Abstract
BackgroundFor osteoporotic femoral neck fractures, suitable bone-implant stability is critical for pain relief, early return to daily activities and reduction of complications. Teriparatide (parathyroid hormone [PTH1-34]) can improve bone-implant stability in some basic studies. However it’s use in osteoporotic femoral neck fractures treated by cementless hemiarthroplasties for the beneficial effects on bone-implant stability is sparse in the literature. The aim of this study was to determine if post-operative teriparatide administration can reduce femoral stem migration and improve early functional recovery and health-related quality of life (HRQoL).MethodsBetween 2010 and 2014, patients with osteoporotic femoral neck fracture who underwent cementless bipolar hemiarthroplasty were included into this retrospective cohort study. Group A included patients treated with cementless bipolar hemiarthroplasty only; Group B patients had additional teriparatide. Demographic data, complications, radiographic and functional outcomes as well as health-related quality of life (HRQoL) were compared.ResultsThere were 52 hips in group A (no teriparatide) and 40 hips in group B (patient who received teriparatide). The subsidence of the femoral stem tended to be significantly decreased in the teriparatide group at 6 and 12 weeks post-operatively (p = 0.003 and p = 0.008, respectively). The Harris Hip Score (HHS) increased significantly from pre-operation to 6 weeks post-operatively and thereafter up to one year in both groups. However, there were no significant differences in terms of subsequent fracture, mortality, HHS, and HRQoL between two groups during the entire study period.ConclusionsTeriparatide significantly reduces the subsidence of the cementless femoral stem in elderly patients in the early post-operative period, but this benefit does not reflect better functional outcomes and HRQoL. Further prospective randomized large-scale cohort study is warranted for evidence-based recommendations.
Highlights
For osteoporotic femoral neck fractures, suitable bone-implant stability is critical for pain relief, early return to daily activities and reduction of complications
We manually reviewed patient records in our database to identify all patients who met the indication of teriparatide treatment
There were no differences in age, body mass index, American Society of Anesthesiologists (ASA) classification, hospital stay, Bone mineral density (BMD) of the contralateral hip, femoral stem-canal ratio, and follow-up time between the two groups (Table 1)
Summary
For osteoporotic femoral neck fractures, suitable bone-implant stability is critical for pain relief, early return to daily activities and reduction of complications. Teriparatide (parathyroid hormone [PTH1-34]) can improve bone-implant stability in some basic studies. It’s use in osteoporotic femoral neck fractures treated by cementless hemiarthroplasties for the beneficial effects on bone-implant stability is sparse in the literature. Displaced femoral neck fracture has been treated traditionally with cemented or cementless hemiarthroplasty, with the goal of accomplishing pain relief and early recovery of daily activities, Bisphosphonate (BP) has been demonstrated to possess anti-fracture efficacy, preventing peri-prosthetic bone loss [5] and lowering the risk of revision surgery after hip. Recent animal studies reveal an acceleration of fracture healing and improvement of bone-implant stability in teriparatidetreated animals [10]. Teriparatide appears to enhance fracture healing [11], accelerate lumbar postero-lateral fusion [12], lessen the risk of pedicle screw loosening [13], and increase the purchase of the pedicle screws to the bone [14]
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