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Andrés-Peiró JV, Nomdedéu J, Aguado HJ, González-Morgado D, Minguell-Monyart J, Joshi-Jubert N, Teixidor-Serra J, Tomàs-Hernández J, Selga-Marsà J, García-Sánchez Y, Noriega-González DC, Mateos-Álvarez E, Pereda-Manso A, Cervera-Díaz MC, Balvis-Balvis P, García-Pérez Á, Rodríguez-Arenas M, Castro-Menéndez M, Moreta J, Olías-López B, Amaya-Espinosa P, Boluda-Mengod J, Bárcena-Goitilandia L, Blas-Dobón JA, Freile-Pazmiño P, Castillón P, Lanuza-Lagunilla L, Cabria-Fernández J, Valle-Cruz J, García-Coiradas J, Bonome-Roel C, Cano-Leira MDLÁ, Benjumea-Carrasco A, Chico-García M, Fernández-Juan A, Saura-Sánchez E, Sánchez-Gómez P, Ricón-Recarey FJ, García-García EM, Medrano-Morte I, Cuadrado-Abajo F, Pérez-Núñez MI, García-González S, Pozo-Manrique PD, García-Navas-García FM, García-Paredero E, Guijarro-Valtueña A, Navas-Pernía I, Videla-Cés M, Muñoz-Vives JM, Querolt-Coll J, Triana-López de Santamaría G, Serra-Porta T, Carrasco-Becerra MC, Pena-Paz S, Otero-Naveiro V, Fernández-Dorado F, Martínez-Menduiña A, Galián-Muñoz E, Hernández JM, Renau-Cerrillo M, Campuzano-Bitterling B, Carreras-Castañer A, Vives-Barquiel M, Camacho-Carrasco P, Jornet-Gibert M, Muñoz-Vicente A, Gámez-Asunción C, Plaza-Salazar N, Benito-Santamaría J, Cuenca-Copete A, Alonso-Viana L, Mingo-Robinet J, Briso-Montiano R, Barbería-Biurrun A, Chouza-Montero L, Ojeda-Thies C, Ajuria-Fernández E, Díaz-Suárez R, Gasset-Teixidor A, Domínguez-Ibarrola A, Gosálbez J, Pérez-Hevia I, Riera-Álvarez L, Roche-Albero A, Macho-Mier M, Criado-Albillos G, Cabello-Benavides HG, Cunchillos-Pascual J, Saló-Cuenca JC, Espona-Roselló J, Salamanca-Ontiveros C, García-Portabella P, Martínez-Íñiguez Blasco J, Sevilla-Ortega P, Cano-Porras JR, Martínez-Díaz S, Carabelli GS, Slullitel P, Astore I, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Sánchez-Hernández N, García-García G, Rodríguez-Gangoso A, Pérez-Sánchez JM, Piñeiro-Borrero A, Mandía-Martínez A, De Caso-Rodríguez J, Benito-Mateo M, Murillo-Vizuete AD, Herrán-Núnez GDL, Nunes-Ugarte N, Pérez-Salazar NE, De Sande-Díaz M, García-Fuentes XD, de Cortázar-Antolín UG, Sánchez DE. Predictors of outcomes after internal fixation of periprosthetic femoral hip fractures Subgroup analysis of the peri-implant and peri-prosthetic fractures Spanish registry (PIPPAS). Injury 2024; 55:111715. [PMID: 39032221 DOI: 10.1016/j.injury.2024.111715] [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: 04/02/2024] [Revised: 06/02/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems. METHODS Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay). RESULTS One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization. CONCLUSION Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization.
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Affiliation(s)
- José Vicente Andrés-Peiró
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Josep Nomdedéu
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Héctor J Aguado
- Department of Orthopaedic Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain.
| | - Diego González-Morgado
- Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Minguell-Monyart
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Nayana Joshi-Jubert
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Awwad K, Gebert C, Dudda M, Hardes J, Streitbürger A, Hanusrichter Y, Wessling M. The Megaendoprosthesis in Revision Arthroplasty - a Cost-revenue Analysis in the aG-DRG System. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37871630 DOI: 10.1055/a-2174-1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Megaendoprosthesis offer a viable treatment in complex revision arthroplasty cases with good functional outcome. In the context of a neoplastic indication, the diagnosis-related group (DRG) I95A is usually assigned with a relative weight of 4.906 (2021). In contrast, in revision arthroplasty, the appropriate DRG is assigned, depending on the joint replacement. The additional costs compared to the invoiced DRG are to be compensated by agreeing on hospital-specific individual fees. These complex revision arthroplasties set high technical and operative demands and are mainly performed in specialised departments. We conducted a cost-benefit analysis of the use of the megaendoprosthesis in revision cases in a specialised orthopaedic clinic, as a single centre study. The question we sought to answer was: Is cost recovery possible in the modified German DRG system (aG-DRG)?A retrospective single centre analysis of treatment costs was performed. From 2018 to 2020, 113 patients treated with a megaendoprosthesis reconstruction in a referral centre due to extensive bone loss after aseptic or septic revision of a hip or knee prosthesis were included in the study. Relevant case-related cost drivers of the aG-DRG matrix (including staff and material costs of the operating theatre area and the ward) were taken into account. The actual costs were determined according to the specifications of the calculation manual published by the German institute for the remuneration system in hospitals (InEK). For each case, the contribution margin was calculated by relating the hospital's internal costs to the corresponding cost pool of the aG-DRG matrix.According to the DRG system 2021, 17 different DRGs were used for billing - in 70% based on a patient clinical complexity level (PCCL) ≥ 4. Compared with the InEK calculation, there is a deficit of -2,901 € per case in the examined parameters. The costs of physicians show a shortfall in both the operating theatre and on the ward. Implant costs, which were supposed to be compensated by hospital-specific additional charges, show a hospital-specific shortage of -2,181 €. When analysing the risk factors for cost recovery, only these showed a significant difference.Implantation of the megaendoprosthesis in revision arthroplasty is often the last option to preserve limb function. At present, despite a high degree of specialisation and process optimisation, this treatment cannot be provided cost-effectively even in tertiary care. The politically desired specialised department structure requires sufficient reimbursement for complex cases. The economic outcome of each treatment case is often unpredictable, however the surgeon is confronted with these cases and is expected to treat them. The high standard deviation indicates large differences in the cost/revenue situation of each individual case. Our results show for the first time a realistic cost analysis for megaprosthesis in revision arthroplasty and underline the importance of an adequate hospital-specific charge, individually agreed by the funding units. The calculation should include not only the implant costs, but also the increased staff costs (increased, complex planning effort, quality management, surgery time, etc.).
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Affiliation(s)
- Katharina Awwad
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Carsten Gebert
- Abteilung für Tumororthopädie und Revisionsendoprothetik, Orthopädische Klinik Volmarstein, Wetter, Deutschland
| | - Marcel Dudda
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
| | - Jendrik Hardes
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Arne Streitbürger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Yannik Hanusrichter
- Abteilung für Tumororthopädie und Revisionsendoprothetik, Orthopädische Klinik Volmarstein, Wetter, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Martin Wessling
- Abteilung für Tumororthopädie und Revisionsendoprothetik, Orthopädische Klinik Volmarstein, Wetter, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
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Di Martino A, Pederiva D, Bordini B, Di Carlo G, Panciera A, Geraci G, Stefanini N, Faldini C. Proximal femoral replacement for non-neoplastic conditions: a systematic review on current outcomes. J Orthop Traumatol 2022; 23:18. [PMID: 35348913 PMCID: PMC8964877 DOI: 10.1186/s10195-022-00632-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/19/2022] [Indexed: 11/10/2022] Open
Abstract
Proximal femoral replacement (PFR) is a well-established treatment for neoplasia of the proximal femur. The use of this surgical technique for non-neoplastic conditions has increased over the years. We carried out a systematic review of the literature to study the indications, complications, and functional results when PFR is used for non-neoplastic conditions. Twenty-seven studies were included in the review with a total of 828 PFRs with a mean follow-up of 50 months (range 1-225 months). The main indications were infection (28%), periprosthetic fracture (27%), aseptic loosening (22%), and fracture (16%). The rate of reoperation was 20.3% overall. The overall revision rate was 15.4%. The main complications were dislocation (10.2%) and infection (7.3%). After 2010, the rates of reoperation (25.5% versus 18.2%), loosening (9.4% versus 3.2%), and dislocation (15.7% versus 7.9%) were lower than before 2010. The 30-day mortality ranged from 0% to 9%. The hip function scores improved post-surgery. In conclusion, the use of PFR in non-neoplastic conditions remains a marginal tool, associated with low direct mortality and high complication rates, but we expect its use to increase in the near future.
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Affiliation(s)
- Alberto Di Martino
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy. .,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
| | - Davide Pederiva
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Gabriele Di Carlo
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Alessandro Panciera
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Geraci
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Niccolò Stefanini
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.,Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
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Kösters C, den Toom D, Märdian S, Roßlenbroich S, Metzlaff S, Daniilidis K, Everding J. LOQTEQ ® VA Periprosthetic Plate-A New Concept for Bicortical Screw Fixation in Periprosthetic Fractures: A Technical Note. J Clin Med 2022; 11:jcm11051184. [PMID: 35268275 PMCID: PMC8911225 DOI: 10.3390/jcm11051184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Internal fixation using angle stable plates is the treatment standard in periprosthetic fractures around stable implants. To provide instant postoperative full weight-bearing, bicortical screw fixation is advisable but often surgically demanding. This work presents the first clinical results of the LOQTEQ® VA Periprosthetic Plate (aap Implantate AG, Berlin, Germany), a new plate system to simplify screw placement around implants. This plate system uses insertable hinges that allow for variable angle screw anchorage. Data of 26 patients with a mean age of 80 years and a mean follow-up of 13.9 months were retrospectively collected. Patients were clinically and radiologically examined. Bony union was achieved in 14 out of 15 patients with no signs of non-union or implant loosening. One patient, however, presented with implant failure. Clinical scores demonstrated acceptable results. Since the hinge plates are easy to apply, the first results are promising.
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Affiliation(s)
- Clemens Kösters
- Klinik für Orthopädie, Unfall-und Handchirurgie, Maria-Josef-Hospital Greven, 48268 Greven, Germany;
- Correspondence: ; Tel.: +49-2571-502-12001
| | - Daniel den Toom
- Klinik für Orthopädie, Unfall-und Handchirurgie, Maria-Josef-Hospital Greven, 48268 Greven, Germany;
| | - Sven Märdian
- Centrum für Muskuloskelettale Chirurgie, Charité Berlin, 13353 Berlin, Germany;
| | - Steffen Roßlenbroich
- Klinik für Unfall-, Hand-und Wiederherstellungschirurgie, Universitätsklinikum Münster, 48149 Münster, Germany; (S.R.); (J.E.)
| | - Sebastian Metzlaff
- Klinik für Orthopädie und Unfallchirurgie, St. Joseph Krankenhaus Berlin, 12101 Berlin, Germany;
| | | | - Jens Everding
- Klinik für Unfall-, Hand-und Wiederherstellungschirurgie, Universitätsklinikum Münster, 48149 Münster, Germany; (S.R.); (J.E.)
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