title: Effects of teriparatide on cementless bipolar hemiarthroplasty in patients with osteoporotic femoral neck fractures.
abstract: For osteoporotic femoral neck fractures, suitable bone-implant stability is critical for pain relief, early return to daily activities and reduction of complications. Teriparatide (parathyroid hormone [PTH1-34]) can improve bone-implant stability in some basic studies. However it's use in osteoporotic femoral neck fractures treated by cementless hemiarthroplasties for the beneficial effects on bone-implant stability is sparse in the literature. The aim of this study was to determine if post-operative teriparatide administration can reduce femoral stem migration and improve early functional recovery and health-related quality of life (HRQoL).
  
  
  
  Between 2010 and 2014, patients with osteoporotic femoral neck fracture who underwent cementless bipolar hemiarthroplasty were included into this retrospective cohort study. Group A included patients treated with cementless bipolar hemiarthroplasty only; Group B patients had additional teriparatide. Demographic data, complications, radiographic and functional outcomes as well as health-related quality of life (HRQoL) were compared.
  
  
  
  There were 52 hips in group A (no teriparatide) and 40 hips in group B (patient who received teriparatide). The subsidence of the femoral stem tended to be significantly decreased in the teriparatide group at 6 and 12 weeks post-operatively (p = 0.003 and p = 0.008, respectively). The Harris Hip Score (HHS) increased significantly from pre-operation to 6 weeks post-operatively and thereafter up to one year in both groups. However, there were no significant differences in terms of subsequent fracture, mortality, HHS, and HRQoL between two groups during the entire study period.
  
  
  
  Teriparatide significantly reduces the subsidence of the cementless femoral stem in elderly patients in the early post-operative period, but this benefit does not reflect better functional outcomes and HRQoL. Further prospective randomized large-scale cohort study is warranted for evidence-based recommendations.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan.|Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tsan-Wen
authors.initials: TW
authors.lastname: Huang
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan.|Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan.
authors.forename: Shih-Jie
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan.
authors.forename: Po-Yao
authors.initials: PY
authors.lastname: Chuang
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.|Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsin-Nung
authors.initials: HN
authors.lastname: Shih
authors.affiliation: Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Niaosong Dist., Kaohsiung City, 83301, Taiwan. bone@doctor.com.|Chang Gung University, Taoyuan, Taiwan. bone@doctor.com.
authors.forename: Mel S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan. wwh@adm.cgmh.org.tw.|Chang Gung University, Taoyuan, Taiwan. wwh@adm.cgmh.org.tw.
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
authors.affiliation: PO CHENG Orthopedic Institute, 100 Bo-ai 2nd Road Zuoying District, Kaohsiung, Taiwan.
authors.forename: Wun-Jer
authors.initials: WJ
authors.lastname: Shen
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D062785:Hemiarthroplasty / Q000379:methods*; D006621:Hip Joint / Q000000981:diagnostic imaging; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000401:mortality / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011475:Prosthesis Failure / Q000187:drug effects*; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D019379:Teriparatide / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide
keywords: Femoral neck fracture; Hip arthroplasty; Implant migration; Osteoporosis; Teriparatide