Is calcium phosphate augmentation a viable option for osteoporotic hip
Received: 4 February 2018 /Accepted: 13 May 2018
International Osteoporosis Foundation and National Osteoporosis Foundation 2018
Summary The use of calcium phosphate bone cement has been described to allow for retention of reduction. Therefore, we
evaluated whether augmentation with resorbable calcium phosphate could improve fracture stability in osteoporotic hip fractures.
The results showed that augmentation with calcium phosphate cement significantly improved the stability of intertrochanteric
Introduction The aim with this study was to measure whether augmentation with resorbable calcium phosphate cement could
improve fracture stability in osteoporotic hip fractures.
Methods We retrospectively reviewed 82 patients who underwent closed reduction and internal fixation with proximal femoral
nail (PFN) for unstable intertrochanteric fractures between 2014 and 2017. In 42 of 82 patients, patients were treated with a PFN
alone (group I). These patients were compared with 40 patients for whom the same device combined with calcium phosphate
cement for augmentation was used (group II). Questionnaire surveys or telephone interviews were conducted and patients
completed a self-report Harris hip score (HHS) and visual analog scale (VAS) scores. Radiographic outcomes including mean
sliding distance of screw, femoral shortening, and varus collapse were compared. Postoperative complications were compared.
Results Clinical outcomes at 6 months after surgery were equivalent in both groups. Screw sliding, femoral shortening, and varus
collapse were all significantly reduced in the cemented group at the last follow-up (p <0.001,p =0.005,p <0.001,respectively).
A total of 9 (21%) complications occurred in group I. In contrast, 2 (5%) complications were seen in group II (p =0.029).
Conclusions Augmentation with calcium phosphate cement significantly improved the stability of intertrochanteric fractures
fixed with a PFN and reduced overall failure rates. We believe augmentation with resorbable calcium phosphate cement for
osteoporotic hip fractures is a reasonable option in selected patients.
Keywords Calcium phosphate
Intertrochanteric fractures are frequent injuries affecting elder-
ly, osteoporotic patients, leading to significant morbidity and
mortality. In elderly patients, unstable intertrochanteric frac-
tures of the femur are often associated with osteoporosis mak-
ing it difficult to achieve stable and reliable fixation. In pa-
tients with severe osteoporosis, loss of proximal fixation or
cut-out can occur when adequate fixation is not achieved in
the femoral head . With the advancing age of the general
population, complications during bone healing due to inade-
quate fixation cause a significant consumption of the re-
sources of the health care system [2, 3].
Available options to fill fracture voids include autogenous
bone, allograft bone, and synthetic bone materials. Calcium
phosphate cement has been reported in the treatment of frac-
tures , especially depressed tibial plateau fractures [5, 6]. The
application of calcium phosphates to metallic substrates takes
advantage of both the strength of the metal and the biocompat-
ibility of the ceramic . It is a precisely balanced β-tricalcium
phosphate/calcium sulfate hemihydrate compound that is used
* S.-J. Kim
Department of Orthopaedics, Hanil General Hospital, 308
Uicheon-ro, Dobong-Gu, Seoul 132-703, South Korea