Hip Fracture Management. Product overview

Transcription

1 Hip Fracture Management Product overview

2 Hip Fracture Management Intracapsular fractures Total hip replacement (THR) can offer clinical benefits over traditional internal fixation or hemiarthroplasty solutions in the treatment of intracapsular hip fracture. Patients treated with THR have demonstrated better health outcomes 1,2 and a significantly lower occurrence of increased pain levels at both 1 and 13 year intervals than those treated with hemiarthroplasty 3, as well as having fewer major re-operations 4 and a lower risk of mortality 5. Garden type I Garden type II Garden Type III Garden Type IV Abducted or impacted Complete without Complete with partial Complete with displacement displacement displacement 2

3 In September 2007 the British Orthopaedic Association published a report in collaboration with the British Geriatric Society on the care of patients with fragility fracture. The report stated that the use of cemented arthroplasty is associated with a lower aseptic loosening rate, may also make the hip less painful and improves function. Accordingly, it should usually be preferred to a cementless technique 6. In 2011, a report produced in the UK by the National Clinical Guideline Centre (NCGC) and the National Institute for Health and Clinical Excellence (NICE) recommended the use of a proven femoral stem design rather than Austin Moore or Thompson stems 7 for treating fractured necks of femur. A systematic review 8 of randomised controlled trials compared the outcomes of cemented and uncemented hemiarthroplasty for treatment of intracapsular hip fractures. Eight studies involving 1169 patients were determined to be appropriate for the required meta-analysis. The report found a lower reduction in mobility score for those treated with a cemented prosthesis and fewer patients with residual pain in the hip and lower pain score (signifying less pain) for those treated with a cemented prosthesis. Additionally the authors concluded that there is good evidence that the use of cement during hemiarthroplasty will reduce the amount of residual hip pain and also allow better restoration of function plus that there is no evidence of significant adverse effects of cement on mortality or other complications. 3

4 Hip Fracture Management TaperFit TaperFit cemented femoral stems have been in use for over 17 years and are clinically proven to produce excellent results. Manufactured from a high strength, high nitrogen stainless steel alloy*, the comprehensive range of 36, 38, 45 and 50mm offset stems allows the surgeon to fine tune leg length, offset and femoral fill intraoperatively and independently of each other. The lateral shoulder provides for enhanced visibility for more accurate in-line stem placement, enhanced cement pressurisation and may also increase rotational stability. TaperFit is suitable for use with a wide range of surgical philosophies and approaches. 4 *BS EN ISO 21534

5 Design History Function TaperFit is a collarless, polished and tapered cemented stem based on biomechanical principles that have been clinically proven over more than 40 years 9. These functionally inseparable features allow for subsidence without damaging the cement-bone interface 10. The TaperFit total hip system. Interim results in an unselected consecutive cohort 11 No revisions for obvious clinical stem loosening Kaplan-Meier Survivorship: 97.7% at 7 years The TaperFit total hip system 10 year results. An unselected consecutive cohort 12 Survivorship: 100.0% at 10 years for aseptic loosening 5

6 Hip Fracture Management MetaFix The MetaFix stem is manufactured from forged titanium alloy (Ti-6Al-4V)* and is corundum grit blasted prior to being plasma sprayed with highly crystalline hydroxyapatite (HA) coating for initial press-fit. This provides a biocompatible, osteoconductive surface for enhanced and accelerated bone integration without producing an inflammatory response 13,14. The low modulus of elasticity of titanium alloy reduces the mismatch with the cortical bone to minimise thigh pain while ensuring high fatigue resistance, strength and biocompatibility 13,14. The MetaFix stem is straight and has a quadrangular cross-section. The proximal section is flared in both planes for three-dimensional stabilisation in the metaphysis and the distal portion is tapered to produce a stiffness gradient to avoid medullary blocking. The horizontal and vertical grooves enhance primary mechanical stability 13,14. The HA coating is applied to the entire length of the stem to maximise osseointegration and to prevent the interposition of a fibrous membrane around the distal portion of the stem which is especially important during the early post-operative period and to prevent the release of metal ions. 6 *BS EN ISO 21534

7 Evolution Versatility Simplicity A low profile polished neck increases the head-neck diameter ratio, reducing impingement and increasing the range of motion for the patient, while meeting the highest international standards for fatigue strength. MetaFix is a collarless, cementless, fully hydroxyapatite coated implant that utilises a world-class stem design principle that has proven itself for some 25 years in the clinical setting 13,14 and is suitable for use with a wide range of surgical philosophies and approaches. The design was developed in France during the early 1980s by a group of surgeons, the ARTRO Group, who trained together in Lyon. Typical survivorship rates with stems of this type are: 98% at 15 years in 2956 hips % at 18 years in 5456 hips 14. 7

8 Hip Fracture Management Modular heads for hemiarthroplasty Corin s trunnion is compatible with a comprehensive range of cobalt chrome alloy* heads and BIOLOX delta ceramic heads for total hip replacement, as well as bipolar and unipolar heads for hemiarthroplasty/fracture management. The pre-assembled captive head of the bipolar option provides maximum security and ease of use. The eccentric, self-centring bipolar design ensures against the adverse effects of varus positioning. When used with Corin s range of hemiarthroplasty (unipolar and bipolar) heads, the TaperFit stem or MetaFix stem represents excellent choice for treating fractured necks of femur. 8 *BS EN ISO 21534

9 Surgical technique* Long neck Standard neck Short neck 1. Sizing the head X-ray templates may be used pre-operatively to estimate the size the femoral head and assist in determining offset. Alternatively, the head gauge/sizer can also be used intraoperatively to directly measure the excised femoral head so that the appropriate component size can be selected. 2. Trialling the head The appropriate diameter trial heads are used to determine which definitive Corin hemiarthoplasty implant will optimise offset and leg length. Note that the trial heads may be trialled directly on the neck of the trial broach/rasp or on the definitive Corin stem, depending on surgeon preference. 3. Impacting the femoral head The correct definitive Corin femoral head is placed on to the femoral stem with a twist and impacted to ensure taper engagement. *The femur itself is prepared and the femoral component is implanted in accordance with the appropriate Corin surgical technique 9

10 Hip Fracture Management Ordering information CoCr Unipolar heads with Eurocone taper 10 Outer Ø Short neck Standard neck Long neck 38mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E CoCr Bipolar heads with Eurocone taper Outer Ø* Short neck Standard neck Long neck 40mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E mm E E E *Inner head diameter 26mm

11 Hip continuum of care 11

12 References: Hip Fracture Management 1. Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized controlled trial performed at four years. J Bone Joint Surg [Am] 2005;87: Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty, treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg [Am] 2006;88: Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of the femur 13 year results of a prospective randomised study. Injury 2000; 31: Baker RP, Squires B, Gargan MF, Bannister GC. 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] 2006;88: Parker MJ, Gurusamy KS. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database of Systematic Reviews. 2006; The care of patients with fragility fracture. A report published by the British Orthopaedic Association in collaboration with the British Geriatric Society, September The management of hip fracture in adults - methods, evidence and guidance. Published by the National Clinical Guideline Centre (NCGC) at The Royal College of Physicians and the National Institute for Health and Clinical Excellence (NICE), England Azegami S, Gurusamy KS, Parker MJ. Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials. Hip Int (2011;05) Ling RSM, Charity J, Lee AJC, Whitehouse SL, Timperley AJ, Gie GA. The long-term results of the original Exeter polished cemented femoral component A Follow-up Report. J Arthroplasty. Vol. 24 No Timperley AJ, Gie GA, Lee AJC, et al. The femoral component as a taper in cemented total hip arthroplasty. J Bone Joint Surg 1993;75-B(Suppl I): Finlayson D, Baird K, Barnett K, Nelson R. The TaperFit Total Hip Interim Results An unselected consecutive cohort. Data on file at Corin, Finlayson D, Baird K, Barnett K, Nelson R. The TaperFit Total Hip System 10 year Results An unselected consecutive cohort. Data on file at Corin, Epinette JA, Manley MT. Fifteen years of clinical experience with hydroxyapatite coatings in joint arthroplasty. Springer-Verlag Hallan G, Lie SA, Furnes O, Engesaeter LB, Vollset SE, Havelin LI. Medium and long term performance of uncemented femoral primary stems from the Norwegian arthroplasty register. J Bone Joint Surg [Br] 2007 Dec;89(12): The Corinium Centre Cirencester, GL7 1YJ t: +44(0) f: +44(0) e: info@coringroup.com Printed on 9lives 80 which contains 80% total recycled fibre and is produced at a mill which holds the ISO for Environmental Management Systems. The pulp is bleached using Elemental Chlorine Free processes Corin P No. I934 Rev.1 01/2012 ECR 11462