Thompson Hemiarthroplasty Research Articles

INCIDENCE OF FEMORAL OSTEOLYSIS IN THE TITANIUM ALLOY THOMPSON PROSTHESIS

The Thompson hemiarthroplasty is a common treatment option for acute neck of femur fractures in the elderly population. Our department noted a significant number of patients returning with thigh pain, radiographic loosening and femoral osteolysis following cemented implantation of the titanium alloy version of the Thompson hemiarthroplasty. We are not aware of any previous reports documenting complications specific to the titanium Thompson implant and a retrospective cohort study was therefore initiated following clinical governance approval.366 titanium alloy Thompson prostheses were implanted for hip fracture treatment between 2017 and 2020. As of February 2023, 6 of these have been revised at our hospital. 5 were revised for symptomatic femoral osteolysis and 1 presented with an acute periprosthetic fracture. All revised cases were determined to be aseptic. 32 living patients were excluded from recall on compassionate grounds due to permanent nursing home residence. 47 living patients were identified of which 33 attended for xray. 28 deceased and/or nursing home resident patients who had pelvis x-rays in the previous 12 months were also included in the analysis. Including the 6 index hips already revised, a total of 61 hip xrays were analysed, of which 19 hips (31.1%) showed radiographic evidence of femoral osteolysis or loosening.We conclude that there is a concerning incidence of femoral osteolysis and implant loosening associated with the titanium Thompson implant. We have discontinued use of the implant and reported our experience to the MHRA. We encourage other Scottish Health-Boards who use this implant to consider enhanced follow-up.

Thompson Hemiarthroplasty for Femoral Neck Fracture Is Associated With Increased Risk of Dislocation

BackgroundThis contemporaneous large multicenter retrospective study reflective of current practice, assesses the impact of patient factors, prosthesis selection, and implant features on the risk of dislocation after hip hemiarthroplasty for femoral neck fracture. MethodsRadiographic records for 4116 consecutive patients who underwent a hip hemiarthroplasty between January 1, 2009 and September 30, 2017 at 3 acute hospitals (including a regional major trauma center) for a neck of femur fracture were reviewed in conjunction with United Kingdom National Hip Fracture Database records. ResultsIn total, 4116 patients were eligible for inclusion in the study; 63 of 4116 (1.5%) dislocations were identified. Patient age, gender, preoperative abbreviated mental test score, postoperative abbreviated mental test score, and American Society of Anaesthesiologists grade were not found to be significant predictors of dislocation rates (P < .05). The Furlong prosthesis was the most commonly used implant (2280/4116, 55.4%) followed by the Exeter V40 + Unitrax head (1179/4116, 28.6%), other implants used during the study period were the monoblock Austin-Moore and Thompson implants. Hemiarthroplasty operations undertaken with the Thompson (24/273, 3.7%) were found to have significantly higher dislocation rates (P < .05). Cemented vs uncemented, variable vs fixed offset, and monoblock vs modular implant designs did not contribute to higher dislocation rates (P < .05). Surgeon seniority was also not a significant risk factor for subsequent dislocation (P < .05). ConclusionsThompson hip hemiarthroplasties are associated with higher dislocation rates when compared to a contemporaneous cohort of implant choices and considerations for their use should be made in conjunction with this major risk factor for the need for subsequent operations.

Correction to: Uncemented Thompson's hemiarthroplasty: safe, palliative and cost-effective surgery in the infirm patient-a consecutive series of 1445 cases.

The original version of this article unfortunately contained a mistake. David Morley was not listed among the authors.

Historically, did Cemented Thompson perform better than uncemented Austin Moore hemiarthroplasty for femoral neck fractures? A meta-analysis of available evidence.

Introduction: Thompson and Austin Moore prostheses have been commonly used in hemiarthroplasties for displaced femoral neck fractures. There has been considerable debate about which of these prostheses is preferred. The purpose of this meta-analysis was to compare historical data for clinical outcomes of cemented Thompson and uncemented Austin Moore hemiarthroplasty in displaced femoral neck fractures.Methods: We searched Medline via PubMed, Cochrane Central, Scopus, Ovid and Web of Science for relevant articles up to February 2019. The included outcomes measured were hip function, hip pain, implant-related complications, surgical complications, reoperation rate and hospital stay. The data were pooled as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) between the two compared groups in a meta-analysis model.Results: Ten studies (four RCTs and six observational studies) with a total of 4378 patients were included in the final analysis. The pooled RR showed that the Thompson group was associated with a lower incidence of postoperative hip pain (RR = 0.66, 95% CI [0.54, 0.80]), lesser reoperation rate (RR = 0.46, 95% CI [0.24, 0.88]), lesser intraoperative fractures (RR = 0.15, 95% CI [0.09, 0.25]), but a longer operative time (MD = 12.04 min, 95% CI [2.08, 22.00]) in comparison to the Austin Moore group. The effect estimate did not favour either group in terms of hip function, periprosthetic fractures, prosthetic dislocations, wound infection, mortality and hospital stay.Conclusion: Evidence shows that Thompson hemiarthroplasty is better than Austin Moore hemiarthroplasty in terms of hip pain, reoperation rate and intraoperative fractures. Whereas the postoperative hip function is equivalent, these results could be considered when assessing the outcomes in modern hips.

Uncemented Thompson's hemiarthroplasty: safe, palliative and cost-effective surgery in the infirm patient-a consecutive series of 1445 cases.

Guidelines on the management of displaced intracapsular fractures recommend using an Orthopaedic Data Evaluation Panel-rated cemented implant. Prior to the National Institute for Health and Care Excellence guidelines, uncemented implants were commonly used in the UK. We retrospectively examined the outcomes of patients with uncemented Thompson's hemiarthroplasties at our unit, between April 2005 and December 2010. Patients who underwent revision surgery before December 2011 were identified. Implant survival calculation utilised the primary outcome of revision to total hip arthroplasty, revision hemiarthroplasty or excision arthroplasty. Patients who died post-operatively were identified and censored. A total of 1445 patients received uncemented Thompson's implant. Patient mean age was 82years with 76% female. Forty-six (3.2%) patients required revision with 15% performed within 30days of surgery and 62% within 1year. Reasons for revision were infection (0.83%), acetabular erosion (0.83%) and loosening (0.62%). Twenty-seven patients (59% of total revisions) underwent revision to THA, 14 (30%) to excision arthroplasty and 5 (11%) to revision hemiarthroplasty. Cumulative survival rate was 98% at 1year and 95% at 5years. Thirty-day mortality was 7.1%. One-year mortality was 28.1%. Current guidelines strongly favour cemented hemiarthroplasty. Recognition that fractured hip patients are a non-homogeneous group is important. In patients with limited life expectancy, an uncemented Thompson is a quick, simple, palliative solution to early mobilisation. Correct surgical technique avoids using cement in this cohort, which is most vulnerable to bone cement implantation syndrome. Cost-effective resource utilisation with an increasingly elderly population remains a surgical responsibility.

Thompson hemiarthroplasty versus modular unipolar implants for patients requiring hemiarthroplasty of the hip: A systematic review of the evidence.

ObjectivesThe objective of this study was to assess all evidence comparing the Thompson monoblock hemiarthroplasty with modular unipolar implants for patients requiring hemiarthroplasty of the hip with respect to mortality and complications.MethodsA literature search was performed to identify all relevant literature. The population consisted of patients undergoing hemiarthroplasty of the hip for fracture. The intervention was hemiarthroplasty of the hip with a comparison between Thompson and modular unipolar prostheses.Pubmed, Embase, CINAHL, Web of Science, PROSPERO and the Cochrane Central Register of Controlled Trials.The study designs included were randomised controlled trials (RCTs), well designed case control studies and retrospective or prospective cohort studies. Studies available in any language, published at any time until September 2015 were considered. Studies were included if they contained mortality or complications.ResultsThe initial literature search identified 4757 items for examination. Four papers were included in the final review. The pooled odds ratio for mortality was 1.3 (95% confidence Interval 0.78 to 2.46) favouring modular designs. The pooled odds ratio for post-operative complications was 1.1 (95% CI 0.79 to 1.55) favouring modular designs. Outcomes were reported at 12 or six months. These papers all contained potential sources of bias and significant clinical heterogeneity.ConclusionThe current evidence comparing monoblock versus modular implants in patients undergoing hemiarthroplasty is weak. Confidence intervals around the pooled odds ratios are broad and incorporate a value of one. Direct comparison of outcomes from these papers is fraught with difficulty and, as such, may well be misleading. A well designed randomised controlled trial would be helpful to inform evidence-based implant selection.Cite this article: A. L. Sims, A. J. Farrier, M. R. Reed, T. A. Sheldon. Thompson hemiarthroplasty versus modular unipolar implants for patients requiring hemiarthroplasty of the hip: A systematic review of the evidence. Bone Joint Res 2017;6:–513. DOI: 10.1302/2046-3758.68.BJR-2016-0256.R1.

Cemented Thompson's hemiarthroplasty in patients with intracapsular neck of femur fractures: survival analysis of 1,670 procedures.

Cemented Thompson's prostheses have been used to treat elderly patients with displaced intracapsular hip fractures at our two units for the last 15 years, amid growing support for the use of newer implant designs for hip hemiarthroplasty. This provided us with an opportunity to investigate survival of the Thompson's stem in our patients. A retrospective cohort study was set up to review previously collected data on patients who underwent Thompson's hemiarthroplasty over a 7-year period. These were linked to surgical notes, clinical letters and radiographs to record post-operative course and subsequent admissions and procedures. The identifiers were then linked to mortality data from the Office of 'National Statistics. Kaplan-Meier survival analyses were done for implants and patients. A total of 1,632 patients (mean age 82.7 years) underwent 1,670 procedures. Five-year implant survival was 95.4 %. A total of 36 stems were revised, including 14 revisions to total hip arthroplasty and 22 excision arthroplasties. Reasons for revision included infection (2.1 %), dislocation (1.1 %) and aseptic loosening (0.5 %). Symptomatic aseptic loosening and acetabular erosion occurred late (mean time 3.2 and 5.7 years, respectively following surgery). Aseptic loosening and erosion following hemiarthroplasty are relatively late complications.

Historical Implant or Current Best Standard? Minimum Five Year Follow-Up Outcomes of Cemented Thompson Hemiarthroplasties

UK NICE guidelines recommend abandoning the Thompson hemiarthroplasty (TH) in favour of a ‘proven prosthesis’ such as the Exeter Trauma Stem. The aim of this study was to assess the hip fracture treatment with the TH. Between 2002 and 2006, 430 cemented THs were performed (minimum 5year follow-up). Death rates at 1year and 5years were 26.6% and 67.4% with low complication (Dislocation 1.4%) and revision rate (1.2%). The TH remains a reliable and proven implant in appropriate patients (over the age of 80, with low activity levels, low ambulatory status and who maybe cognitively impaired), due to low complication and revision rates. Modern implants may provide better function or longevity, but there is little evidence to support abandoning the TH.

Does using a modular variable offset hemiarthroplasty reduce length of stay after hip fracture? Early experience with the Exeter Unipolar hemiarthroplasty

The Exeter Unipolar hemiarthroplasty is a variable offset modular device. We compared the early results of the Exeter Unipolar (Exeter) with the Cemented Thompson (Thompson) hemiarthroplasty in a retrospective cohort study. One hundred and twenty-three patients underwent Thompson (n = 68) or Exeter (n = 55) hemiarthroplasty by 24 different primary surgeons. Median follow-up was 9 months (interquartile range (IQR) 6–11, Range 3–13). Median length of stay was lower in the Exeter group 5.72 days (IQR 4.01–7.95, Range 2.7–33.7) vs 6.99 days (IQR 4.58–9.24, Range 1.2–59), p = 0.048. Median time to discharge from rehabilitation was also lower in the Exeter group (13.6 days (IQR 11.0–23.8, Range 5.8–59) vs 21.7 days (IQR 16.0–31.2, Range 1.2–86.3), p = 0.0003). Three Thompson prostheses dislocated, there was one deep infection and one superficial wound infection. One Exeter prosthesis became infected requiring revision; there were no dislocations. There were no statistically significant differences between groups in other factors studied. Power analysis suggested these differences should have been observed if present. Rehabilitation was faster in the Exeter group. This might result from more accurate restoration of femoral neck offset during surgery. The higher cost of the Exeter prosthesis is likely to be offset by the reduction in length of hospital stay. The Exeter Unipolar hemiarthroplasty reduces length of stay and hastens rehabilitation after hip fracture.

Comparison of the Exeter Trauma Stem and the Thompson Hemiarthroplasty for Intracapsular Hip Fractures

A planned change in the prosthesis used for hip hemiarthroplasty in one orthopaedic trauma unit from the Thompson prosthesis to the Exeter Trauma Stem (ETS) was studied. We completed a prospective continuous audit study comparing outcomes for patients undergoing the procedure before (766 patients) and after (388 patients) the change of practice. Outcomes measured included surgical complications (including infection or dislocation) and a postoperative radiographic review. There was no difference in the incidence of surgical complications between the groups, and no difference in ratings given to postoperative radiographs between both groups. In theory, the ETS may be easier to revise, should this be required in future, but in other respects the devices are comparable.

Is there benefit for using smooth tapered cemented hemiarthroplasties in ASA grade 3 and 4 patients

Following the recommendation of NICE guidelines (CG124) we have recently started using cemented smooth tapered stem hemiarthroplasty as our standard management of intra-capsular neck of femur fractures. Prior to publication of the above guidelines the standard implant utilised was Thompson Hemiarthroplasty prosthesis. The cost implications of this change have not been fully appreciated and the benefit of these changes in ASA grade 3–4 patients has not previously been analysed. We identified a cohort of 89 patients admitted with displaced intra-capsular neck of femur fracture with an ASA grade 3–4. These underwent hip hemiarthroplaties at our centre over a period of 12 months (before and after guideline implementation). Data regarding in-hospital mortality, dislocation, reoperation and place of discharge were retrospectively collected and analysed. Our cohort included 46 patients who underwent a Thompsons Hemiarthroplasty, 30 patients who had a cemented smooth tapered stem hemiarthroplasty and 13 patients who had an Austin-moore Hemiarthroplasty. In-patient mortality rates were highest in the Austin-moore group, followed by the Thompsons group compared to none in the smooth tapered stem group. However, this was not statistically significant. One patient in the Thompsons group and one patient in the smooth tapered group had multiple dislocations and re-operations, compared with none in the Austin-moore group. In terms of percentage of patients who were discharged home from hospital the smooth tapered stem group had a percentage that was more than twice that of the Thompson9s which was in turn higher than that found in the Austin-moore group. In conclusion, our data suggests that in patients with an ASA grade of 3–4 there is no significant benefit from using cemented smooth tapper stems when performing a Hip Hemiarthroplasty compared with a well performed Thompsons and that the cost savings of this is significant. We accept that our current numbers are relatively small and further work is needed.

One year mortality rates for Thompson Hemiarthroplasty

One year mortality rates for Thompson Hemiarthroplasty

Revision rates of Thompson hemiarthroplasty for intra-capsular neck of femur fractures

Revision rates of Thompson hemiarthroplasty for intra-capsular neck of femur fractures

Cemented Thompson hemiarthroplasty versus cemented Exeter Trauma Stem (ETS) hemiarthroplasty for intracapsular hip fractures: A randomised trial of 200 patients

Numerous different designs of hemiarthroplasty are available but few have been compared within the context of a randomised controlled trial. Two-hundred patients presenting with a displaced intracapsular fracture of the hip were randomised to receive either a cemented Thompson hemiarthroplasty or a cemented smooth tapered stem hemiarthroplasty (Exeter Trauma Stem). All operations were undertaken or directly supervised by one surgeon using the same operative approach. Patients were followed up for 1 year from injury by a research nurse blinded to the treatment used. The smooth tapered stem was felt to present less operative difficulties compared to the Thompson prosthesis. There were no other statistically significant differences in outcomes between the two prostheses.

A Comparative Study of the Postoperative Morbidity and Mortality in Femoral Neck Fractures in Elderly Patients Treated With Cemented and Uncemented Thompson Hemiarthroplasty

Background Thompson hip hemiarthroplasty is a well-established procedure for the treatment of displaced intracapsular fracture neck of femur in the elderly. However, considerable debate exists regarding the use of cemented prosthesis in this elderly group of patients. The main purpose of our study was to analyse the outcomes following cemented and uncemented Thompson hemiarthroplasty of the hip with particular reference to cement-related morbidity and 30-day mortality. Methods Of the 110 patients who underwent Thompson hemiarthroplasty for intracapsular hip fracture, 30 (27.3%) had cemented and 80 (72.7%) had uncemented prosthesis. The mean age was 83.2 years with 87 female patients. The thigh pain and mobility at discharge, the inpatient complications and the 30-day mortality rates were compared between the cemented and uncemented groups. Results The study revealed no statistically significant differences in any of the postoperative outcome measures between the two groups. Conclusion Cemented and uncemented Thompson hip hemiarthroplasty have similar outcomes at discharge. Patients who underwent cementation without pressurisation did not show any higher incidence of bone cement implantation syndrome compared to their uncemented counterparts. Uncemented Thompson hemiarthroplasty can be an option in patients with very poor cardiopulmonary reserve without any significant complications in the short term.

A note of caution: size mismatch between the reamer rasp and the actual Thompson hemiarthroplasty implant

Objective We present two case reports of patients who underwent cemented Thompson’s hemiarthroplasty.

An Abbreviated cementing technique for Thompson’s Hemiarthroplasty.

Thompsons Prosthesis is one of the most commonly used hemiarthroplasty for the neck of femur fractures. We describe an abbreviated cementing technique for Thompson Hemiarthroplasty which has the benefit of preserving the bone stock and reduction in operating time. We looked at 24 patients who underwent hemiarthroplasty using this technique with a very good outcome.

Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures

We undertook a prospective randomised controlled trial involving 400 patients with a displaced intracapsular fracture of the hip to determine whether there was any difference in outcome between treatment with a cemented Thompson hemiarthroplasty and an uncemented Austin-Moore prosthesis. The surviving patients were followed up for between two and five years by a nurse blinded to the type of prosthesis used. The mean age of the patients was 83 years (61 to 104) and 308 (77%) were women. The degree of residual pain was less in those treated with a cemented prosthesis (p < 0.0001) three months after surgery. Regaining mobility was better in those treated with a cemented implant (p = 0.005) at six months after operation. No statistically significant difference was found between the two groups with regard to mortality, implant-related complications, re-operations or post-operative medical complications. The use of a cemented Thompson hemiarthroplasty resulted in less pain and less deterioration in mobility than an uncemented Austin-Moore prosthesis with no increase in complications.

Thompson hemiarthroplasty of hip: Is cement an essential ingredient?

Introduction: Thompson hemiarthroplasty of hip for fractured neck of femur is traditionally done with cement to improve stability of fixation. Thompson prosthesis was designed originally to be used without cement. It has now become a routine practice to cement this prosthesis in most centres. In our department most elderly patients with a fractured neck of femur are treated with an uncemented Thompson prosthesis. Cement is used only if the prosthesis appears unstable at any stage of the operation. Materials & Methods: We audited all thompson hemi-arthroplasties performed over a year with a minimum follow up of a year. Results: In hospital mortality was 9.5% and 1 year mortality was 47.6%. Prosthesis survival at end of first year with revision as end point was 100%. We found acceptable complication rate in these patients; respiratory infection (19%), cardiac failure (6%). The rate of dislocation (1.5%) and deep infection (3%) were low as well. Intra-operatively plan was changed and 5 prostheses were cemented because of obvious loose fit. Conclusions: We conclude that cement is not an essential ingredient in Thompson hemiarthroplasty. Along with the obvious reduction in cost, a low revision rate in contrast to general belief makes it an even more attractive option in these elderly patients.

Cemented hemiarthroplasty after a femoral neck fracture. Survivorship analysis

To analyze the factors that affect the survivorship of subjects treated by hemiarthroplasty after a femoral neck fracture. This is a retrospective study of 1196 consecutive subcapital fractures in 1166 patients treated with a Thompson hemiarthroplasty between 1989 and 2001 for a femoral neck fracture. A clinical follow-up was made of a random sample of 220 fractures. Of these, 210 cases were followed up for at least two years or until the patients’ death (95.5%). A multivariate analysis was carried out of the effect on survivorship of age, gender, associated conditions, delay of surgery and post-op complications. Implant survivorship was also analyzed. Median survivorship was 4.5 years. Male gender had a higher mortality rate (RR = 2.47, 95% confidence interval: 1.65-3.70; p < 0.001) as did old age (RR = 1.04, CI: 1.01-1.07; p = 0.005). Although, delay of surgery did not affect long-term survivorship, it did affect survivorship at 6 months: patients operated the same day they were admitted had a higher mortality rate than those operated in the first 10 days after admission (33.3% vs. 10.4%; OR = 4.38; CI: 1.12-16.5; p = 0.03). Only three implants had to be explanted, all of them further to aseptic loosening. The factors that most significantly contribute to mortality in this group of patients are male gender, age and the presence of a disease. A 24-hour delay of surgery can increase short-term survivorship. Implants rarely fail. Analizar los factores que afectan a la supervivencia de sujetos tratados con hemiartroplastia tras una fractura subcapital de fémur. Estudio retrospectivo de 1.196 fracturas subcapitales consecutivas en 1.166 pacientes tratados con hemiartroplastia de Thompson tras una fractura subcapital de fémur entre 1989 y 2001. Se realizó seguimiento clínico de una muestra aleatoria de 220 fracturas; de éstas, 210 casos fueron seguidos al menos dos años o hasta el fallecimiento (95,5%). Se realizó un análisis multivariante del efecto de la edad, el sexo, las enfermedades asociadas, la demora de la intervención quirúrgica y las complicaciones postoperatorias en la supervivencia. Se analizó también la supervivencia de los implantes. La mediana de supervivencia fue de 4,5 años. El sexo masculino incrementaba la mortalidad (riesgo relativo [RR]= 2,47; intervalo de confianza para un 95% [IC 95%]: 1,65-3,70; p < 0,001) y también la edad avanzada (RR = 1,04; IC 95%: 1,01-1,07; p = 0,005). La demora de la intervención quirúrgica no afectaba la supervivencia a largo plazo, pero sí a los 6 meses teniendo los operados en el día del ingreso una mortalidad superior a la de los operados en los primeros 10 días tras el ingreso (33,3% frente a 10,4%; odds ratio [OR] = 4,38; IC 95%:1,12-16,5; p = 0,03). Sólo tres implantes fueron retirados, todos ellos por aflojamiento aséptico. Los factores que más aumentan la mortalidad en este grupo de pacientes son el sexo masculino, la edad y la presencia de enfermedades. Una demora de la intervención de 24 horas puede aumentar la supervivencia a corto plazo. Los implantes rara vez fracasan.