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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 3, 294-303.
doi: 10.1302/0301-620X.91B3.21273  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Fractures of the hip and osteoporosis

THE ROLE OF BONE SUBSTITUTES

T. Lindner, MD, Orthopaedic Surgeon1; N. K. Kanakaris, MD, PhD, Orthopaedic Surgeon2; B. Marx, MD, Orthopaedic Surgeon1; A. Cockbain, MD, Senior House Officer2; G. Kontakis, MD, PhD, Assistant Professor3; and P. V. Giannoudis, BSc, MD, EEC(Ortho), Professor2

1 Center of Musculoskeletal Surgery, Department of Trauma Charité University Hospital, 13353 Berlin, Germany.
2 Department of Trauma and Orthopaedics, Academic Unit, Clarendon Wing, Floor A, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
3 Academic Unit, Trauma & Orthopaedic Surgery University of Crete, 1 Pindarou Street, 71305 Heraklion, Crete, Greece.

Correspondence should be sent to Professor P. V. Giannoudis; e-mail: pgiannoudi{at}aol.com

Failure of fixation is a common problem in the treatment of osteoporotic fractures around the hip. The reinforcement of bone stock or of fixation of the implant may be a solution. Our study assesses the existing evidence for the use of bone substitutes in the management of these fractures in osteoporotic patients. Relevant publications were retrieved through Medline research and further scrutinised. Of 411 studies identified, 22 met the inclusion criteria, comprising 12 experimental and ten clinical reports. The clinical studies were evaluated with regard to their level of evidence. Only four were prospective and randomised.

Polymethylmethacrylate and calcium-phosphate cements increased the primary stability of the implant-bone construct in all experimental and clinical studies, although there was considerable variation in the design of the studies. In randomised, controlled studies, augmentation of intracapsular fractures of the neck of the femur with calcium-phosphate cement was associated with poor long-term results. There was a lack of data on the long-term outcome for trochanteric fractures. Because there were only a few, randomised, controlled studies, there is currently poor evidence for the use of bone cement in the treatment of fractures of the hip.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General