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Scalici G, Boncinelli D, Zanna L, Buzzi R, Antonucci L, Di Maida F, De Biase P. Periprosthetic femoral fractures in Total Hip Arthroplasty (THA): a comparison between osteosynthesis and revision in a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:200. [PMID: 35241039 PMCID: PMC8892795 DOI: 10.1186/s12891-022-05159-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Periprosthetic femoral fractures are challenging complications of hip arthroplasty. They are supposed to be a rare complication, but their incidence is rapidly increasing. Surgical treatment aims to achieve early mobilization and avoid the complications of prolonged bed rest. Aim of this study is to evaluate the clinical outcomes of surgical treatment comparing two surgical approaches: revision arthroplasty (RA) versus open reduction and internal fixation (ORIF). Methods Authors retrospectively reviewed a series of 117 patients with total hip arthroplasty treated for periprosthetic femur fractures in the period between January 2013 and March 2018 at a single tertiary referral center. Of these, 70 patients satisfied strict inclusion criteria. Patients were classified according to the Unified Classification System (UCS) and distributed in two groups according to surgical treatment. Clinical outcomes were assessed using the Oxford Hip recorded preoperatively and post operatively, Barthel Score, CIRS score (Cumulative illness rating scale), type of fracture and post-operative complications with a minimum follow up of 1 year. Results Nominal univariate statistical analysis revealed significant differences between the post and pre-operative Oxford Hip Score (Δ Oxford) and the surgical treatment (p = 0.008) and CIRS score (p = 0.048). Moreover, we observed a significant relationship between type of treatment and type of fracture (p = 0.0001). Multivariate analyses revealed that CIRS score was independently associated with Oxford Score improvement after surgery (p = 0.024). Conclusions Data from this case series confirmed that surgical treatment was correlated to type of fracture, according to UCS classification. Patients treated by RA had a better functional outcome than patients treated with ORIF, but these results are strongly influenced from the patients’ age, Barthel index and CIRS score. Also, authors found a correlation between functional outcome and comorbidities evaluated by CIRS score. Based on these data we suggest a multimodal approach to these patients, like those used for proximal femoral fractures.
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Affiliation(s)
- Gianluca Scalici
- Traumatology and General Orthopedics Department, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy.
| | - Debora Boncinelli
- Traumatology and General Orthopedics Department, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy
| | - Luigi Zanna
- Traumatology and General Orthopedics Department, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy
| | - Roberto Buzzi
- Traumatology and General Orthopedics Department, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy
| | - Laura Antonucci
- Physical Medicine and Rehabilitation Section, Careggi University Hospital, 50100, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, Careggi University Hospital, 50100, Florence, Italy
| | - Pietro De Biase
- Traumatology and General Orthopedics Department, Careggi University Hospital, Largo Brambilla 3, 50100, Florence, Italy
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Kang JS, Moon KH, Ko BS, Roh TH, Na Y, Youn YH, Park JH. Prognostic Factors and Clinical Outcomes after Treatment of Periprosthetic Femoral Fractures Using a Cable-plate. Hip Pelvis 2019; 31:166-173. [PMID: 31501766 PMCID: PMC6726864 DOI: 10.5371/hp.2019.31.3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct. Materials and Methods A retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12–58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed. Results At the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12–24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (P=0.040), plate overlap percentage to stem length (P<0.001) and T-score at the preoperative bone mineral density (P=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II. Conclusion The cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.
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Affiliation(s)
- Joon Soon Kang
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Kyoung-Ho Moon
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Bong Sung Ko
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | | | - Yeop Na
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Yung-Hun Youn
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Joo Hyun Park
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
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Stoffel K, Sommer C, Kalampoki V, Blumenthal A, Joeris A. The influence of the operation technique and implant used in the treatment of periprosthetic hip and interprosthetic femur fractures: a systematic literature review of 1571 cases. Arch Orthop Trauma Surg 2016; 136:553-61. [PMID: 26781127 DOI: 10.1007/s00402-016-2407-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A systematic literature review on periprosthetic/interprosthetic fracture fixation after hip arthroplasties was performed to summarize available clinical data. Operation techniques and implants used were evaluated as possible risk factors for outcomes. MATERIALS AND METHODS MEDLINE and Cochrane databases were searched. Articles describing patients with postoperative periprosthetic femur fractures sustained around a hip arthroplasty and with interprosthetic fractures treated with plates, nails, screws and/or cerclage were included. Considered articles were from 2000 or newer. Eligible abstracts were screened by two independent persons and discrepancies were resolved by consensus. Absolute numbers of complications and/or reoperation events along with their corresponding rates were calculated according to operation technique and type of implant. Relative risks of having a complication and/or a reoperation according to the operation technique and the type of implant used were estimated. RESULTS Available data from 49 prospective and retrospective studies were analyzed. Of 1574 fractures, 81.7 % were treated with plating. For 83.0 % of all fractures, an open approach was applied. The overall complication rate was 14.3 %. Fixation failure and nonunion were most often reported (fixation failure: 4.4 %; nonunion: 3.9 %). Nonunion and refracture occurred more often after open approaches than after minimal invasive osteosynthesis (nonunion: 4.5 vs. 0.0 %, p = 0.001; refracture: 3.8 vs. 0.6 %. p = 0.024). The relative risk for nonunion was 11.9 (95 % CI 4.5-31.5) times higher (p < 0.0001) for non-locking plates (13.0 %) than for locking plates (1.1 %). CONCLUSIONS The clinical evidence of published studies dealing with periprosthetic/interprosthetic fractures after hip arthroplasty is generally low. This literature search suggested higher rates of nonunion and refracture after an open approach and a higher risk of nonunion for non-locking plates compared to locking plates. Based on the available clinical evidence, no treatment recommendations can be given.
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Affiliation(s)
- Karl Stoffel
- Department of Orthopedics and Traumatology, University of Basel and Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
| | - Christoph Sommer
- Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland
| | - Vasiliki Kalampoki
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
| | - Andrea Blumenthal
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland
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Kim Y, Tanaka C, Tada H, Kanoe H, Shirai T. Treatment of periprosthetic femoral fractures after femoral revision using a long stem. BMC Musculoskelet Disord 2015; 16:113. [PMID: 25958328 PMCID: PMC4494722 DOI: 10.1186/s12891-015-0565-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periprosthetic femoral fractures are becoming increasingly common and are a major complication of total hip arthroplasty and hemiarthroplasty. The treatment of periprosthetic femoral fracture after femoral revision using a long stem is more complex and challenging. The purpose of this study was to identify the clinical and radiographical features of periprosthetic femoral fractures after revision using a long stem. METHODS We report a retrospective review of the outcomes of treatment of 11 periprosthetic fractures after femoral revision using a long stem. Eleven female patients with a mean age of 79.2 years (70 to 91) were treated for a Vancouver type B1 fracture between 1998 and 2013. The mean numbers of previous surgeries were 3.1 (2 to 5). RESULTS The average follow-up was 58.9 months (8 to 180). We found several important features that might influence the outcome of treatment for periprosthetic femoral fractures after femoral revision using a long stem: 1) all cases were classified as Vancouver type B1. 2) 6 patients (55%) had a transverse fracture around the tip of the long stem. 3) 7 patients (64%) had a history of previous fracture of the ipsilateral femur. The type B1 fractures were treated with open reduction and internal fixation in 9 hips, 6 of which were reinforced with bone grafts. Two other periprosthetic fractures were treated with femoral revision. One was revised because of stem breakage, and the other was a transverse fracture associated with poor bone quality, which received a femoral revision with a long stem and a plate. All fractures except one achieved primary union. This failed case had a bone defect at the fracture site, and revision surgery using a cementless long stem and allografts was successful. CONCLUSIONS These findings suggest that most cases of type B1 fracture after revision using a long stem have been treated successfully with open reduction and internal fixation. However, a transverse fracture with very poor bone quality might be considered as a type B3 fracture, and femoral revision might be a treatment of choice.
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Affiliation(s)
- Youngwoo Kim
- Department of Orthopaedic Surgery, Kyoto City Hospital, 1-2 Mibu,higashitakada-cho, Nakagyo, Kyoto, 604-8845, Japan.
| | - Chiaki Tanaka
- Department of Orthopaedic Surgery, Kyoto City Hospital, 1-2 Mibu,higashitakada-cho, Nakagyo, Kyoto, 604-8845, Japan.
| | - Hiroshi Tada
- Department of Orthopaedic Surgery, Kyoto City Hospital, 1-2 Mibu,higashitakada-cho, Nakagyo, Kyoto, 604-8845, Japan.
| | - Hiroshi Kanoe
- Department of Orthopaedic Surgery, Kyoto City Hospital, 1-2 Mibu,higashitakada-cho, Nakagyo, Kyoto, 604-8845, Japan.
| | - Takaaki Shirai
- Department of Orthopaedic Surgery, Kyoto City Hospital, 1-2 Mibu,higashitakada-cho, Nakagyo, Kyoto, 604-8845, Japan.
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Froberg L, Troelsen A, Brix M. Periprosthetic Vancouver type B1 and C fractures treated by locking-plate osteosynthesis: fracture union and reoperations in 60 consecutive fractures. Acta Orthop 2012; 83:648-52. [PMID: 23140109 PMCID: PMC3555447 DOI: 10.3109/17453674.2012.747925] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Historically, the treatment of periprosthetic femoral fractures (PFFs) has been associated with a high frequency of complications and reoperations. The preferred treatment is internal fixation, a revision of the femoral stem, or a combination of both. An improved understanding of plate use during internal fixation, and the introduction of locking-plate osteosynthesis may lead to improved outcome. We evaluated the outcome of Vancouver type B1 and C PFFs treated by locking-plate osteosynthesis, by assessing rates of fracture union and reoperations and by analyzing failure cases. PATIENTS AND METHODS From 2002 through 2011, 58 consecutive patients (60 fractures) with low-energy PFF around or below a stable femoral stem, i.e. Vancouver type B1 and C fractures, underwent osteosynthesis with a locking plate. All patients had a total hip replacement (THR). They were followed up clinically and radiographically, with 6 weeks between visits, until fracture union or until death. Fracture union was evaluated 6 months postoperatively. RESULTS At a median follow-up time of 23 (0-121) months after PFF, 8 patients (8 fractures) had been reoperated due either to infection (n = 4), failure of fixation (n = 3), or loosening of the femoral stem (n = 1). All the patients who had been followed up for at least 6 months-and who did not undergo reoperation or die-went on to fracture union (n = 43). INTERPRETATION Locking-plate osteosynthesis of periprosthetic Vancouver type B1 and C fractures gives good results regarding fracture union. It appears that spanning of the prosthesis to avoid stress-rising areas is important for successful treatment. Infection is the major cause of failure.
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Affiliation(s)
- Lonnie Froberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark.
| | - Michael Brix
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense
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Ehlinger M, Adam P, Abane L, Rahme M, Moor BK, Arlettaz Y, Bonnomet F. Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 2011; 19:1473-8. [PMID: 21431372 DOI: 10.1007/s00167-011-1480-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE We report a continuous series of periprosthetic femoral fractures after knee arthroplasty treated with a locking plate. We hypothesize that minimally invasive surgery and immediate weight-bearing improve functional recovery. METHODS From June 2002 to December 2008, 15 patients with 16 fractures were treated. Median age was 81 years. The autonomy level according to the mobility score of Parker and Palmer showed a median of 5 (0-9). Osteosynthesis was performed mainly through a minimally invasive approach using a locking compression plate. The rehabilitation protocol consisted of immediate mobilization and, whenever possible, immediate unrestricted weight-bearing. RESULTS Five patients died during follow-up, more than 1 year after osteosynthesis. Their results were included. Autonomy and mobility were preserved with a median postoperative score of 4 (0-9) according to Parker and Palmer. The consolidation rate was 93.8%, which was obtained within 10 weeks. There were no mechanical or infectious complications. Fourteen cases were treated with minimally invasive surgery without fracture exposition; the remaining 2 required a slightly more extended approach. Full weight-bearing occurred 10 times; 20-kg partial weight-bearing was advised twice; and on 4 occasions, no weight-bearing was allowed for 6 weeks. CONCLUSION Osteosynthesis with a minimally invasive bridge-plating technique is effective in the treatment of periprosthetic, distal femoral fractures without component loosening. Immediate full weight-bearing is possible if certain rules are respected. The surgical management presented herein is beneficial for these challenging fractures, and it may help reduce the complication rate and improve functional outcome.
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Affiliation(s)
- Matthieu Ehlinger
- Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098 Strasbourg cedex, France.
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Cornell CN, Ayalon O. Evidence for success with locking plates for fragility fractures. HSS J 2011; 7:164-9. [PMID: 22754418 PMCID: PMC3145849 DOI: 10.1007/s11420-010-9194-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 12/15/2010] [Indexed: 02/07/2023]
Abstract
Fixation of fragility fractures with plates and screws often results in loss of fixation and need for revision surgery. Locking plates and screw were introduced to improve fixation of fragility fractures and have been in use for a decade. This review was conducted to compile evidence that locking plates and screws improve fixation of fragility fractures. A search of PubMed was performed to identify biomechanical studies as well as clinical series of fragility fractures treated with locking plates. Biomechanics papers had to use models of osteoporotic bone and had to directly compare locking plates with traditional plates. Clinical studies included case series in which locking plates were applied to elderly patients with fractures of the proximal humerus and periprosthetic distal femur fractures. Most studies are retrospective case series. Locking plates lead to greater stability and higher loads to failure than traditional plates. When applied to proximal humerus fractures, uncomplicated healing occurs in 85% of patients. Constant and Dash scores approach normal values. For distal femoral periprosthetic fractures, union rates of 75% are reported with a malunion rate of 10%. Early evidence suggests that locking plates improve results of treatment of proximal humerus fractures and distal femoral periprosthetic fractures in the elderly. Loss of fixation is associated with failure to achieve stability at the fracture site. Principles of fracture fixation in osteoporotic bone defined prior to the introduction of locking plates should still be applied.
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Affiliation(s)
- Charles N. Cornell
- Hospital For Special Surgery, 535 East 70th Street, New York, NY 10021 USA
- Weill Cornell College of Medicine, New York, NY 10065 USA
| | - Omri Ayalon
- Hospital For Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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