1
|
Wilke BK, Spaulding AC, Crowe MM, Ledford CK, Sherman CE, Spencer-Gardner L, Blasser KE. Do All Postoperative Vancouver B2 Fractures Require Revision Arthroplasty With Cementless Stems? Arthroplast Today 2024; 28:101444. [PMID: 38974717 PMCID: PMC11225803 DOI: 10.1016/j.artd.2024.101444] [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: 11/14/2023] [Revised: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 07/09/2024] Open
Abstract
Background Management of periprosthetic fractures has been guided by the Vancouver classification, which recommends revision for fractures around a loose femoral implant (B2). New studies have challenged this approach, demonstrating acceptable outcomes with internal fixation. This study evaluates our experience with Vancouver B2 fractures, comparing internal fixation to femoral revision. We hypothesized that in select cases with cementless stems, internal fixation would provide acceptable results with reduced morbidity. Methods A retrospective review was performed of periprosthetic hip fractures treated at our institution between 1 January 2012 and 4 November 2022. We excluded patients who did not have prior radiographs and evidence of stem subsidence, suggestive of a Vancouver B2 fracture. Thirteen patients were included in the analysis. Results Four patients (31%) underwent revision of the femoral component, 4 patients (31%) underwent plating, and 5 patients (38%) underwent internal fixation with cerclage cabling. The average operative duration was 158 minutes, 203 minutes, and 62 minutes for the revision, plating, and cabling cohorts, respectively (P = .009). Blood loss was 463 cc, 510 cc, and 90 cc for the revision, plating, and cabling cohorts, respectively (P = .036). Three patients in both the revision and plating cohorts each received a transfusion (75%), whereas no patients in the cabling cohort required a transfusion (P = .033). All patients demonstrated fracture healing on the postoperative radiographs. No patients required additional surgery during the follow-up period. Conclusions We have demonstrated that Vancouver B2 periprosthetic fractures with intact lateral cortices may be treated with internal fixation with cerclage cabling with excellent results.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Kurt E. Blasser
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
2
|
Schopper C, Luger M, Hipmair G, Schauer B, Gotterbarm T, Klasan A. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review. BMC Musculoskelet Disord 2022; 23:280. [PMID: 35321671 PMCID: PMC8944079 DOI: 10.1186/s12891-022-05240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. Methods Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. Results One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). Conclusions Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05240-w.
Collapse
Affiliation(s)
- Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria.
| | - Günter Hipmair
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| |
Collapse
|
3
|
Effect of Combining Operating Room Nursing Based on Clinical Quantitative Assessment with WeChat Health Education on Postoperative Complications and Quality of Life of Femoral Fracture Patients Undergoing Internal Fixation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2452820. [PMID: 35186223 PMCID: PMC8849898 DOI: 10.1155/2022/2452820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of combining operating room nursing based on clinical quantitative assessment with WeChat health education on postoperative complications and quality of life (QOL) of femoral fracture patients undergoing internal fixation. Methods Ninety femoral fracture patients treated in our hospital (July 2018 to July 2021) were chosen as the research objects and split into the control group (routine intervention) and the study group (combination of operating room nursing based on clinical quantitative assessment and WeChat health education) according to the nursing intervention modes, with 45 cases each. After nursing, the postoperative complications and QOL of patients were compared between the two groups. Results No statistical between-group differences in general data were observed (P > 0.05); the hospital stay, weight-bearing time, and fracture healing time were obviously shorter in the study group than in the control group (P < 0.05); 1 d after surgery, the VAS pain status was not significantly different between the two groups (P > 0.05), and 2 d and 3 d after surgery, the VAS scores were significantly lower in the study group than in the control group (P < 0.05); 1 d after surgery, the Harris scores of patients in the two groups were close and did not present statistical difference (P > 0.05), and 8 weeks after surgery, the Harris score was significantly higher in the study group than in the control group (P < 0.05); the scores on self-care agency such as self-concept, self-care skills, sense of self-care responsibility, and health knowledge level were significantly higher in the study group than in the control group (P < 0.05); compared with the control group, the probability of occurring incision infection, lung infection, pressure sore, swelling and pain, and other complications was significantly lower in the study group (P < 0.05). Conclusion Implementing operating room nursing based on clinical quantitative assessment combined with WeChat health education to femoral fracture patients undergoing internal fixation can effectively improve their postoperative clinical indicators, reduce their postoperative pain sensation and complication incidence, and effectively promote the joint motion range, which is conducive to enhancing their self-care agency and QOL.
Collapse
|
4
|
Lamb JN, Nix O, Al-Wizni A, West R, Pandit H. Mortality After Postoperative Periprosthetic Fracture of the Femur After Hip Arthroplasty in the Last Decade: Meta-Analysis of 35 Cohort Studies Including 4841 Patients. J Arthroplasty 2022; 37:398-405.e1. [PMID: 34543696 DOI: 10.1016/j.arth.2021.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Postoperative periprosthetic fracture of the femur (POPFF) is associated with increased mortality. There is a lack of general estimates of mortality after POPFF and a need for higher-level evidence in this area. The aim of this study was to estimate mortality after POPFF using data reported in cohort studies from the last decade. METHODS Literature search was conducted using Medline and Embase. The primary outcome was all-cause mortality during time as an inpatient, within 30 days, within 90 days, and within one year of POPFF. Mortality (95% confidence interval [CI]) was estimated using metaregression. RESULTS A total of 4841 patients from 35 cohort studies were included. Study quality was generally low. The weighted mean follow-up was 2.3 years, and the most common POPFF was Vancouver B. The pooled mortality as an inpatient was 2.4% (95% CI 1.6% to 3.4%). The pooled mortality within 30 days was 3.3% (95% CI 2.0% to 5.0%). The pooled mortality within 90 days was 4.8% (95% CI 3.6% to 6.1%). The pooled mortality within one year was 13.4% (95% CI 11.9% to 14.8%). Mortality after POPFF was like that of neck of femur fracture up to 30 days, but better at one year. CONCLUSION Mortality is like that experienced by patients after neck of femur fracture up to 30 days, but better at one year, which may represent the lower underlying risk of death in the POPFF cohort. These results may form the basis for evaluation of services treating POPFF in the future.
Collapse
Affiliation(s)
- Jonathan N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Oliver Nix
- School of Medicine, University of Leeds, Leeds, UK
| | | | - Robert West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Hirao M, Miyatake K, Takada R, Tachibana T, Okawa A, Jinno T. Periprosthetic fragility fracture of the femur after primary cementless total hip arthroplasty. Mod Rheumatol 2021; 32:626-633. [PMID: 34897489 DOI: 10.1093/mr/roab025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/15/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Periprosthetic bone fragility due to stress shielding (SS) can be a risk factor of periprosthetic fracture after cementless total hip arthroplasty (THA). We aimed to obtain epidemiological information on periprosthetic fragility fracture of the femur (PPFF) after THA. METHODS We retrospectively reviewed the medical records of 1062 hips that had undergone cementless THA. We evaluated the epidemiological data as well as the features of PPFFs. RESULTS Of the 1062 hips, 8 (0.8%) were diagnosed with PPFFs. The survival rates, with the occurrence of PPFF as the end point, were 99.2% and 97.6% at 10 and 16 years postoperatively, respectively. When patients were classified as having either mild or severe SS on radiographs 5 years postoperatively, there was no significant difference in the survival rate, with PPFF as the end point. CONCLUSIONS In our cases, the incidence of PPFF after cementless THA was 0.8%.
Collapse
Affiliation(s)
- Masanobu Hirao
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryohei Takada
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Tachibana
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| |
Collapse
|
6
|
Regis D, Sandri A, Samaila E, Magnan B. Two-stage management of a spontaneous fracture of the greater trochanter through osteolytic lesions induced by polyethylene wear of a total hip arthroplasty. A case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:177-182. [PMID: 30715021 PMCID: PMC6503396 DOI: 10.23750/abm.v90i1-s.8086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 11/23/2022]
Abstract
Pelvic osteolysis induced by particulate debris derived from bearing surfaces is a well-known complication following total hip arthroplasty (THA). Atraumatic fractures of the greater trochanter (GT) associated with osteolytic lesions have been occasionally described. We present a case of a 71-year-old male patient who sustained an undisplaced fracture of the GT nine years following cementless metal-on-polyethylene THA. The fracture occurred through a 2.5-cm large osteolytic area, and no hip trauma was recorded. Conventional radiographs revealed peculiar signs of massive wear of the polyethylene acetabular liner (marked eccentricity of the prosthetic head and extensive osteolysis around the iliac screws), allowing to immediately conclude about the benign nature of the pathological fracture. To our knowledge, a two-stage management, planning conservative healing of the fracture and subsequent surgical replacement of the worn acetabular liner, has never been previously detailed. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Dario Regis
- Department of Orthopaedic and Trauma Surgery, Integrated University Hospital, Verona.
| | | | | | | |
Collapse
|
7
|
Gao YS, Guo YJ, Yu XG, Chen Y, Chen C, Lu NJ. A novel cerclage wiring technique in intertrochanteric femoral fractures treated by intramedullary nails in young adults. BMC Musculoskelet Disord 2018; 19:359. [PMID: 30292231 PMCID: PMC6173908 DOI: 10.1186/s12891-018-2284-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intertrochanteric femoral fractures (IFFs) in young adults, generally due to severe trauma, are increasingly presented. Different from IFFs in the geriatric population, these fractures in young adults are always comminuted and substantially displaced. Natural traction induced by musculature following IFFs determines closed reduction on a fracture table is extremely difficult. METHODS To achieve anatomical reduction before intramedullary nail (IMN) fixation, we made an extended or a mini petrotrochantetic incision to facilitate temporary reduction using a pointed clamp. Subsequently, a curved and cannulated wire-passer was employed to pass through a multistrand cable to surround displaced fragments and strengthen intertrochanteric fixation. Afterward, a standard procedure was conducted to nail the fracture. RESULTS We used the surgical technique in 9 young patients with an age range of 28~ 48 years old. The fractures were categorized as AO/OTA 31-A2.2 (3 cases) and 31-A2.3 (6 cases). The injury-to-surgery interval was 2.5 days on average. Mean operation time was 55 min. All fractures achieved anatomical reduction and healed within 14 weeks postoperatively without cable breakage, implant irritation or deep infection. CONCLUSIONS In conclusion, the surrounding technique with cerclage wire in IFFs in young adults is an effective surgical technique with easily achieved anatomical reduction to facilitate operative maneuvers and fracture healing.
Collapse
Affiliation(s)
- You-Shui Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Yan-Jie Guo
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Xin-Gang Yu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Yang Chen
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Chen Chen
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Nan-Ji Lu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| |
Collapse
|