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Di Martino A, Brunello M, Villari E, D'Agostino C, Cosentino M, Bordini B, Rivera F, Faldini C. Stem revision vs. internal fixation in vancouver B2/B3 periprosthetic hip fractures: systematic review and metanalysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05469-1. [PMID: 39105834 DOI: 10.1007/s00402-024-05469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Vancouver B2 and B3 periprosthetic fractures (PFF) are associated with stem instability and often require a demanding stem implant revision (SR) or internal fixation (ORIF). This latter surgery is increasingly performed in the last few years instead of SR, but it is unclear which is the best treatment to manage PFF patients. The aim of this study is the compare the outcomes of B2/B3 PFF managed by either ORIF or SR, by performing a systematic review and meta-analysis of current literature. MATERIALS AND METHODS Cochrane Database, PubMed, Google Scholar and MEDLINE were examined to find out relevant publications dealing with the different outcomes of SR vs. ORIF in B2/B3 PFF of the hip. The effect model (EM) was calculated using Cohen´s d index. RESULTS Fifteen studies were included, reporting on a total of 1629 patients (564 ORIF and 1065 SR). The pooled random EM estimates for reoperation was 0.87 (95% CI, 0.39-1.96; I2 = 78%) in favor of ORIF surgery; EM for complications was 1.01 (95% CI, 0.45-2.27; I2 = 85%) without difference among procedures. The EM for transfusion was 0.72 (95% CI, 0.46-1.12; I2 = 62%) in favor of fixation. CONCLUSION ORIF and SR were both suitable and effective options in PFF patients, being associated to similar complications rates. Our results show that ORIF performance in PFF patients is associated to significantly less in blood loss, surgical time and in-hospital stay. These advantages are particularly appealing in patients with multiple comorbidities.
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Affiliation(s)
- Alberto Di Martino
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy.
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy.
| | - Matteo Brunello
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
| | - Eleonora Villari
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
| | - Claudio D'Agostino
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Fabrizio Rivera
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano, 12038, Italy
| | - Cesare Faldini
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
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Aguado HJ, Castillón-Bernal P, Teixidor-Serra J, García-Sánchez Y, Muñoz-Vives JM, Camacho-Carrasco P, Jornet-Gibert M, Ojeda-Thies C, García-Portabella P, Pereda-Manso A, Mateos-Álvarez E, Manzano-Mozo J, Carrillo-Gómez R, País-Ortega S, García-Virto V, Noriega-González D, Álvarez-Ramos BA, Ganso-Pérez A, Cervera-Díaz C, Plata-García M, Ortega-Briones A, Berrocal-Cuadrado J, Criado del Rey-Machimbarrena D, Salvador J, Rey L, Tomás-Hernández J, Selga-Marsà J, Andrés-Peiró JV, Querolt-Coll J, Triana G, Vives-Barquiel M, Renau-Cerrillo M, Campuzano-Bitterling B, Hernández JM, Ostilla R, Carreras-Castañer A, Torner P, Díaz-Suárez R, Fernández EA, Olaya-González C, Fernández-Villán M, García de Cortázar U, Arrieta M, Escobar D, Castrillo E, Balvis P, Rodríguez-Arenas M, García-Pérez Á, Moreta J, Bidea I, Jiménez-Urrutia X, Olías-López B, Boluda-Mengod J, González-Martín D, Bárcena-Goitiandia L, López-Dorado D, Borrás-Cebrián JC, García-Aguilera D, Freile-Pazmiño PA, Suárez-Suárez MÁ, Lanuza-Lagunilla L, García-Arias A, Sánchez-Saz J, García-Coiradas J, Valle-Cruz J, Mora-Fernández J, Cano-Leira MÁ, Rieiro G, Benjumea-Carrasco A, Priego-Sánchez RJ, Sánchez-Pérez C, Guadilla-Arsuaga J, Fernández-Juan A, Sánchez P, Ricón J, Fuentes-Díaz A, García-García EM, Cuadrado-Abajo F, García-Portal G, del PozoManrique P, Castillo del Pozo V, Garcia-Navas FM, García-Paredero E, Beteta-Robles T, Guijarro-Valtueña A, Gutiérrez-Baiget G, Alonso-García N, Navas-Pernía I, Ariza-Herrera D, Vilanova J, Videla-Cés M, Serra-Porta T, Vázquez-García C, Carrasco-Becerra C, Pena-Paz S, Otero-Naveiro V, Fernández-Billón-Castrillo I, Martínez-Menduiña A, Hernández-Galera C, Fernández-Dorado F, Madrigal-López M, Murcia-Asensio A, Galián-Muñoz E, Castro-Sauras Á, Espallargas-Doñate T, Royo-Agustín M, Plaza-Salazar N, Gámez-Asunción C, Muñoz-Vicente A, Pareja-Sierra T, Benito-Santamaría J, Cuenca-Copete A, Verdejo-González A, González-Montero B, Giraldo-Vegas LA, Alonso-Viana L, Díez-Pérez EJ, Briso-Montiano R, Andrés AI, Mingo-Robinet J, Naharro-Tobío M, Escudero-Martínez E, Serrano-Sanz J, Peñalver-Matamoros JM, Fernàndez-Poch N, Martínez-Carreres L, Macho-Mier M, Martín-Hernández C, Laclériga-Giménez AF, Saló-Cuenca JC, Salamanca-Ontiveros C, Espona-Roselló J, Altemir-Martínez V, Criado-Albillos G, Cunchillos-Pascual J, Millán-Cid M, Cabello-Benavides HG, Martínez-Íñiguez-Blasco J, Sevilla-Ortega P, Cano JR, Ramírez A, Marqués-López F, Martínez-Díaz S, Carabelli GS, Slullitel PA, Astore I, Boietti BR, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Dot-Pascuet I, Pereira-Mosquera E, Martín-Antúnez J, Pérez JM, Mandía-Martínez A, De Caso J, Martín-Marcuello J, Benito-Mateo M, Murillo-Vizuete AD, Delgado LG, dela Herrán G, Nunes N, Pérez-Coto I, González-Panisello MR, Iglesias-Fernández S, Ruete-Gil GL, Ramos-García S, Villarreal JP. Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain. J Orthop Traumatol 2024; 25:13. [PMID: 38451303 PMCID: PMC10920552 DOI: 10.1186/s10195-024-00746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. METHODS PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. RESULTS The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. CONCLUSIONS Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge. Level of Evidence Level IV case series. TRIAL REGISTRATION registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 20-2041.
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Yoon BH, Park SG, Roh YH. Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis. Hip Pelvis 2023; 35:217-227. [PMID: 38125267 PMCID: PMC10728046 DOI: 10.5371/hp.2023.35.4.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2). Materials and Methods We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty. Results The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, P=0.542), nonunion (OR=0.49; CI 0.22-1.10, P=0.085) and deep infection (OR=1.89, CI 0.48-7.46, P=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), P=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, P=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, P=0.130). Conclusion ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong Gyun Park
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Young Hak Roh
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Toci GR, Stambough JB, Martin JR, Mears SC, Saxena A, Lichstein PM. Effect of Fracture Type, Treatment, and Surgeon Training on Reoperation After Vancouver B Periprosthetic Femur Fractures. J Arthroplasty 2023; 38:1864-1868. [PMID: 36933681 DOI: 10.1016/j.arth.2023.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The treatment of Vancouver B periprosthetic proximal femur fractures (PPFFs) is complex due to the overlap between arthroplasty and orthopedic trauma techniques. Our purpose was to assess the effects of fracture type, treatment difference, and surgeon training on the risk of reoperation in Vancouver B PPFF. METHODS A collaborative research consortium of 11 centers retrospectively reviewed PPFFs from 2014 to 2019 to determine the effects of variations in surgeon expertise, fracture type, and treatment on surgical reoperation. Surgeons were classified as per fellowship training, fractures using the Vancouver classification, and treatment as open reduction internal fixation (ORIF) or revision total hip arthroplasty with or without ORIF. Regression analyses were performed with reoperation as the primary outcome. RESULTS Fracture type (Vancouver B3 versus B1: odds ratio [OR]: 5.70) was an independent risk factor for reoperation. No differences were found in reoperation rates with treatment (ORIF versus revision: OR 0.92, P = .883). Treatment by a nonarthroplasty-trained surgeon versus an arthroplasty specialist led to higher odds of reoperation in all Vancouver B fracture (OR: 2.87, P = .023); however, no significant differences were seen in the Vancouver B2 group alone (OR: 2.61, P = .139). Age was a significant risk factor for reoperation in all Vancouver B fractures (OR: 0.97, P = .004) and in the B2 fractures alone (OR: 0.96, P = .007). CONCLUSION Our study suggests that age and fracture type affect reoperation rates. Treatment type did not affect reoperation rates and the effect of surgeon training is unclear.
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Affiliation(s)
- Gregory R Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Paul M Lichstein
- Novant Health Orthopaedics and Sports Medicine, Winston-Salem, North Carolina
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