLink
Log in

Duokopf- versus Totalendoprothese zur Versorgung von Schenkelhalsfrakturen

Ist die Hemiendoprothese eine halbe Sache?

Hemiarthroplasty vs. total hip arthroplasty in the treatment of femoral neck fractures

Is hemiarthroplasty only a half measure?

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

In Deutschland ist die Therapie der Wahl der dislozierten medialen Schenkelhalsfraktur des älteren Menschen die endoprothetische Versorgung innerhalb von 24 h. Als operative Optionen stehen sich die Hüfttotalendoprothese (HTEP) und die Hemiendoprothese (HE) gegenüber.

Fragestellung

Es wird folgenden Fragen nachgegangen: differenzierte Patientenselektion für HTEP oder HE, „Ist die HE eine halbe Sache?“, zementierte oder zementfreie (Schaft‑)Implantation, geänderte Vorgehensweise durch neue, operative Zugänge.

Material und Methode

Es erfolgte eine Analyse der nationalen Prothesenregister sowie des Endoprothesenregister Deutschlands (EPRD) mit Darstellung der Versorgungshäufigkeit der medialen Schenkelhalsfraktur mit der endoprothetischen Versorgung durch HE vs. HTEP.

Ergebnisse

Die Durchsicht der nationalen Register zeigt eine Favorisierung der zementierten Technik bei älteren Patienten und bestätigt die niedrigeren Luxations- und Revisionsraten für die HE im Vergleich zur HTEP. Aus den Daten des EPRD zeigt sich, dass 2017 insgesamt 9,5 % der hüftendoprothetischen Eingriffe mit HEs durchgeführt wurden. Es ergab sich eine höhere Revisionsrate für nichtelektive HTEPs von 7,0 % im Vergleich zu HEs mit 4,5 %.

Schlussfolgerungen

Die Auswahl des Implantats für die endoprothetische Versorgung nach medialer Schenkelhalsfraktur ist abhängig von einer Vielzahl von patienten-, operateur- und implantatspezifischen Faktoren. Die geringeren Revisionsraten der HE widerlegen die Annahme, dass eine HE nur „eine halbe Sache“ sei. Anteriore oder anterolaterale Zugänge sind dem posterioren Zugang hinsichtlich Luxationstendenz überlegen. Nationale Unterschiede zeigen sich in Bezug auf die Zementierung der Prothese.

Abstract

Background

In Germany the treatment of choice for dislocated medial femoral neck fractures in older patients is arthroplasty of the hip within 24 h. Operative options include total hip arthroplasty (THA) and hemiarthroplasty (HA).

Objective

Differentiated patient selection for THA or HA, is HA only a half measure, cemented or cementless (stem) implantation, altered approach due to new surgical access routes?

Material and methods

Analysis of the national prosthesis registers worldwide and the German Arthroplasty Register (EPRD) with presentation of the rates of arthroplasty options THA vs. HA for dislocated medial femoral neck fractures.

Results

The review of the national registries showed that a cemented technique was favored in older patients and confirmed the lower revision rate for HA. The data from the EPRD showed that in 2017 a total of 9.5% of all hip arthroplasty surgeries were performed with HA. There was a higher revision rate for patients undergoing non-elective THA (7.0%) compared to HA (4.5%).

Conclusion

The choice of implant in hip arthroplasty for medial femoral neck fractures depends on a variety of patient, surgeon and implant-specific factors. The significantly lower revision rate of the HA disproves the assumption that HA is “only a half measure”. Anterior or lateral approaches seem to be superior compared to posterior approaches, particularly with respect to the dislocation rate. National differences are evident in cementation of the prosthesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Bonnaire F, Weber A (2015) AWMF S2e-Leitlinie 012/001 – Schenkelhalsfraktur des Erwachsenen

    Google Scholar 

  2. Grothaus F‑J, Hasenpflug J, Jansson V, Liebs TR, Mannel H, Melsheimer O, Steinbrück A, Wente M (2015) Endoprothesenregister Deutschland (EPRD) – Statusbericht 2014. EPRD Deutsche Endoprothesenregister, Berlin

    Google Scholar 

  3. Grimberg A, Jansson V, Liebs TR, Melsheimer O, Steinbrück A (2016) Endoprothesenregister Deutschland (EPRD) – Jahresbericht 2015. EPRD, Berlin

    Google Scholar 

  4. Grimberg A, Jansson V, Liebs TR, Melsheimer O, Steinbrück A (2017) Endoprothesenregister Deutschland (EPRD) – Jahresbericht 2016. EPRD, Berlin

    Google Scholar 

  5. Grimberg A, Jansson V, Liebs TR, Melsheimer O, Steinbrück A (2018) Endoprothesenregister Deutschland (EPRD) – Jahresbericht 2017. EPRD, Berlin

    Google Scholar 

  6. Lübbeke A, Silman AJ, Barea C, Prieto-Alhambra D, Carr AJ (2018) Map** existing hip and knee replacement registries in Europe. Health Policy 122:548–557

    Article  Google Scholar 

  7. Yli-Kyyny T, Sund R, Heinanen M, Venesmaa P, Kroger H (2014) Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures? Acta Orthop 85:49–53

    Article  Google Scholar 

  8. Leonardsson O, Karrholm J, Akesson K, Garellick G, Rogmark C (2012) Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop 83:459–466

    Article  Google Scholar 

  9. Moerman S, Mathijssen NMC, Tuinebreijer WE, Vochteloo AJH, Nelissen R (2018) Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision. Acta Orthop 89:509–514

    Article  Google Scholar 

  10. National Joint Registry UK (2018) 15th annual report national joint registry for England, Wales, Northern Ireland and the Isle of Man

    Google Scholar 

  11. Kannan A, Kancherla R, McMahon S, Hawdon G, Soral A, Malhotra R (2012) Arthroplasty options in femoral-neck fracture: answers from the national registries. Int Orthop 36:1–8

    Article  Google Scholar 

  12. Picus R, Ziernhöld G, Bonetti M (2017) 2. Bericht Prothesenregister Hüftprothesen 2010–2015 Autonome Provinz Bozen. Autonome Provinz Bozen, Bozen

    Google Scholar 

  13. Gillam MH, Ryan P, Graves SE, Miller LN, de Steiger RN, Salter A (2010) Competing risks survival analysis applied to data from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 81:548–555

    Article  Google Scholar 

  14. Costain DJ, Whitehouse SL, Pratt NL, Graves SE, Ryan P, Crawford RW (2011) Perioperative mortality after hemiarthroplasty related to fixation method. Acta Orthop 82:275–281

    Article  Google Scholar 

  15. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (2018) Hip, Knee & Shoulder Arthroplasty: 2018 Annual Report. AOANJRR, Adelaide

    Google Scholar 

  16. Parker MJ, Gurusamy KS, Azegami S (2010) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001706.pub4

    Article  PubMed  Google Scholar 

  17. Hansson S, Nemes S, Karrholm J, Rogmark C (2017) Reduced risk of reoperation after treatment of femoral neck fractures with total hip arthroplasty. Acta Orthop 88:500–504

    Article  Google Scholar 

  18. Ochi H, Baba T, Homma Y, Matsumoto M, Watari T, Ozaki Y, Kobayashi H, Kaneko K (2017) Total hip arthroplasty via the direct anterior approach with a dual mobility cup for displaced femoral neck fracture in patients with a high risk of dislocation. SICOT J 3:56

    Article  Google Scholar 

  19. Assi CC, Barakat HB, Caton JG, Najjar EN, Samaha CT, Yammine KF (2019) Mortality rate and mid-term outcomes of total hip Arthroplasty using dual mobility cups for the treatment of femoral neck fractures in a middle eastern population. J Arthroplasty 34(2):333. https://doi.org/10.1016/j.arth.2018.10.030

    Article  PubMed  Google Scholar 

  20. Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J (2007) A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br 89:160–165

    Article  CAS  Google Scholar 

  21. Gjertsen JE, Fenstad AM, Leonardsson O, Engesaeter LB, Karrholm J, Furnes O, Garellick G, Rogmark C (2014) Hemiarthroplasties after hip fractures in Norway and Sweden: a collaboration between the Norwegian and Swedish national registries. Hip Int 24:223–230

    Article  Google Scholar 

  22. Cornell CN, Levine D, O’Doherty J, Lyden J (1998) Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly. Clin Orthop Relat Res 348:67–71

    Article  Google Scholar 

  23. Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur—13 year results of a prospective randomised study. Injury 31:793–797

    Article  CAS  Google Scholar 

  24. Keating JF, Grant A, Masson M, Scott NW, Forbes JF (2005) Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty. Health Technol Assess (Rockv) 9:iii–iv, ix–x, 1–65

    CAS  Google Scholar 

  25. Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, Bannister GC (2011) Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br 93:1045–1048

    Article  CAS  Google Scholar 

  26. Baker RP, Squires B, Gargan MF, Bannister GC (2006) Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Am 88:2583–2589

    Article  CAS  Google Scholar 

  27. Nilsson LT, Jalovaara P, Franzen H, Niinimaki T, Stromqvist B (1994) Function after primary hemiarthroplasty and secondary total hip arthroplasty in femoral neck fracture. J Arthroplasty 9:369–374

    Article  CAS  Google Scholar 

  28. Nemes S, Lind D, Cnudde P, Bulow E, Rolfson O, Rogmark C (2018) Relative survival following hemi-and total hip arthroplasty for hip fractures in Sweden. BMC Musculoskelet Disord 19:407

    Article  Google Scholar 

  29. Azegami S, Gurusamy KS, Parker MJ (2011) Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials. Hip Int 21:509–517

    Article  Google Scholar 

  30. Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 16:229

    Article  Google Scholar 

  31. Frenken MRM, Schotanus MGM, van Haaren EH, Hendrickx R (2018) Cemented versus uncemented hemiarthroplasty of the hip in patients with a femoral neck fracture: a comparison of two modern stem design implants. Eur J Orthop Surg Traumatol 28:1305–1312

    Article  CAS  Google Scholar 

  32. Langslet E, Frihagen F, Opland V, Madsen JE, Nordsletten L, Figved W (2014) Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5‑year followup of a randomized trial. Clin Orthop Relat Res 472:1291–1299

    Article  Google Scholar 

  33. Kärrholm J, Lindahl H, Malchau H, Mohaddes M, Nemes S, Rogmark C, Rolfson O (2017) The Swedish hip arthroplasty register—annual report 2016

    Google Scholar 

  34. Ames JB, Lurie JD, Tomek IM, Zhou W, Koval KJ (2010) Does surgeon volume for total hip arthroplasty affect outcomes after hemiarthroplasty for femoral neck fracture? Am J Orthop 39:E84–E89

    PubMed  Google Scholar 

  35. Sheikh HQ, Aqil A, Hossain FS, Kapoor H (2018) There is no weekend effect in hip fracture surgery—A comprehensive analysis of outcomes. Surgeon 16:259–264

    Article  Google Scholar 

  36. NZOA—New Zealand Orthopaedic Association (2018) The New Zealand joint registry 19th year report January 1999 to December 2017. NZOA—New Zealand Orthopaedic Association, New Zealand

    Google Scholar 

  37. Bhandari M, Sprague S, Schemitsch EH (2009) Resolving controversies in hip fracture care: the need for large collaborative trials in hip fractures. J Orthop Trauma 23:479–484

    Article  Google Scholar 

  38. Hochfelder JP, Khatib ON, Glait SA, Slover JD (2014) Femoral neck fractures in New York State. Is the rate of THA increasing, and do race or payer influence decision making? J Orthop Trauma 28:422–426

    Article  Google Scholar 

  39. Woon CYL, Moretti VM, Schwartz BE, Goldberg BA (2017) Total hip arthroplasty and hemiarthroplasty: US national trends in the treatment of femoral neck fractures. Am J Orthop 46:E474–E478

    PubMed  Google Scholar 

  40. Masionis P, Uvarovas V, Mazarevicius G, Popov K, Venckus S, Bauzys K, Porvaneckas N (2019) The reliability of a Garden, AO and simple II stage classifications for intracapsular hip fractures. Orthop Traumatol Surg Res 105:29. https://doi.org/10.1016/j.otsr.2018.11.007

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. BG Unfallklinik Murnau, Endoprothetikzentrum der Maximalversorgung (EPZmax), Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland

    Sven Hungerer M.D., Claudio Glowalla & Markus Berninger

  2. Institut für Biomechanik, Paracelsus Medizinische Universität (PMU) Salzburg an der BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland

    Sven Hungerer M.D.

  3. BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland

    Fabian Stuby

Authors
  1. Sven Hungerer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudio Glowalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Markus Berninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabian Stuby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sven Hungerer M.D..

Ethics declarations

Interessenkonflikt

S. Hungerer, C. Glowalla, M. Berninger und F. Stuby geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hungerer, S., Glowalla, C., Berninger, M. et al. Duokopf- versus Totalendoprothese zur Versorgung von Schenkelhalsfrakturen. Trauma Berufskrankh 21, 31–38 (2019). https://doi.org/10.1007/s10039-019-0421-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-019-0421-3

Schlüsselwörter

Keywords

Search

Navigation