Product overview

Hip Fracture Management

Hip Fracture Management

Intracapsular fractures

Garden type I

Abducted or impacted

Garden type II

Complete without

displacement

Garden Type III

Complete with partial

displacement

Garden Type IV

Complete with

displacement

Total hip replacement (THR) can offer clinical benefits over traditional

internal fixation or hemiarthroplasty solutions in the treatment of

intracapsular hip fracture.

Patients treated with THR have demonstrated better health outcomes1,2

and a significantly lower occurrence of increased pain levels at both 1 and

13 year intervals than those treated with hemiarthroplasty3, as well as

having fewer major re-operations4 and a lower risk of mortality5.

2 |

In September 2007 the British Orthopaedic

Association published a report in

collaboration with the British Geriatric

Society on the care of patients with fragility

fracture. The report stated that the use of

cemented arthroplasty ‘is associated with a

lower aseptic loosening rate, may also make

the hip less painful and improves function.

Accordingly, it should usually be preferred to

a cementless technique’6.

In 2011, a report produced in the UK by the

National Clinical Guideline Centre (NCGC)

and the National Institute for Health and

Clinical Excellence (NICE) recommended the

use of a ‘proven femoral stem design rather

than Austin Moore or Thompson stems’7 for

treating fractured necks of femur.

A systematic review8 of randomised

controlled trials compared the outcomes of

cemented and uncemented hemiarthroplasty

for treatment of intracapsular hip fractures.

Eight studies involving 1169 patients

were determined to be appropriate for the

required meta-analysis.

The report found a ‘lower reduction in

mobility score for those treated with a

cemented prosthesis’ and ‘fewer patients

with residual pain in the hip and lower pain

score (signifying less pain) for those treated

with a cemented prosthesis’.

Additionally the authors concluded that

‘there is good evidence that the use of

cement during hemiarthroplasty will reduce

the amount of residual hip pain and also

allow better restoration of function’ plus that

there is ‘no evidence of significant adverse

effects of cement on mortality or other

complications’.

| 3

Hip Fracture Management

TaperFit cemented femoral stems have been

in use for over 17 years and are clinically

proven to produce excellent results.

Manufactured from a high strength,

high nitrogen stainless steel alloy*, the

comprehensive range of 36, 38, 45 and

50mm offset stems allows the surgeon to fine

tune leg length, offset and femoral fill intra-

operatively and independently of each other.

The lateral shoulder provides for enhanced

visibility for more accurate in-line stem

placement, enhanced cement pressurisation

and may also increase rotational stability.

TaperFit is suitable for use with a wide range

of surgical philosophies and approaches.

TaperFit™

*BS EN ISO 215344 |

TaperFit is a collarless, polished and tapered

cemented stem based on biomechanical

principles that have been clinically proven

over more than 40 years9. These functionally

inseparable features allow for subsidence without

damaging the cement-bone interface10.

The TaperFit total hip system. Interim results in

an unselected consecutive cohort11

■ No revisions for obvious clinical stem loosening

■ Kaplan-Meier Survivorship: 97.7% at 7 years

The TaperFit total hip system 10 year results. An

unselected consecutive cohort12

■ Survivorship: 100.0% at 10 years for aseptic

loosening

Design | History | Function

| 5

Hip Fracture Management

MetaFix™

*BS EN ISO 21534

The MetaFix stem is manufactured from forged titanium alloy (Ti-6Al-4V)* and is corundum

grit blasted prior to being plasma sprayed with highly crystalline hydroxyapatite (HA) coating

for initial press-fit. This provides a biocompatible, osteoconductive surface for enhanced and

accelerated bone integration without producing an inflammatory response13,14.

The low modulus of elasticity of titanium alloy reduces the mismatch with the cortical

bone to minimise thigh pain while ensuring high fatigue resistance, strength and

biocompatibility13,14.

The MetaFix stem is straight and has a quadrangular cross-section. The proximal

section is flared in both planes for three-dimensional stabilisation in the metaphysis and

the distal portion is tapered to produce a stiffness gradient to avoid medullary blocking.

The horizontal and vertical grooves enhance primary mechanical stability13,14. The HA

coating is applied to the entire length of the stem to maximise osseointegration and to

prevent the interposition of a fibrous membrane around the distal portion of the stem

which is especially important during the early post-operative period and to prevent the

release of metal ions.

6 |

A low profile polished neck increases the head-neck diameter ratio,

reducing impingement and increasing the range of motion for the patient,

while meeting the highest international standards for fatigue strength.

MetaFix is a collarless, cementless, fully hydroxyapatite coated implant

that utilises a world-class stem design principle that has proven itself for

some 25 years in the clinical setting13,14 and is suitable for use with a wide

range of surgical philosophies and approaches.

Evolution | Versatility | Simplicity

The design was developed in France during the early 1980s by

a group of surgeons, the ARTRO Group, who trained together

in Lyon. Typical survivorship rates with stems of this type are:

■ 98% at 15 years in 2956 hips13.

■ 98% at 18 years in 5456 hips14.

| 7

Hip Fracture Management

Modular heads for hemiarthroplasty

Corin’s trunnion is compatible with a

comprehensive range of cobalt chrome alloy*

heads and BIOLOX® delta ceramic heads for total

hip replacement, as well as bipolar and unipolar

heads for hemiarthroplasty/fracture management.

The pre-assembled captive head of the bipolar

option provides maximum security and ease of

use. The eccentric, self-centring bipolar design

ensures against the adverse effects of varus

positioning.

When used with Corin’s range of hemiarthroplasty

(unipolar and bipolar) heads, the TaperFit stem

or MetaFix stem represents excellent choice for

treating fractured necks of femur.

*BS EN ISO 215348 |

Surgical technique*

3. Impacting the femoral headThe correct definitive Corin femoral head is placed on to the femoral stem with a twist and impacted to ensure taper engagement.

1. Sizing the headX-ray templates may be used pre-operatively to estimate the size the femoral head and assist in determining offset. Alternatively, the head gauge/sizer can also be used intra-operatively to directly measure the excised femoral head so that the appropriate component size can be selected.

2. Trialling the headThe appropriate diameter trial heads are used to determine which definitive Corin hemiarthoplasty implant will optimise offset and leg length. Note that the trial heads may be trialled directly on the neck of the trial broach/rasp or on the definitive Corin stem, depending on surgeon preference.

*The femur itself is prepared and the femoral component is implanted in accordance with the appropriate Corin surgical technique

Long neck Standard neck Short neck

| 9

Hip Fracture Management

CoCr Unipolar heads with Eurocone taper

Outer Ø Short neck Standard neck Long neck38mm E016.038 E016.138 E016.23839mm E016.039 E016.139 E016.23940mm E016.040 E016.140 E016.24041mm E016.041 E016.141 E016.24142mm E016.042 E016.142 E016.24243mm E016.043 E016.143 E016.24344mm E016.044 E016.144 E016.24445mm E016.045 E016.145 E016.24546mm E016.046 E016.146 E016.24647mm E016.047 E016.147 E016.24748mm E016.048 E016.148 E016.24849mm E016.049 E016.149 E016.24950mm E016.050 E016.150 E016.25051mm E016.051 E016.151 E016.25152mm E016.052 E016.152 E016.25253mm E016.053 E016.153 E016.25354mm E016.054 E016.154 E016.25455mm E016.055 E016.155 E016.25556mm E016.056 E016.156 E016.25657mm E016.057 E016.157 E016.25758mm E016.058 E016.158 E016.25859mm E016.059 E016.159 E016.25960mm E016.060 E016.160 E016.26061mm E016.061 E016.161 E016.26162mm E016.062 E016.162 E016.262

CoCr Bipolar heads with Eurocone taper

Outer Ø* Short neck Standard neck Long neck– – – –– – – –40mm E011.540 E011.640 E011.74041mm E011.541 E011.641 E011.74142mm E011.542 E011.642 E011.74243mm E011.543 E011.643 E011.74344mm E011.544 E011.644 E011.74445mm E011.545 E011.645 E011.74546mm E011.546 E011.646 E011.74647mm E011.547 E011.647 E011.74748mm E011.548 E011.648 E011.74849mm E011.549 E011.649 E011.74950mm E011.550 E011.650 E011.75051mm E011.551 E011.651 E011.75152mm E011.552 E011.652 E011.75253mm E011.553 E011.653 E011.75354mm E011.554 E011.654 E011.75455mm E011.555 E011.655 E011.75556mm E011.556 E011.656 E011.75657mm E011.557 E011.657 E011.75758mm E011.558 E011.658 E011.75859mm E011.559 E011.659 E011.75960mm E011.560 E011.660 E011.760– – – – _ _ _ _

*Inner head diameter 26mm

Ordering information

10 |

Hip continuum of care

| 11

Hip Fracture Management

The Corinium CentreCirencester, GL7 1YJt: +44(0)1285 659 866f: +44(0)1285 658 960e: info@coringroup.com

www.coringroup.com

References:

1. Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J. Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized controlled trial performed at four years. J Bone Joint Surg [Am] 2005;87:1680-8.

2. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty, treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg [Am] 2006;88:249-60.

3. Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of the femur – 13 year results of a prospective randomised study. Injury 2000; 31:793-7.

4. Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg [Am] 2006;88:2583-2589.

5. Parker MJ, Gurusamy KS. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database of Systematic Reviews. 2006; 4.

6. The care of patients with fragility fracture. A report published by the British Orthopaedic Association in collaboration with the British Geriatric Society, September 2007.

7. The management of hip fracture in adults - methods, evidence and guidance. Published by the National Clinical Guideline Centre (NCGC) at The Royal College of Physicians and the National Institute for Health and Clinical Excellence (NICE), England. 2011.

8. Azegami S, Gurusamy KS, Parker MJ. Cemented versus uncemented hemiarthroplasty for hip fractures: a systematic review of randomised controlled trials. Hip Int (2011;05) 509-517 21

9. Ling RSM, Charity J, Lee AJC, Whitehouse SL, Timperley AJ, Gie GA. The long-term results of the original Exeter polished cemented femoral component – A Follow-up Report. J Arthroplasty. Vol. 24 No. 4 2009.

10. Timperley AJ, Gie GA, Lee AJC, et al. The femoral component as a taper in cemented total hip arthroplasty. J Bone Joint Surg 1993;75-B(Suppl I):33.

11. Finlayson D, Baird K, Barnett K, Nelson R. The TaperFit Total Hip Interim Results – An unselected consecutive cohort. Data on file at Corin, 2004.

12. Finlayson D, Baird K, Barnett K, Nelson R. The TaperFit Total Hip System 10 year Results – An unselected consecutive cohort. Data on file at Corin, 2006.

13. Epinette JA, Manley MT. Fifteen years of clinical experience with hydroxyapatite coatings in joint arthroplasty. Springer-Verlag. 2004. 2-287-00508-0

14. Hallan G, Lie SA, Furnes O, Engesaeter LB, Vollset SE, Havelin LI. Medium and long term performance of 11516 uncemented femoral primary stems from the Norwegian arthroplasty register. J Bone Joint Surg [Br] 2007 Dec;89(12):1574-80

©2012 Corin P No. I934 Rev.1 01/2012 ECR 11462

Printed on 9lives 80 which contains 80% total recycled fibre and is produced at a mill which holds the ISO 14001 for Environmental Management Systems. The pulp is bleached using Elemental Chlorine Free processes.