Research Article

Hemiartroplasti Bipolar menghasilkan luaran C-Reactive Protein dan Harris Hip Score yang lebih tinggi dibandingkan Cephalomedulary Nailing

Komang Septian Sandiwidayat , Putu Astawa, Ketut Gede Mulyadi Ridia, Ketut Siki Kawiyana, I Wayan Suryanto Dusak, I Ketut Suyasa, I Gede Eka Wiratnaya, Anak Agung Wiradewi Lestari

Komang Septian Sandiwidayat
Program Studi Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, Bali, Indonesia. Email: septiansandiwidayat@gmail.com

Putu Astawa
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia

Ketut Gede Mulyadi Ridia
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia

Ketut Siki Kawiyana
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia

I Wayan Suryanto Dusak
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia

I Ketut Suyasa
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia

I Gede Eka Wiratnaya
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia

Anak Agung Wiradewi Lestari
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana/RSUP Sanglah Denpasar, Bali, Indonesia
Online First: April 01, 2020 | Cite this Article
Sandiwidayat, K., Astawa, P., Ridia, K., Kawiyana, K., Dusak, I., Suyasa, I., Wiratnaya, I., Lestari, A. 2020. Hemiartroplasti Bipolar menghasilkan luaran C-Reactive Protein dan Harris Hip Score yang lebih tinggi dibandingkan Cephalomedulary Nailing. Intisari Sains Medis 11(1): 346-351. DOI:10.15562/ism.v11i1.556


Background: Bipolar Hemiarthroplasty and Cephalomedullary Nailing (PFNA) are operative procedures for the management of proximal femoral fractures. Both of these surgical techniques have their respective advantages and disadvantages. This study aims to determine the differences in biological and functional outcomes. C-Reactive Protein (CRP) used to measure inflammation due to tissue damage and Harris Hip Score (HHS) used to measure functional output. This study hoped to facilitate the selection of appropriate techniques for the treatment of proximal femoral fractures.

Methods: Prospective cohort study conducted among patient with proximal femoral fractures who underwent Bipolar Hemiarthroplasty and PFNA surgery. CRP levels were examined before surgery and 12 hours postoperatively. The HHS assessment was performed at weeks 4, 6, and 8 postoperatively.

Results: In general, the preoperative CRP levels of the groups undergoing Bipolar Hemiarthroplasty and PFNA were not significantly different (32.4±16.7 and 33.7±17.1; p> 0.05), whereas postoperatively, Bipolar Hemiarthroplasty shown significantly higher CRP (76.5±27.3 and 42.6±17.6; p <0.0001). Similar results were also shown from the ∆CRP analysis (45.1±22.1 and 8.9±3.2; p<0.0001). The mean HHS score was higher in the Bipolar Hemiarthroplasty group than in PFNA group at each measurement. At the 4th week, the mean HHS score did not show a significant difference (52.3±4.2 vs 52.2±5.4; p>0.05). The 6th week evaluation showed Bipolar Hemiarthroplasty had a mean HHS of 76.5±4.6 while PFNA 61.4±5.4 (p <0.0001). At week 8, HHS in Bipolar Hemiarthroplasty was consistently higher than PFNA (89.43±4.5 and 74.95±4.9; p <0.0001). The Bipolar Hemiarthroplasty group was hospitalized 56% longer (6.1±1.3 and 3.9±1.3 days; p<0.0001) and the Bipolar Hemiarthroplasty had an average bleeding volume of 4.5 times more (407.4±122.8 and 90±13 ml; p <0.0001).

Conclusion: Bipolar Hemiarthroplasty and PFNA procedures have significantly different functional and biological outcomes. The postoperative HHS score in Bipolar Hemiarthroplasty is better but with a higher delta CRP.

 

Latar Belakang: Hemiarthroplasti bipolar dan Cephalomedullary Nailing (PFNA) merupakan prosedur operatif penatalaksanaan fraktur proksimal femur. Kedua prosedur tersebut menggunakan pendekatan yang berbeda utamanya pada upaya preservasi bagian proksimal femur. Kedua teknik bedah ini memiliki keuntungan dan kerugian masing-masing. Penelitian ini bertujuan untuk mengetahui perbedaan luaran biologis dan fungsional kedua teknik tersebut. C-Reactive Protein (CRP) digunakan sebagai parameter terkait inflamasi akibat kerusakan jaringan dan Harris Hip Score (HHS) digunakan mengukur luaran fungsional. Studi ini diharapkan dapat mempermudah pemilihan teknik yang tepat untuk penanganan fraktur proksimal femur.

Metode: Penelitian ini adalah penelitian kohort prospektif pada pasien dengan fraktur proksimal femur yang menjalani operasi Hemiartroplasti Bipolar dan PFNA. Kadar CRP diperiksa sebelum operasi dan 12 jam paska operasi. Penilaian HHS dilakukan pada minggu ke-4, 6, dan 8 paska operasi.

Hasil: Secara umum kadar CRP preoperasi kelompok yang menjalani Hemiarthroplasti Bipolar dan PFNA tidak berbeda signifikan (32,4±16,7 dan 33,7±17,1; p>0,05), sedangkan pada paska operasi kadar CRP Hemiarthroplasti Bipolar secara signifikan lebih tinggi (76,5±27,3 dan 42,6±17,6; p<0,0001). Hasil yang sama juga ditunjukan dari analisis ∆CRP (45,1±22,1 dan 8,9±3,2; p < 0,0001). Rerata skor HHS lebih tinggi pada kelompok Hemiarthroplasti Bipolar daripada PFNA pada setiap kali pengukuran. Pada minggu ke-4 nilai rerata HHS tidak menunjukan perbedaan yang signifikan (52,3±4,2 vs 52,2±5,4, p>0,05). Evaluasi minggu ke-6 menunjukan Hemiarthroplasti Bipolar memiliki rerata HHS 76,5±4,6 sementara PFNA 61,4±5,4 (p<0,0001). Pada minggu ke-8, HHS pada Hemiarthroplasti Bipolar konsisten lebih tinggi daripada PFNA (89,43±4,5 dan 74,95±4,9; p<0,0001). Kelompok Hemiarthroplasti Bipolar menjalani rawat inap 56% lebih lama (6,1±1,3 dan 3,9±1,3 hari; p < 0,0001) serta Hemiarthroplasti Bipolar memiliki rerata volume perdarahan 4,5 kali lebih banyak (407,4±122,8 dan 90±13 ml; p < 0,0001).

Kesimpulan: Prosedur Hemiarthroplasti Bipolar dan PFNA memiliki luaran fungsional dan biologis yang berbeda secara signifikan. Skor HHS pada Hemiarthroplasti Bipolar lebih baik tetapi selisih CRP yang lebih tinggi.

References

Saudan M., Lübbeke A., Sadowski C., Riand N., Stern R., Hoffmeyer P. Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail? J Orthop Trauma. 2002;16(6):386–93.

Bakker A., Blokhuis T., Meeks M., Hermens H., Holtslag H. Dynamic weight loading in older people with hip fracture. J Rehabil Med. 2014;46(7):708–11.

Tang P., Hu F., Shen J., Zhang L., Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: A study for the treatment of intertrochanteric fractures. Injury. 2012;43(6):876–81.

Parker M.J., Handoll H.H.G. Intramedullary nails for extracapsular hip fractures in adults. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 2006.

Min W.-K., Kim S.-Y., Kim T.-K., Lee K.-B., Cho M.-R., Ha Y.-C., et al. Proximal Femoral Nail for the Treatment of Reverse Obliquity Intertrochanteric Fractures Compared With Gamma Nail. J Trauma Inj Infect Crit Care. 2007;63(5):1054–60.

Kakkar R., Kumar S., Singh A.K. Cephalomedullary nailing for proximal femoral fractures. Int Orthop. 2005/01/13. 2005;29(1):21–4.

Young B., Gleeson M., Cripps A.W. C-reactive protein: A critical review. Pathology. 1991;23(2):118–24.

Wiryadana K.A., Supadmanaba I.G.P., Samatra D.P.G.P. Progress and potential roles blood biomarkers of ischemic stroke in clinical setting. Indones J Biomed Sci. 2017;11(2):19–29.

Bonnevialle P., Saragaglia D., Ehlinger M., Tonetti J., Maisse N., Adam P., et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop Traumatol Surg Res. 2011;97(6):S95–100.

Kumar P., Rajnish R.K., Sharma S., Dhillon M.S. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop. 2020;44(4):623–33.

Lee S.Y., Lee S.-H., Tan J.H.H., Foo H.S.L., Phan P.H., Kow A.W.C., et al. Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review. BMC Health Serv Res. 2018;18(1):5.

Munot S., Saraf H. Comparative study of PFN antirotation vs bipolar hemiarthroplasty in unstable senile intertrochanteric fractures. Indian J Orthop Surg. 2018;4(4):380–5.

Lagoe R.J., Johnson P.E., Murphy M.P. Inpatient hospital complications and lengths of stay: a short report. BMC Res Notes. 2011;4:135.

Esen E. Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Jt Dis Relat Surg. 2017;28(1):35–40.


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