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Safety and Effectiveness of the Anchor Augmentation with Bone Cement on Osteoporotic Femoral Fracture: A Systematic Reviews

Article information

J Musculoskelet Trauma. 2019;32(2):89-96
Publication date (electronic) : 2019 April 10
doi : https://doi.org/10.12671/jkfs.2019.32.2.89
So Young Kim, MPH
National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
Correspondence to: So Young Kim, MPH National Evidence-Based Healthcare Collaborating Agency, Namsan Square 7F, 173 Toegye-ro, Jung-gu, Seoul 04554, Korea Tel: +82-2-2174-2867 Fax: +82-2-2174-2800 E-mail: syni@neca.re.kr
Received 2019 January 22; Revised 2019 February 10; Accepted 2019 February 22.

Abstract

Abstract

Purpose

This paper reviewed the safety and effectiveness of anchor augmentation with bone cement in osteoporotic femoral fractures.

Materials and Methods

A systematic review was conducted by searching multiple databases including five Korean databases, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. Safety was assessed through the incidence of complication. The effectiveness was assessed through the failure rate of anchor fixation, improvement of function and radiological assessment (sliding distance of lag screw and cutout). The safety and effectiveness of anchor augmentation with bone cement were assessed by reviewing all articles reporting on the treatment. Two researchers carried out independently each stage from the literature search to data extraction. The tools of Scottish Intercollegiate Guidelines Networks were used to assess the quality of studies.

Results

Six studies were considered eligible. The safety results revealed a small amount of cement leakage (1 case), but no other severe complications were encountered. Regarding the effectiveness, the failure rate of anchor fixation was 16.7% and the Harris's hip score showed no significant improvement. The sliding distance of the anchor was similar in the cement augmentation group and non-cement group but there was no cutout.

Conclusion

The results of the assessment suggest that the safety is acceptable, but further research will be needed to verify the effectiveness of the treatment.

Keywords: Femur; Osteoporotic fractures; Bone cements; Systematic reviews
Fig. 1.

Study flowchart. Searching through the literature identified 1,824 documents. Of these, 196 studies duplicated data from other reports and were excluded. 1,622 studies did not meet the inclusion criteria. A total of six studies were included in the final evaluation.

Levels of Evidence

Grades of Recommendations (Health Insurance Review Agency 2005)

Selected Studies Characteristics

Safety Results: Complications Related to Intervention

Effectiveness Results: Improvement of Function

Effectiveness Results: Radiological Assessment

References

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Article information Continued

Copyright © 2019 The Korean Fracture Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fig. 1.

Fig. 1.

Study flowchart. Searching through the literature identified 1,824 documents. Of these, 196 studies duplicated data from other reports and were excluded. 1,622 studies did not meet the inclusion criteria. A total of six studies were included in the final evaluation.

Table 1.

Levels of Evidence

1++ • High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias
1+ • Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias
1– • Meta-analyses, systematic reviews, or RCTs with a high risk of bias
2++ • High quality systematic reviews of case control or cohort or studies
  • High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is
  causal
2+ • Well-conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship
  is causal
2– • Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
3 • Non-analytic studies, e.g., case reports, case series
4 • Expert opinion

RCT: randomized controlled trial.

Table 2.

Grades of Recommendations (Health Insurance Review Agency 2005)

A At least one meta-analysis, systematic review, or RCT rated as 1++, and directly applicable to the target population; or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target population, and demonstrating the overall consistency of results
B Body of evidence, including studies rated as 2++, directly applicable to the target population, and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 1++ or 1+
C Body of evidence including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++
D Evidence level 3 or 4; or extrapolated evidence from studies rated as 2+

RCT: randomized controlled trial.

Table 3.

Selected Studies Characteristics

No. Type Author (year) Country Patients (n) Intervention (cement) Quality of study
1 RCT Dall’Oca et al. (2010) [11] Italy Osteoporotic intertrochanteric fractures (80) Cement augmentation (PMMA) 1+
2 Case series Lin et al. (2015) [12] Korea Osteoporotic femoral neck fractures (6) Cement augmentation (PMMA) 3
3 Case series Kammerlander et al. (2014) [13] Austria Osteoporotic petrochanteric fractures (62) Cement augmentation (PMMA) 3
4 Case series Gupta et al. (2012) [14] India Osteoporotic trochanteric fractures (60) Cement augmentation (PMMA) 3
5 Case series Kwon et al. (2008) [15] Korea Osteoporotic intertrochanteric fractures* (10) Cement augmentation (PMMA) 3
6 Case series Benum (1997) [16] Norway Osteoporotic femoral fractures (14) Cement augmentation (PMMA) 3
*

Treatment of failed intertrochanteric fractures. RCT: randomized controlled trial, PMMA: polymethymethacrylate.

Table 4.

Safety Results: Complications Related to Intervention

No. Author (year) Patients (n) Complications
% (n) Specific complications
1 Dall’Oca et al. (2010) [11] Osteoporotic intertrochanteric fractures (80) – Intervention: 2.5 (1/40) – Comparator: NA Cement leakage
2 Lin et al. (2015) [12] Osteoporotic femoral neck fractures (6) 33.3 (2/6) Cement leakage
3 Kammerlander et al. (2014) [13] Osteoporotic petrochanteric fractures (62) 0 (0/62) –
4 Gupta et al. (2012) [14] Osteoporotic trochanteric fractures (60) 21.7 (13/60) Hematoma, infection, urinary retention
5 Benum (1997) [16] Osteoporotic femoral fractures (14) 0 (0/14) –

NA: not available.

Table 5.

Effectiveness Results: Improvement of Function

Author (year) Patients (n) Improvement of function
Index Pre-fracture Postoperation
Dall’Oca et al. (2010) [11] Osteoporotic intertrochanteric fractures (80) HHS Intervention: 56.49* Comparator: 56.75* Intervention: 59.71* Comparator: 59.86*
Kammerlander et al. (2014) [13] Osteoporotic petrochanteric fractures (62) Parker score 5.1 4.6
Gupta et al. (2012) [14] Osteoporotic trochanteric fractures (60) Normal Walking 96.7% 76.7%
Kwon et al. (2008) [15] Osteoporotic intertrochanteric fractures* (10) Clawson   Good: 30% Moderate: 60% Severe: 10%
Benum (1997) [16] Osteoporotic femoral fractures (14) Walking function   Most patients slightly or moderately impaired
*

p>0.05. HHS: Harris's hip score.

Table 6.

Effectiveness Results: Radiological Assessment

Author (year) Patients (n) Radiological assessment
Index Results
Dall’Oca et al. (2010) [11] Osteoporotic intertrochanteric fractures (80) Sliding distance (mm) Intervention: 12.7*
    Comparator: 14.2*
  Cut-out Intervention: 0%
    Comparator: 0%
Kammerlander et al. (2014) [13] Osteoporotic petrochanteric fractures (62) Sliding distance (mm) 5.2
  Cut-out 0%
Gupta et al. (2012) [14] Osteoporotic trochanteric fractures (60) Sliding distance (mm) 3.4
*

p>0.05.