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Neitzke CC, Coxe FR, Chandi SK, Belay ES, Sculco PK, Chalmers BP, Westrich GH, Gausden EB. High Rate of Unplanned Reoperation for Interprosthetic Femur Fractures After Total Hip and Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00451-0. [PMID: 38735554 DOI: 10.1016/j.arth.2024.05.018] [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: 12/10/2023] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Interprosthetic femur fractures (IPFFs) are a rare, but devastating complication following total joint arthroplasty. There is limited evidence to help guide their management. The purpose of this study was to describe the features, treatment, and outcomes of surgically managed IPFFs. METHODS We retrospectively identified 75 patients who had 76 IPFFs. The mean age at the time of IPFF was 75 years (range, 29 to 94), and 78% were women. The mean body mass index was 30 (range, 19 to 51), and the mean follow-up was 3 years (range, 0 to 14). There were 16 Vancouver B1 fractures, 28 Vancouver B2 fractures, 2 Vancouver B3 fractures, and 30 Vancouver C fractures. All B1 fractures underwent open reduction internal fixation (ORIF). All Vancouver B2 and B3 fractures underwent revision arthroplasty, including 1 proximal femur replacement and 1 total femur replacement. Vancouver C fractures were treated with ORIF (n = 20), distal femoral replacement (n = 9), and in 1 case, total femur replacement (n = 1). Kaplan-Meier survivorship was used to calculate 2-year survival free from all-cause reoperation and periprosthetic joint infection (PJI). RESULTS The 2-year survivorship-free rate from reoperation was 71%. There were 18 reoperations following initial surgical management of the IPFF, including 9 for infection, 3 for refracture, 3 for nonunion, 2 for hardware failure, and 1 for instability. An initial IPFF involving a stemmed femoral total knee arthroplasty component was associated with increased risk for reoperation (P = .007) and PJI (P = .044). There was no difference in survivorship free of reoperation between IPFFs managed with ORIF or revision arthroplasty (P = .72). CONCLUSIONS An IPFF is a devastating complication following total joint arthroplasty with high reoperation rates, most commonly secondary to PJI. Those IPFFs that occurred between 2 stemmed components were at the highest risk for reoperation.
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Affiliation(s)
- Colin C Neitzke
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Francesca R Coxe
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Sonia K Chandi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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2
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Maslaris A, Grimberg A, Melsheimer O, Tsiridis E, Matziolis G. Aseptic midterm survival rates between different cemented tibial stem designs in hinged total knee arthroplasty: a 6-year evaluation from the German Arthroplasty Registry. Arch Orthop Trauma Surg 2024; 144:2283-2295. [PMID: 38625551 PMCID: PMC11093826 DOI: 10.1007/s00402-024-05273-x] [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: 10/06/2023] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The rate of revision TKA and thus the use of hinged implants (HI) steadily rises. Aseptic loosening lies on the top of the failure patterns. However, no evidence exists until now based on national scale high-caseloads that analyzes the impact of cemented HI stem-design on aseptic survival rates. METHODS Data on aseptic HI-revisions with full-cemented tibia-stems were conducted from the German Arthroplasty Registry. Cases were divided in primary HI (PHI) and HI used in revision operations (RHI). Endpoint was a new revision following either a PHI or an RHI. The impact of stem conicity (conical vs. cylindrical), diameter (≤ 13 mm vs. > 13 mm), length (≤ 90 mm vs. > 90 mm) and offset on the 6-Year-Cumulative-Aseptic-Revision-Rate (6Y-CARR) was estimated via Kaplan-Meier curve and compared between groups via Log-Rank-Tests. RESULTS 3953 PHI and 2032 RHI fulfilled inclusion-criteria. Stem conicity had no impact on 6Y-CARR (p = 0.08 and p = 0.8). Diameter > 13 mm hat an impact on PHI (p = 0.05) with lower 6Y-CARR but not on RHI (p = 0.2). Length > 90 mm showed significantly worst 6Y-CARR in PHI (p = 0.0001) but not in RHI (p = 0.3). Offset-stems showed significantly better 6Y-CARR in PHI (p = 0.04), but not in RHI (p = 0.7). CONCLUSION There was no significant impact of the cemented tibia-stem conicity on 6Y-CARR, neither in PHI nor in RHI. The effect of length, diameter and offset on the 6Y-CARR observed in the PHI, was not detectable in the more complex RHI-cases reflecting its limited clinical relevance by itself in more multifactorial backgrounds. Therefore, results must be interpreted with caution due to considerable system-effects and different utilization-scenarios.
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Affiliation(s)
- Alexander Maslaris
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Alexander Grimberg
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Elefterios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloníki, Greece
| | - Georg Matziolis
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Ghanem M, Kalb A, Heyde CE, Roth A. Management of complications of mega-implants following treatment of primary and periprosthetic fractures of the lower extremities. Sci Rep 2023; 13:17594. [PMID: 37845299 PMCID: PMC10579354 DOI: 10.1038/s41598-023-44992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/14/2023] [Indexed: 10/18/2023] Open
Abstract
In recent years, indications for implanting mega-implants were established in managing major bone defects linked to revision arthroplasty due to loosening, periprosthetic fractures, re-implantation following periprosthetic joint infection, non-union following fractures as well as complex intraarticular primary fractures. This study was conducted to discuss and analyze the strategy of diagnosis and management of complications following the use of mega-implants in treating primary and periprosthetic fractures of the lower extremities. This is a monocentric retrospective study. Patients aged ≥ 18 years who underwent implantation of a megaendoprosthesis due to periprosthetic or primary fractures of the lower extremity between January 2010 and February 2023 were identified from the authors' hospital information system. We identified 96 patients with equal numbers of fractures (71 periprosthetic fractures and 25 primary fractures). 90 cases out of 96 were investigated in this study. The drop-out rate was 6.25% (six cases). The average follow-up period was 22 months (1 to 8 years) with a minimum follow-up of 1 year. The diagnosis of complications was provided on the basis of subjective symptoms, clinical signs, radiological findings and laboratory investigations such as C-reactive protein, leucocyte count and the microbiological findings. The indications for implantations of modular mega-implants of the lower extremities were periprosthetic fractures (65 cases/72.22%) and primary fractures (25 cases/27.78%). Pathological fractures due to malignancy were encountered in 23 cases (25.56%), in one case due to primary tumor (1.11%) and 22 cases due to metastatic lesions (24.44%). Two cases (2.22%) presented with primary intraarticular fractures with severe osteoporosis and primary arthrosis. In all cases with malignancy staging was performed. Regarding localization, proximal femur replacement was encountered in 60 cases (66.67%), followed by distal femur replacement (28 cases/31.11%) and total femur replacement (2 cases/2.22%). The overall complication rate was 23.33% (21 complications in 21 patients). The most common complication was dislocation which was encountered in nine cases (10%), all following proximal femoral replacement (9 cases out of 60, making 15% of cases with proximal femoral replacement). The second most common complication was infection (six cases, 6.67%), followed by four aseptic loosenings (4.44%), further intraoperative periprosthetic fracture in one case (1.11%) and a broken implant in one case (1.11%). We noticed no cases with wear and tear of the polyethylene components and no cases of disconnections of the modular components. Mega-endoprostheses enable versatile management options in the treatment of primary and periprosthetic fractures of the lower extremities. The rate of complications such as loosening, implant failure, dislocation and infection are within an acceptable range in this preliminary analysis. However, implantation of mega-endoprostheses must be strictly indicated due the limited salvage options following surgery.
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Affiliation(s)
- M Ghanem
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany.
- Department of Physical Therapy and Rehabilitation, University Hospital Leipzig, Leipzig, Germany.
| | - A Kalb
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany
| | - C-E Heyde
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany
| | - A Roth
- Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig (Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR), Liebigstrasse 20, 04103, Leipzig, Germany
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Corces A, Heifner J, Zavurov G. A Custom Device to Couple Proximal and Distal Femoral Stems: A Case Report and Literature Review. Arthroplast Today 2023; 19:101089. [PMID: 36713938 PMCID: PMC9873500 DOI: 10.1016/j.artd.2022.101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/20/2023] Open
Abstract
Complex periprosthetic fractures may occur with existing ipsilateral hip and knee implants. These cases are challenging with few options. We report on a custom coupler used to connect a hinged distal femoral replacement to an existing revision hip stem. This option was preferred to a total replacement of the femur. The custom coupler maintained the anatomic attachments of the proximal femur, preserved abductor strength during ambulation, and mitigated the morbidity which may arise from a total femur replacement. At 15 months postoperatively, the patient reported no pain, did not demonstrate an antalgic gait pattern, and had satisfactory range of motion at the hip and knee. The literature displays clinical and biomechanical efficacy for coupling devices although complications and device failure are quite variable.
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Affiliation(s)
- Arturo Corces
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| | - John Heifner
- St George’s University College of Medicine, Greta River, NY, USA,Corresponding author. St George’s University College of Medicine, 8905 SW 87th Ave, Miami, FL 33176, USA. Tel.: +1 305 667 8686.
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Maslaris A, Tsiridis E, Schoeneberg C, Pass B, Spyrou G, Maris A, Matziolis G. Does stem profile have an impact on the failure patterns in revision total knee arthroplasty? Arch Orthop Trauma Surg 2023; 143:1549-1569. [PMID: 36450936 PMCID: PMC9957861 DOI: 10.1007/s00402-022-04683-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/23/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Revision total knee arthroplasty (RTKA) has been increasing continuously. The results of RTKA still remain unsatisfactory. Failure patterns and risk factors in RTKA were thoroughly analyzed, with periprosthetic joint infections (PJI) and aseptic loosening remaining at the forefront of re-revision (ReRTKA) causes. While there is evidence that stem profile impacts the revisability of cemented implants, its association with the modes of RTKA failure is unknown. METHODS 50 consecutive ReRTKA performed in a single orthopedic center during 2016-2017 were retrospectively analyzed. The cases were stratified according to age, sex, number of preexisting revisions, fixation technique, stem design and causes of re-revision. All explanted implants with conical vs. cylindrical stem profiles were compared. RESULTS Mean age was 67 ± 11.5, and 54% were females. 72% of the cases had ≥ 3 previous revisions. 88% were full-cemented, 3% hybrid and 9% press-fit stems. 36% of the RTKA had conical, 58% cylindrical and 6% combined stem profiles. 92% of the RTKA components were removed. Removal causes were: PJI (52.2%), aseptic loosening (34.8%), implant malposition (9.8%), painful knee (1.1%) and instability (2.2%). While the overall RTKA failure patterns were equally distributed between conical and cylindrical stems, subgroup analysis of only cemented ReRTKA revealed a higher incidence of aseptic loosening within cylindrical stem profiles (46.7% vs. 25.7%, P = 0.05). CONCLUSION Stem profile may have an impact on the process of aseptic loosening in cemented non-metaphyseal engaging RTKA, with cylindrical designs tending to worse outcomes than conical designs. Large cohort studies could provide more clarity on current observation.
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Affiliation(s)
- Alexander Maslaris
- Department of Orthopedics, Waldkliniken Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany. .,Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Eleftherios Tsiridis
- grid.4793.90000000109457005Academic Orthopedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC Greece
| | - Carsten Schoeneberg
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Bastian Pass
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Georgios Spyrou
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Alexandros Maris
- grid.420468.cDepartment of Orthopedics, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Georg Matziolis
- grid.275559.90000 0000 8517 6224Department of Orthopedics, Waldkliniken Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
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6
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Rao BM, Stokey P, Tanios M, Liu J, Ebraheim NA. A systematic review of the surgical outcomes of interprosthetic femur fractures. J Orthop 2022; 33:105-111. [PMID: 35958982 PMCID: PMC9357707 DOI: 10.1016/j.jor.2022.07.013] [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: 02/16/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Interprosthetic femur fractures (IFFs) are rare, but the treatment is challenging. Currently, there are many treatment methods used in practice, but an updated systematic review of comparison of common different surgical outcomes has not been thoroughly inspected. Methods A systematic review of retrospective studies was conducted. The resource databases of PubMed, Cochrane, and Embase were searched using a combination of the keywords involving IFFs and surgical outcomes from inception through June 2021. Data collected included patient demographics, intraoperative data, and postoperative outcomes. Outcomes were measured based on healing time, revision rate, complication rate, and functional scores. Results Forty studies were included for review with a total of 508 patients. Average reported age of patients was 78.7 years old and 403 (79.3%) were females. Overall union rate was 74.0% with 376 of 508 patients achieving fracture union after primary treatment of IFF. Only 271 patients had reported healing times of fractures with a mean of 5.15 months. The plate, prosthetic revision, nail/rod, and external fixator groups had mean healing times of 4.69, 8.73, 6.5, and 5.1 months, respectively. Revision rates were highest in the femur replacement treatment group with 9 (32.1%) patients needing at least one reoperation surgery for any reason. Overall, hardware failure and non-unions were the most reported complications in treatment of IFFs. Postoperative functional outcome scores were available for 242 patients. Harris Hip Scores for the plate, revision, replacement, nail/rod, and plate + revision groups were 76.84, 77.14, 69.9, 77, and 78.4, respectively. Conclusion Each treatment method should be carefully considered by the surgeon depending on the patient. Locking plate was the most common method for the treatment of the patients with IFFs. Half of them combined with cerclage wires/cables. Around two thirds' patients could achieve union with the fastest mean healing time around 4.69 months. Other less common methods included prosthetic revision, femur replacement, nail/rod, external fixator, etc. A small number of patients treated with Ilizarov external fixator, and it has proven to be a viable option with few complications and high union rates.
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Affiliation(s)
- Brian M. Rao
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Phillip Stokey
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Mina Tanios
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Jiayong Liu
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Nabil A. Ebraheim
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
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7
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McMellen CJ, Romeo NM. Interprosthetic Femur Fractures: A Review Article. JBJS Rev 2022; 10:01874474-202209000-00004. [PMID: 36137069 DOI: 10.2106/jbjs.rvw.22.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ The prevalence of interprosthetic femur fractures (IFFs) is rising with the aging population and increased prevalence of total joint arthroplasty. ➢ IFFs have high rates of complications and high associated morbidity and mortality. ➢ The main treatment methods available for IFFs include plate fixation, intramedullary nailing, combined plate fixation and intramedullary nailing, and revision arthroplasty including partial and total femur replacement. ➢ There have been several proposed classification systems and at least 1 proposed treatment algorithm for IFFs; however, there is no consensus. ➢ Whichever treatment option is chosen, goals of surgery should include preservation of blood supply, restoration of length, alignment, rotation, and sufficient stabilization to allow for early mobilization.
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Affiliation(s)
- Christopher J McMellen
- MetroHealth Medical Center, Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, Cleveland, Ohio
| | - Nicholas M Romeo
- MetroHealth Medical Center, Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Bonnomet F, Favreau H, Bonnevialle P, Adam P, Ehlinger M. Interimplant femoral fractures. Orthop Traumatol Surg Res 2022; 108:103117. [PMID: 34666198 DOI: 10.1016/j.otsr.2021.103117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population, whose life expectancy is lengthening. Thus, fractures of the femur between proximal and distal implants, although rare, are becoming more frequent. Women over the age of 70, with fragile bones and whose ends of the two implants are close to each other ("kissing implants") are particularly vulnerable to them. Reliable and reproducible fracture classifications exist when it comes to 2 prostheses, but they are less well established in the presence of one, or even two, non-prosthetic implants. Their treatment is difficult and must consider the possibility of fracture consolidation while ensuring or restoring the stability and role of the implants. Whether it is the main element of treatment or a complement to prosthesis revision, locked plating forms the basis of the treatment but it must be rigorous, considering that failures are mainly the result of technical errors. Other more invasive treatments (total femoral arthroplasty, cortical sleeves) are offered more rarely if consolidation appears compromised.
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Affiliation(s)
- François Bonnomet
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France.
| | - Henri Favreau
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Paul-Riquet, place Baylac, 31052 Toulouse, France
| | - Philippe Adam
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - Matthieu Ehlinger
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
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9
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Loucas M, Loucas R, Akhavan NS, Fries P, Dietrich M. Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients. Geriatr Orthop Surg Rehabil 2021; 12:21514593211013790. [PMID: 34017616 PMCID: PMC8114290 DOI: 10.1177/21514593211013790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence Level III, Therapeutic study.
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Affiliation(s)
- Marios Loucas
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nico Safa Akhavan
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
| | - Patrick Fries
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
| | - Michael Dietrich
- Department of Orthopedic Surgery, Handsurgery and Traumatology at City Hospital Waid and Triemli, Zurich, Switzerland
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10
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Ramavath A, Lamb JN, Palan J, Pandit HG, Jain S. Postoperative periprosthetic femoral fracture around total hip replacements: current concepts and clinical outcomes. EFORT Open Rev 2020; 5:558-567. [PMID: 33072408 PMCID: PMC7528669 DOI: 10.1302/2058-5241.5.200003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The rising incidence of postoperative periprosthetic femoral fracture (PFF) presents a significant clinical and economic burden. A detailed understanding of risk factors is required in order to guide preventative strategies. Different femoral stems have unique characteristics and management strategies must be tailored appropriately. Consensus regarding treatment of PFFs around well-fixed stems is lacking, but revision surgery may provide more predictable outcomes for unstable fracture patterns and fractures around polished taper-slip stems. Future research should focus on implant-related risk factors, treatment of concurrent metabolic bone disease and the use of large endoprostheses.
Cite this article: EFORT Open Rev 2020;5:558-567. DOI: 10.1302/2058-5241.5.200003
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Affiliation(s)
- Ashoklal Ramavath
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - Jonathan N Lamb
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - Jeya Palan
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
| | - Hemant G Pandit
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK.,University of Leeds, Leeds, UK
| | - Sameer Jain
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, UK
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11
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Graulich TJ, Graeff P, Heidenblut T, Krettek C, Liodakis E. Revision of a Fractured Titanium Modular Revision Hip Stem Without Removal of the Well-Fixed Part of the Stem: A New Approach Using a Cemented Tube. Arthroplast Today 2020; 6:363-368. [PMID: 32566718 PMCID: PMC7298535 DOI: 10.1016/j.artd.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
Component fracture is a rare cause for revision in total hip arthroplasty. For a fractured well-fixed long femoral stem, the options are limited. We sought to develop a technique to address this problem with lower morbidity. A newly developed cemented tube was constructed and cemented onto a fractured Revitan revision hip femoral stem to retain the distal well-fixed component. At the 2-year follow-up, the Harris Hip Score, pain level, and radiographic images were analyzed. At the 2-year follow-up, no radiological signs of loosening or failure could be observed. The patient's preoperative Harris Hip Score improved from 42.8 to 97 points. The pain level improved from 7/10 to 0/10. Our case report depicts excellent clinical and radiographic outcomes at 2-year follow-up by a newly developed cemented tube technique. This technique is a potential new option for revision of fractured well-fixed diaphyseal stems without major bone loss. Our successful results suggest this technique is worthy of consideration and further study.
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Affiliation(s)
| | - Pascal Graeff
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Thorsten Heidenblut
- Institute of Material Science From the Leibniz University of Hannover, Garbsen, Germany
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Internal fixation and revision arthroplasty for interprosthetic femoral fractures: a case series of fifty patients. INTERNATIONAL ORTHOPAEDICS 2020; 44:1391-1399. [DOI: 10.1007/s00264-020-04561-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
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Rozell JC, Delagrammaticas DE, Schwarzkopf R. Interprosthetic femoral fractures: management challenges. Orthop Res Rev 2019; 11:119-128. [PMID: 31572021 PMCID: PMC6754334 DOI: 10.2147/orr.s209647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022] Open
Abstract
Interprosthetic femur fractures are a rare but serious complication following total hip and knee arthroplasty. Classification systems have focused not only on diagnosis but also on treatment algorithm. Critical to the evaluation of patients with these fractures are an assessment of fracture location, bone quality, and the presence of stemmed implants. The gold standard for fracture fixation is locked plating with bicortical and unicortical screws, supplemented with wires or cables as needed. For patients with compromised bone stock or insufficient bony area for fixation, allograft augmentation with struts or interprosthetic sleeves may be used. For fractures with severe bone loss, conversion to a megaprosthesis or total femur replacement may be warranted.
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Affiliation(s)
- Joshua C Rozell
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | | | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
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