Kognitif veya nöromusküler bozukluğu olan geriatrik hastalarda kalça kırığının tedavisinde iki farklı tipte çimentosuz kısıtlayıcı asetabular komponent kullanılarak yapılan total kalça protezi (TKP) uygulamasının sonuçlarının karşılaştırılması
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Date
2023
Authors
Kantarcı, Adnan
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Amaç: Bu çalışmada kognitif ve/veya nöromusküler bozukluğu olan geriatrik hastalarda gelişen kalça kırığının tedavisinde iki farklı tipte çimentosuz kısıtlayıcı asetabular komponent kullanılarak uygulanılan total kalça protezinin uygulamasının radyografik ve fonksiyonel sonuçlarının belirlenmesi ve karşılaştırılması amaçlandı. Gereç ve Yöntem: İleri yaş (>65 yıl) kognitif ve/veya nöromusküler bozukluğu olup kalça kırığı gelişen Longevity® veya Freedom® kısıtlı asetabular komponent (Grup I) ya da Trident® kısıtlı asetabular komponent (Grup II) kullanılarak total kalça protezi ile tedavi edilen hastalar geriye dönük değerlendirildi. Cinsiyet, Amerikan anestezi topluluğu (ASA) skoru, ek hastalık sayısı, kırık tipi, transfüzyon miktarı, spotorno indeksi, yatış süresi, yürüme fonksiyonlarının değerlendirilmesi, gelişen komplikasyonlar ve Charlson komorbidite indeksi ile ilişkisi ve erken dönem dislokasyon oranları gruplar arası karşılaştırıldı. Bulgular: Grup I’deki 17 olgunun (%42,5) yaş ortalaması 81,06 yıl (65- 92) ve ameliyat sonrası izlem 38,93 ay (13-70 ay) iken Grup II’deki 23 olguda (%57,5) bu değerler 80,39 yıl (65-102) ve 25,56 ay (6-52 ay) idi (yaş ortalaması p>0,05 – takip süreleri p<0,05). Gruplar arasında cinsiyet ve ameliyat tarafı arasında fark yoktu (p>0,05). Gruplar arasındaki ortalama fonksiyonel yürüme kapasitesinin ameliyat öncesi ve sonrası değişimin değerlendirilmesinde Grup I’deki olgularda ortalama 0,36 puan (2,5-2,14) azalma (%9), Grup II’de 0 puan (2,45-2,45) olarak tespit edildi. Grup I’deki ortalama fonksiyonel yürüme kapasitesindeki ameliyat öncesi ve ameliyat sonrasındaki azalma yönünde değişimin anlamlı olduğu tespit edildi (p<0,05). Grup I ve Grup II klinik ve radyolojik sonuçlarda fark tespit edilmedi (p>0,05). Kanama ve transfüzyon miktarı benzer bulundu. Komplikasyon ve morbidite oranları yakın bulundu (p>0,05). Gelişen komplikasyonların 2 olguda (%5,9) protez çıkığı, 2 olguda (%5,9) periprostetik kırık, 2 olguda (%5,9) enfeksiyon olarak saptanırken, gruplarda eşit sayıda dağıldığı tespit edildi (p>0,05). Sonuç: Çıkık riski yüksek geritatrik popülasyonda kognitif ve/veya nöromusküler bozukluğu olan hastalarda gelişen kalça kırığının tedavisinde iki farklı tipte çimentosuz kısıtlı asetabular komponent kullanılarak uygulanılan TKP olgularının sonuçlarının değerlendirildiği bu çalışmada radyolojik olarak, yatış sürelerinde, transfüzyon sayılarında, aspiratif dren miktarında, ameliyat sonrası komplikasyon gelişmesinde, ameliyattan sonra yoğun bakım takip gereksiniminde bir fark bulunamadı. Dislokasyon komplikasyonunu engellemek için seçilen bu modellerin her birinde 1 adet dislokasyon gelişmiş olup, fonksiyonel yürüme kapasiteleri değerlendirmesinde trident (Stryker® UK Ltd, Newbury, UK) kısıtlı asetabular komponent kullanılarak uygulanılan çimentosuz TKP sonuçlarında travma öncesi fonksiyonel sonuçlarına kavuştukları tespit edildi.
Purpose: In this study, it was aimed to determine and compare the radiographic and functional results of total hip replacement using two different types of cementless constrained acetabular components in the treatment of hip fracture in geriatric patients with cognitive and/or neuromuscular disorders. Material and Methods: Patients with advanced age (>65 years) with cognitive and/or neuromuscular disorders who developed hip fractures treated with a total hip replacement using the Longevity® or Freedom® constrained acetabular component (Group I) or Trident® constrained acetabular component (Group II) were evaluated retrospectively. Gender, ASA score, number of additional diseases, fracture type, amount of transfusion, spotorno index, length of hospital stay, evaluation of walking functions, developing complications and their relationship with Charlson comorbidity index and early dislocation rates were compared between groups. Results: While the mean age of 17 patients (42.5%) in Group I was 81.06 years (65-92) and the postoperative follow-up period was 38.93 months (13-70 months), 23 patients in Group II (57.5%) these values were 80.39 years (65-102) and 25.56 months (6-52 months) (the mean age p>0.05 - follow-up period p>0.05). There was no difference between the groups in terms of gender and operation side (p>0.05). In the evaluation of the preoperative and postoperative change in the mean functional walking capacity between the groups, a mean decrease of 0.36 points (2.5-2.14) in the cases in Group I (9%), 0 points in Group II (2.45-2, 45) was found. It was determined that the change in the mean functional walking capacity in Group I decreased before and after the operation was significant (p<0.05). There was no difference in Group I and Group II clinical and radiological results (p>0.05). The amount of bleeding and transfusion were similar. Complication and morbidity rates were found to be similar (p>0.05). Complications were found to be prosthetic dislocation in 2 cases (5.9%), periprosthetic fractures in 2 cases (5.9%), infection in 2 cases (5.9%), and they were equally distributed in the groups (p>0.05). Conclusion: In this study, in which the results of THA cases applied using two different types of cementless constrained acetabular components in the treatment of hip fracture in patients with cognitive and/or neuromuscular disorders in the geriatric population with a high risk of dislocation were evaluated, radiological findings, hospital stay, number of transfusions, amount of aspirative drain, development of postoperative complications, No difference was found in the need for intensive care follow-up after surgery. In each of these models selected to prevent dislocation complications, 1 dislocation developed, and in the evaluation of functional walking capacities, it was determined that the results of cementless THA applied using Trident (Stryker® UK Ltd, Newbury, UK) constrained acetabular component achieved functional results before trauma.
Purpose: In this study, it was aimed to determine and compare the radiographic and functional results of total hip replacement using two different types of cementless constrained acetabular components in the treatment of hip fracture in geriatric patients with cognitive and/or neuromuscular disorders. Material and Methods: Patients with advanced age (>65 years) with cognitive and/or neuromuscular disorders who developed hip fractures treated with a total hip replacement using the Longevity® or Freedom® constrained acetabular component (Group I) or Trident® constrained acetabular component (Group II) were evaluated retrospectively. Gender, ASA score, number of additional diseases, fracture type, amount of transfusion, spotorno index, length of hospital stay, evaluation of walking functions, developing complications and their relationship with Charlson comorbidity index and early dislocation rates were compared between groups. Results: While the mean age of 17 patients (42.5%) in Group I was 81.06 years (65-92) and the postoperative follow-up period was 38.93 months (13-70 months), 23 patients in Group II (57.5%) these values were 80.39 years (65-102) and 25.56 months (6-52 months) (the mean age p>0.05 - follow-up period p>0.05). There was no difference between the groups in terms of gender and operation side (p>0.05). In the evaluation of the preoperative and postoperative change in the mean functional walking capacity between the groups, a mean decrease of 0.36 points (2.5-2.14) in the cases in Group I (9%), 0 points in Group II (2.45-2, 45) was found. It was determined that the change in the mean functional walking capacity in Group I decreased before and after the operation was significant (p<0.05). There was no difference in Group I and Group II clinical and radiological results (p>0.05). The amount of bleeding and transfusion were similar. Complication and morbidity rates were found to be similar (p>0.05). Complications were found to be prosthetic dislocation in 2 cases (5.9%), periprosthetic fractures in 2 cases (5.9%), infection in 2 cases (5.9%), and they were equally distributed in the groups (p>0.05). Conclusion: In this study, in which the results of THA cases applied using two different types of cementless constrained acetabular components in the treatment of hip fracture in patients with cognitive and/or neuromuscular disorders in the geriatric population with a high risk of dislocation were evaluated, radiological findings, hospital stay, number of transfusions, amount of aspirative drain, development of postoperative complications, No difference was found in the need for intensive care follow-up after surgery. In each of these models selected to prevent dislocation complications, 1 dislocation developed, and in the evaluation of functional walking capacities, it was determined that the results of cementless THA applied using Trident (Stryker® UK Ltd, Newbury, UK) constrained acetabular component achieved functional results before trauma.
Description
Keywords
Total kalça protezi, Çıkık, Geriatri, Kognitif ve nöromusküler bozukluklar, Kısıtlayıcı asetabular komponent, Freedom, Longevity, Trident, Total hip arthroplasty, Dislocation, Geriatrics, Cognitive and neuromuscular disorders, Constrained acetabular component
Citation
Kantarcı, A. (2023). Kognitif veya nöromusküler bozukluğu olan geriatrik hastalarda kalça kırığının tedavisinde iki farklı tipte çimentosuz kısıtlayıcı asetabular komponent kullanılarak yapılan total kalça protezi (TKP) uygulamasının sonuçlarının karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.