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Di Martino A, Brunello M, Villari E, D'Agostino C, Cosentino M, Bordini B, Rivera F, Faldini C. Stem revision vs. internal fixation in Vancouver B2/B3 periprosthetic hip fractures: systematic review and metanalysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05469-1. [PMID: 39105834 DOI: 10.1007/s00402-024-05469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Vancouver B2 and B3 periprosthetic fractures (PFF) are associated with stem instability and often require a demanding stem implant revision (SR) or internal fixation (ORIF). This latter surgery is increasingly performed in the last few years instead of SR, but it is unclear which is the best treatment to manage PFF patients. The aim of this study is the compare the outcomes of B2/B3 PFF managed by either ORIF or SR, by performing a systematic review and meta-analysis of current literature. MATERIALS AND METHODS Cochrane Database, PubMed, Google Scholar and MEDLINE were examined to find out relevant publications dealing with the different outcomes of SR vs. ORIF in B2/B3 PFF of the hip. The effect model (EM) was calculated using Cohen´s d index. RESULTS Fifteen studies were included, reporting on a total of 1629 patients (564 ORIF and 1065 SR). The pooled random EM estimates for reoperation was 0.87 (95% CI, 0.39-1.96; I2 = 78%) in favor of ORIF surgery; EM for complications was 1.01 (95% CI, 0.45-2.27; I2 = 85%) without difference among procedures. The EM for transfusion was 0.72 (95% CI, 0.46-1.12; I2 = 62%) in favor of fixation. CONCLUSION ORIF and SR were both suitable and effective options in PFF patients, being associated to similar complications rates. Our results show that ORIF performance in PFF patients is associated to significantly less in blood loss, surgical time and in-hospital stay. These advantages are particularly appealing in patients with multiple comorbidities.
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Affiliation(s)
- Alberto Di Martino
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy.
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy.
| | - Matteo Brunello
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
| | - Eleonora Villari
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
| | - Claudio D'Agostino
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Fabrizio Rivera
- Department of Orthopedic Trauma, SS Annunziata Hospital, Savigliano, 12038, Italy
| | - Cesare Faldini
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, Bologna, 40136, Italy
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Chen JJ, Hung SH, Liou JY, Chang WC, Hsu KH, Su YP, Chiu FY, Cheng MF. Long stem revision versus short stem revision with plate osteosynthesis for Vancouver type B2 periprosthetic femoral fracture: a comparative study of eighty five cases. INTERNATIONAL ORTHOPAEDICS 2024; 48:1997-2005. [PMID: 38652245 PMCID: PMC11246273 DOI: 10.1007/s00264-024-06181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs. METHODS This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups. RESULTS A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups. CONCLUSIONS Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.
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MESH Headings
- Humans
- Female
- Periprosthetic Fractures/surgery
- Male
- Aged
- Retrospective Studies
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/adverse effects
- Reoperation/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/instrumentation
- Femoral Fractures/surgery
- Bone Plates
- Middle Aged
- Hip Prosthesis/adverse effects
- Aged, 80 and over
- Prosthesis Design
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Affiliation(s)
- Jian-Jiun Chen
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Hsin Hung
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Nursing, Chang Jung Christian University, Tainan, Taiwan
| | - Jia-You Liou
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chieh Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuei-Hsiang Hsu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Pin Su
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Yao Chiu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Fai Cheng
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital Shipai Rd Beitou Dist, No. 201, Sec. 2, Taipei City, 112201, Taiwan, Republic of China.
- Department of Orthopedic Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Whiting PS, Hare K, Krueger D, Borchardt G, Parvanta-Johnson K, Bernatz J, Binkley N, Anderson PA. Periprosthetic fractures are osteoporotic fractures: missed opportunities for osteoporosis diagnosis. Osteoporos Int 2024; 35:1165-1171. [PMID: 38561550 DOI: 10.1007/s00198-024-07057-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
Joint replacement surgery is common in older adults, leading to increasing periprosthetic fracture (PPFx) occurrence. We reviewed all PPFx seen over a 4-year period at an academic hospital. Clinical osteoporosis could be diagnosed based on existing data in 104 (67%) at the time of PPFx. Periprosthetic fractures are generally osteoporosis-related. PURPOSE Periprosthetic fractures (PPFx) cause morbidity, mortality, and cost. This study's purpose was to describe osteoporosis-related data available at the time of PPFx. METHODS The electronic medical record (EMR) of PPFx patients seen over 4 years in a university orthopedic practice were reviewed. Demographic data and osteoporosis relevant parameters were collected. Prior DXA studies were reviewed, and L1 Hounsfield unit (HU) measurements were performed on CT scans obtained within 2 years before PPFx. Clinical osteoporosis was defined as prior diagnosis, prescribed osteoporosis treatment, T-score ≤ - 2.5, HU ≤ 100, or prior fracture. RESULTS Records of 156 PPFx patients (115 F/41 M), mean (SD) age 75.4 (11.9), were reviewed. Almost all 153/156 (98%) of these fractures were femoral. Falls caused 139 (89%); 12 (8%) were spontaneous. Mean time post-arthroplasty was 7.9 (6.3) years. Prior fragility fracture(s) occurred in 72 (46%); 14 were PPFx. Osteoporosis was previously diagnosed in 45 (29%) and medications prescribed in 41 (26%). Prior to PPFx, DXA data were available in 62, mean (SD) lowest T-score was - 1.9 (0.9) and was ≤ - 2.5 in 19. CT data were available in 46; mean (SD) L1 HU was 79.0 (29.4) and was ≤ 100 in 35. Based on existing data, clinical osteoporosis could have been diagnosed in 104 (67%) at the time of PPFx. CONCLUSION Periprosthetic fractures are osteoporosis-related. They occur in older adults, often female, and result from falls; BMD, when assessed, is low. Data available at the time of PPFx often allows osteoporosis diagnosis; this should prompt evaluation and pharmacologic treatment consideration.
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Affiliation(s)
- Paul S Whiting
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB 6227, Madison, WI, 53705, USA.
| | - Kristyn Hare
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB 6227, Madison, WI, 53705, USA
| | - Diane Krueger
- Osteoporosis Clinical Research Program, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gretta Borchardt
- Osteoporosis Clinical Research Program, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Kristina Parvanta-Johnson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB 6227, Madison, WI, 53705, USA
| | - James Bernatz
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB 6227, Madison, WI, 53705, USA
| | - Neil Binkley
- Osteoporosis Clinical Research Program, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, MFCB 6227, Madison, WI, 53705, USA
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Washburn F, Mushaben J, Eichenseer C, Sanderson B, Tran B, Golden T. Perioperative periprosthetic femur fracture associated with direct anterior total hip arthroplasty using metaphyseal fit and fill stem. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:869-877. [PMID: 37750976 PMCID: PMC10858129 DOI: 10.1007/s00590-023-03682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/13/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION This study aims to identify radiographic and clinical risk factors of perioperative periprosthetic femur fracture associated with the direct anterior approach (DAA) using a metaphyseal fit and fill stem. We hypothesize stem malalignment with this femoral implant places increased stress on the medial calcar region, which leads to an increased risk of periprosthetic fracture. METHODS We compared patients with periprosthetic femur fractures following DAA total hip arthroplasty (THA) utilizing the Echo Bi-Metric Microplasty Stem (Zimmer Biomet, Warsaw, IN) to a cohort of patients who did not sustain a periprosthetic fracture from five orthopedic surgeons over four years. Postoperative radiographs were evaluated for stem alignment, neck cut level, Dorr classification, and the presence of radiographic pannus. Univariate and logistic regression analyses were performed. Demographic and categorical variables were also analyzed. RESULTS Fourteen hips sustained femur fractures, including nine Vancouver B2 and five AG fractures. Valgus stem malalignment, proud stems, extended offset, and patients with enlarged radiographic pannus reached statistical significance for increased fracture risk. Low femoral neck cut showed a trend toward statistical significance. CONCLUSION Patients undergoing DAA THA using a metaphyseal fit and fill stem may be at increased risk of perioperative periprosthetic fracture when the femoral stem sits proudly in valgus malalignment with extended offset and when an enlarged pannus is seen radiographically. This study identifies a specific pattern in the Vancouver B2 fracture cohort with regard to injury mechanism, time of injury, and fracture pattern, which may be attributed to coronal malalignment of the implant.
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Affiliation(s)
- Frederic Washburn
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA.
| | - Jacob Mushaben
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Clayton Eichenseer
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Brent Sanderson
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Britni Tran
- Graduate Medical Education, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Thomas Golden
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
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Yoon BH, Park SG, Roh YH. Open Reduction and Internal Fixation for Vancouver B1 and B2 Periprosthetic Femoral Fractures: A Proportional Meta-Analysis. Hip Pelvis 2023; 35:217-227. [PMID: 38125267 PMCID: PMC10728046 DOI: 10.5371/hp.2023.35.4.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Periprosthetic femoral fracture (PFF) is a common complication after total hip arthroplasty, and open reduction and internal fixation (ORIF) is a common surgical treatment. We conducted a meta-analysis to compare the outcomes of ORIF in patients with different fracture patterns (Vancouver B1 and B2). Materials and Methods We conducted a systematic search of PubMed, Embase, Cochrane Library and KoreaMed from inception to August 2022. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the 10 comparative studies and a proportional meta-analysis on the data from the 39 articles to determine a consensus. The outcomes were the incidence of reoperations that included osteosynthesis, irrigation/debridement and revision arthroplasty. Results The pair-wise meta-analysis showed similar outcomes between two groups; the risk of reoperation (odds ratio [OR]=0.82, confidence interval [CI] 0.43-1.55, P=0.542), nonunion (OR=0.49; CI 0.22-1.10, P=0.085) and deep infection (OR=1.89, CI 0.48-7.46, P=0.361). In proportion meta-analysis, pooled prevalence of reoperation was 9% (95% CI, 6-12) in B1 and 8% (95% CI, 2-15) in B2 (heterogeneity between two groups (Q), P=0.772). The pooled prevalence of nonunion was same as of 4% in B1 and B2 (Q, P=0.678), and deep infection was 2% (95% CI, 1-3) in B1 and 4% (95% CI, 2-7) in B2 (Q, P=0.130). Conclusion ORIF is a feasible treatment for B1 and B2 periprosthetic femoral fractures, with acceptable outcomes in terms of, nonunion and infection. The results of this study would help clinicians and provide baseline data for further studies validating PFF.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong Gyun Park
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Young Hak Roh
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Sun L, Song W, Zhang Z, Xu Z, Sun M, Gao G, Jiang H, Ju C. Femoral offset restoration affects the early outcome of revision in patients with periprosthetic femoral fractures of Vancouver B2 - a single-center retrospective cohort study. BMC Musculoskelet Disord 2023; 24:567. [PMID: 37434207 DOI: 10.1186/s12891-023-06694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Femoral offset (FO) restoration plays an important role in improving the prognosis and quality of life of patients undergoing hip replacement. However, it is not given enough attention in revisions among patients with periprosthetic femoral fractures (PPFFs); instead, more attention is given to reduction, fixation of fractures and stabilizing prostheses. The primary objective of this study was to evaluate the effect of FO restoration on the function of the hip joint in revisions of patients with PPFF of Vancouver B2. Moreover, we studied whether there is a difference in FO restoration between modular and nonmodular stems. METHODS A retrospective review of 20 patients with PPFF of Vancouver B2 revised with a tapered fluted modular titanium stem and 22 patients with PPFF of Vancouver B2 revised with a tapered fluted nonmodular titanium stem from 2016 to 2021 was conducted. Based on the difference between the FO of the affected side and that of the healthy side, 26 patients were allocated into Group A (difference ≤ 4 mm), and 16 patients were allocated into Group B (difference > 4 mm). The postoperative Harris Hip Score (HHS), range of motion of the hip joint, length of both lower limbs and dislocation were compared between Group A and Group B. The proportions of patients with FO restoration (difference ≤ 4 mm) and stem subsidence were compared between the modular and nonmodular groups. RESULTS The mean follow-up time was 34.3 ± 17.3 months, and all cases achieved fracture healing at the last visit. Patients in Group A had a higher HHS, larger range of abduction, fewer dislocations and less limb length discrepancy (LLD). Patients in the modular group had a higher proportion of FO restoration and less subsidence. CONCLUSION FO restoration improves postoperative hip joint function and reduces dislocation and LLD in revisions of patients with PPFF of Vancouver B2. Compared with nonmodular prostheses, modular prostheses tend to be easier for FO restoration under complex circumstances.
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Affiliation(s)
- Lei Sun
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Wenjing Song
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Zhongyuan Zhang
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Ziyao Xu
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Mengshuai Sun
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Guangling Gao
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Hongjiang Jiang
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Changjun Ju
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China.
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Madanipour S, Singh P, Patel A, Beg R, Sha M, Grewal IS, Iranpour F, Subramanian P. Subsidence in Centraliser Sign: A Novel Tool to Help Predict Early Subsidence in Periprosthetic Femoral Fractures Around Polished Tapered Stems Treated With Internal Fixation. Cureus 2023; 15:e42742. [PMID: 37654957 PMCID: PMC10467608 DOI: 10.7759/cureus.42742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
Background When treating periprosthetic femoral fractures (PPF) around polished taper slip stems (PTS), determining which patients can be successfully treated with internal fixation can be challenging. We have described the subsidence-in-centraliser (SINC) sign as a radiographic feature of PPF around PTS stems. We hypothesise that a positive SINC sign can help predict a poorer outcome for the fixation of these fractures. Patients and methods Retrospective identification of PPFs around cemented PTS with an appreciable centraliser on radiographs was conducted at a single centre. A positive SINC sign was defined as a post-injury radiograph demonstrating >50% reduction in the radiographic lucency representing the stem centraliser when compared to pre-injury films or complete obliteration of distal lucency when no pre-injury film was available. The primary outcome was the rate of subsequent stem subsidence on follow-up radiographs comparing SINC-positive and SINC-negative fractures, which were managed with open reduction and internal fixation (ORIF). Results Fifty-four patients were included in the analysis. The mean age was 76.8 years, and the mean follow-up for all patients was 12.7 months. Thirty-five fractures were deemed SINC-positive, and 19 were SINC-negative. 17/17 (100%) SINC-positive fractures managed with fixation underwent further subsidence (mean 5.4 mm, SD 2.8). A positive SINC sign demonstrated a sensitivity of 90.5% and specificity of 100% for subsequent stem subsidence in fractures treated without revision. SINC positive fractures underwent significantly more subsidence compared with SINC negative fractures when fixed (5.4 mm vs. 0.28 mm, U = 6.50, p<0.001) at a mean follow-up of 12.7 months. The SINC sign demonstrated strong inter- (k=0.96) and intra-rater (k=0.86) reliability. Conclusion The SINC sign can serve as a useful adjunct in the decision to fix or revise PPF around PTS. A positive SINC sign may represent a cement mantle that cannot be reconstituted anatomically, leading to subsidence after treatment with ORIF.
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Affiliation(s)
| | - Prashant Singh
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
| | - Arpit Patel
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
| | - Ruqqayyah Beg
- Trauma and Orthopaedics, University College London Medical School, London, GBR
| | - Menazir Sha
- Trauma and Orthopaedics, University College London Medical School, London, GBR
| | - Ishvinder S Grewal
- Orthopaedic Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - Farhad Iranpour
- Trauma and Orthopaedics, Royal Free London NHS Trust, London, GBR
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Barghi A, Hanna P, Merchan N, Weaver MJ, Wixted J, Appleton P, Rodriguez E. Outcomes of fixation of Vancouver B periprosthetic fractures around cemented versus uncemented stems. BMC Musculoskelet Disord 2023; 24:263. [PMID: 37016368 PMCID: PMC10071713 DOI: 10.1186/s12891-023-06359-0] [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: 12/08/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The incidence of periprosthetic femur fracture (PPFF) in the setting of total hip arthroplasty (THA) is steadily increasing. We seek to address whether there is a difference in outcomes between Vancouver B fracture types managed with ORIF when the original stem was a press-fit stem versus a cemented stem. METHODS In this retrospective cohort study at a level 1 trauma center, we identified 136 patients over 65 years-of-age with Vancouver B-type fractures sustained between 2005 and 2019. Patients were treated by ORIF and had either cemented or press-fit stems prior to their injury. Outcomes were subsidence of the femoral implant, time to full weight bearing, rate of the hip implant revision, estimated blood loss (EBL), postoperative complications, and the one-year mortality rate. RESULTS A total of 103 (75.7%) press-fit and 33 (24.3%) cemented patients were reviewed. Patient baseline characteristics, Vancouver fracture sub-types, and implant characteristics were not found to be significantly different between groups. The difference in subsidence rates, postoperative complications, and time to weight bearing were not significantly different between groups. EBL and one-year mortality rate were significantly higher in the cemented group. CONCLUSIONS In geriatric patients with Vancouver B type periprosthetic fractures managed with ORIF, patients with an originally press fit stem may have lower mortality, lower estimated blood loss, and similar subsidence and hospital length of stays when compared to those with a cemented stem.
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Affiliation(s)
- Ameen Barghi
- Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Philip Hanna
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Nelson Merchan
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Michael J Weaver
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - John Wixted
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Paul Appleton
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Edward Rodriguez
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Stoneman 10, Boston, MA, 02215, USA.
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA.
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Frangie R, Han S, Noble PC, Gold JE, Lanfermeijer ND, Reddy KI, Ismaily SK, Su J, Schroder SJ, Rodriguez-Quintana D. The Stability of Fixation of Vancouver B2 Periprosthetic Femoral Fractures: Effect of Implantation Technique. J Arthroplasty 2023:S0883-5403(23)00237-1. [PMID: 36933680 DOI: 10.1016/j.arth.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Due to increasing volume of total hip arthroplasties, periprosthetic femoral fractures have become a common complication with increased revision burden and perioperative morbidity. The objective of this study was to evaluate the fixation stability of Vancouver B2 fractures treated with two techniques. METHODS A common B2 fracture was created by reviewing 30 type B2 cases. The fracture was then reproduced in 7 pairs of cadaveric femora. The specimens were divided into two groups. In Group I ("reduce-first"), the fragments were reduced first, followed by implantation of a tapered fluted stem. In Group II ("ream-first"), the stem was implanted in the distal femur first, followed by fragment reduction and fixation. Each specimen was loaded in a multi-axial testing frame with 70% of peak load during walking. A motion analysis system was used to track the motion of the stem and fragments. RESULTS The average stem diameter in Group II was 16.1±0.4 millimeters (mm), versus 15.4 ±0.5mm in Group I. The fixation stability was not significantly different in the two groups. After the testing, the average stem subsidence was 0.36±0.31mm and 0.19±0.14mm (P=0.17), and the average rotation was 1.67±1.30° and 0.91±1.11° (P=0.16) in Group I and II, respectively. Compared to the stem, there was less motion of the fragments, and there was no difference between the two groups (P>0.05). CONCLUSIONS When tapered fluted stems were used in combination with cerclage cables for treatment of type B2 periprosthetic femoral fractures, both the "reduce-first" and "ream-first" technique showed adequate stem and fracture stability.
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Affiliation(s)
- Robert Frangie
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Shuyang Han
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Philip C Noble
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Jonathan E Gold
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Nicholas D Lanfermeijer
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Kartik I Reddy
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Jacob Su
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - Steven J Schroder
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston 5420 West Loop South. Bellaire, Texas 77401.
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10
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Takami H, Takegami Y, Tokutake K, Kurokawa H, Iwata M, Terasawa S, Oguchi T, Imagama S. Mortality and clinical outcomes of Vancouver type B periprosthetic femoral fractures : a multicentre retrospective study. Bone Jt Open 2023; 4:38-46. [PMID: 36647618 PMCID: PMC9887342 DOI: 10.1302/2633-1462.41.bjo-2022-0145.r1] [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] [Indexed: 01/18/2023] Open
Abstract
AIMS The objectives of this study were to investigate the patient characteristics and mortality of Vancouver type B periprosthetic femoral fractures (PFF) subgroups divided into two groups according to femoral component stability and to compare postoperative clinical outcomes according to treatment in Vancouver type B2 and B3 fractures. METHODS A total of 126 Vancouver type B fractures were analyzed from 2010 to 2019 in 11 associated centres' database (named TRON). We divided the patients into two Vancouver type B subtypes according to implant stability. Patient demographics and functional scores were assessed in the Vancouver type B subtypes. We estimated the mortality according to various patient characteristics and clinical outcomes between the open reduction internal fixation (ORIF) and revision arthroplasty (revision) groups in patients with unstable subtype. RESULTS The one-year mortality rate of the stable and unstable subtype of Vancouver type B was 9.4% and 16.4%. Patient demographic factors, including residential status and pre-injury mobility were associated with mortality. There was no significant difference in mortality between patients treated with ORIF and Revision in either Vancouver B subtype. Patients treated with revision had significantly higher Parker Mobility Score (PMS) values (5.48 vs 3.43; p = 0.00461) and a significantly lower visual analogue scale (VAS) values (1.06 vs 1.94; p = 0.0399) for pain than ORIF in the unstable subtype. CONCLUSION Among patients with Vancouver type B fractures, frail patients, such as those with worse scores for residential status and pre-injury mobility, had a high mortality rate. There was no significant difference in mortality between patients treated with ORIF and those treated with revision. However, in the unstable subtype, the PMS and VAS values at the final follow-up examination were significantly better in patients who received revision. Based on postoperative activities of daily life, we therefore recommend evision in instances when either treatment option is feasible.Cite this article: Bone Jt Open 2023;4(1):38-46.
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Affiliation(s)
- Hideomi Takami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan,Correspondence should be sent to Yasuhiko Takegami. E-mail:
| | | | - Hiroshi Kurokawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Manato Iwata
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Terasawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Oguchi
- Department of Orhopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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The influence of calcar collar and surface finish in the cemented femoral component on the incidence of postoperative periprosthetic femoral fracture at a minimum of five years after primary total hip arthroplasty. Injury 2022; 53:2247-2258. [PMID: 35292157 DOI: 10.1016/j.injury.2022.03.011] [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: 07/20/2021] [Revised: 01/13/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cemented femoral component design including its mechanical behavior in total hip arthroplasty (THA) has influenced the occurrence of postoperative periprosthetic femoral fracture (PPFF). The main aim of this study was to investigate the influence of the calcar collar and surface finish in the cemented femoral component on the risk of PPFF. MATERIALS AND METHODS This retrospective review was undertaken of 1082 primary THAs in 912 patients using cemented femoral components followed for a minimum of five years (mean, 9.4 years; range, 5-24 years). The incidence of PPFF, patients' demographics and surgical details were evaluated. Kaplan-Meier survivorship analysis was performed for four different outcomes: any PPFF, revision of the femoral component for PPFF, aseptic loosening, and for any reason. RESULTS The overall incidence of PPFFs was 1.0% (n = 11): 1.4% (n = 10) in the collarless polished (CLP) group, none in the collared polished (CP) group and 0.6% (n = 1) in the collared non-polished (CNP) group (p > 0.05). Kaplan-Meier survival analysis for the femoral component at 12 years with PPFF as the end point was 97.4% (95% confidence interval [CI], 94.9 to 99.8) in the collarless group and 99.7% (95% CI, 99.1 to 100) in the collared group (p = 0.048). With revision of the femoral component for aseptic loosening as the end point, survivorship was 100.0% in the CLP and CP groups, and 98.1% (95% CI, 95.9 to 100) in the CNP group (CLP vs CP, p > 0.999; CLP vs CNP, p = 0.001; CP vs CNP, p = 0.112). CONCLUSION This study demonstrated that the calcar collar in the cemented femoral component could play an important role to reduce the incidence of PPFF. The surface finish in the cemented femoral components influenced the incidence of femoral component revision for aseptic loosening over 5-12 years. Surgeons should consider not only the geometry and the mechanical function of the femoral components based on different design philosophies, but also potential complications associated with different designs that may require revision arthroplasty.
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Klasan A, Millar J, Quayle J, Farrington B, Misur PN. Comparable outcomes of in-cement revision and uncemented modular stem revision for Vancouver B2 periprosthetic femoral fracture at 5 years. Arch Orthop Trauma Surg 2022; 142:1039-1046. [PMID: 33575925 DOI: 10.1007/s00402-021-03776-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Periprosthetic femoral fractures (PFF) are detrimental for patients. Vancouver B2 fractures about a cemented stem can be revised to a longer uncemented stem or using an in-cement revision, if the cement mantle is adequate. There are reports documenting the success of both techniques. The aim of this single centre study was to perform a direct comparison of these two procedures. MATERIALS AND METHODS A retrospective study of consecutive Vancouver B2 PFFs around a cemented stem during 16 years was performed. All study cases were treated either using an in-cement revision or with an uncemented stem revision. Preoperatively, the groups were compared based upon age, gender, ASA, BMI, and Charlson comorbidity score. The outcome measures were surgical time, complications, in-hospital stay, revisions, 1-year readmission rate, and survivorship. RESULTS After a median of 3.5 years, there were 70 patients in the uncemented and 31 in the in-cement group. There was no difference in any of the preoperative variables. Surgical time was shorter for in-cement revisions by a mean of 45 min (p < 0.001). There was no difference in in-hospital stay, surgical complications or readmissions. Implant survival at 5 years was 93.5% for the in-cement and 94.4% for the uncemented revision (p = 0.946). Patient survivorship at 5 years was 62.5% for the in-cement and 69.8% for the uncemented group (p = 0.094). CONCLUSIONS This study demonstrates that in-cement revision is a valid treatment option for Vancouver B2 fractures, comparable to uncemented stem revision, if certain criteria are met. There was no difference in revision rate, patient survivorship, complications, readmissions or in-hospital stay.
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Affiliation(s)
- Antonio Klasan
- North Shore Hospital, Auckland, New Zealand. .,Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
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13
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Mondanelli N, Troiano E, Facchini A, Ghezzi R, Di Meglio M, Nuvoli N, Peri G, Aiuto P, Colasanti GB, Giannotti S. Treatment Algorithm of Periprosthetic Femoral Fracturens. Geriatr Orthop Surg Rehabil 2022; 13:21514593221097608. [PMID: 35573905 PMCID: PMC9096211 DOI: 10.1177/21514593221097608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction. The ever-expanding indications for total hip arthroplasty are leading to more implants being placed in younger as well as in older patients with high functional demand. Also, prolonged life expectancy is contributing to an overall increment of periprosthetic femoral fractures. The Vancouver classification has been the most used for guiding the surgeon choice since its proposal in 1995. Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patients' functional demand, age and comorbidities, and surgeon expertise. There are many different treatment techniques available which include osteosynthesis and revision surgery or a combination of both. The goals of surgical treatment are patients' early mobilization, restoration of anatomical alignment and length with a stable prosthesis and maintenance of bone stock. Significance. The aim of this review is to describe the state-of-the-art treatment and outcomes in the management of PFFs. We performed a systematic literature review of studies reporting on the management of PFFs around hip stems and inter-prosthetic fractures identifying 45 manuscripts eligible for the analysis. Conclusions. PFFs present peculiar characteristic that must be considered and special features that must be addressed. Their management is complex due to the extreme variability of stem designs, the possibility of having cemented or uncemented stems, the difficulty in identifying the "real" level of the fracture and the actual stability of the stem. As a result, the definition of a standardized treatment is unlikely, thereby high expertise is fundamental for the surgical management of PPFs, so this kind of fractures should be treated only in specialized centres with both high volume of revision joint arthroplasty and trauma surgery.
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Affiliation(s)
- Nicola Mondanelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Elisa Troiano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Andrea Facchini
- Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia, Italy
| | - Roberta Ghezzi
- Ospedale Santa Maria degli Angeli, Azienda Sanitaria Friuli Occidentale, Italy
| | - Martina Di Meglio
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Nicolò Nuvoli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Giacomo Peri
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Pietro Aiuto
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
| | - Giovanni Battista Colasanti
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
- Ospedale Santa Maria delle Croci, Azienda USL della Romagna, Italy
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
- Section of Orthopedics, Policlinico Santa Maria alle Scotte, Azienda Ospedaliero-Universitaria Senese, Italy
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14
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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.
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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
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González-Martín D, Pais-Brito JL, González-Casamayor S, Guerra-Ferraz A, Ojeda-Jiménez J, Herrera-Pérez M. New Sub-Classification of Vancouver B2 Periprosthetic Hip Fractures According to Fracture Pattern. Injury 2022; 53:1218-1224. [PMID: 34749906 DOI: 10.1016/j.injury.2021.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is currently a debate on whether all Vancouver type B2 (V-B2) periprosthetic hip fractures (PPHF) should be revised. Vancouver classification takes into account fracture location, implant stability and bone stock, but it does not distinguish between fracture patterns. The aim of our work was to study the different fracture patterns of V-B2 PPHF and to analyze if there is any pattern that presents lower osteosynthesis failure rates. MATERIAL AND METHODS All patients with V-B2 PPHF treated by osteosynthesis between January 2009 and January 2019 were included in the study. Using the Gruen system the proximal femur was divided into 3 zones. The lateral zone (Gruen 1±2±3), medial zone (Gruen 5±6±7), and distal zone (Gruen 4±3±5) were analysed and it was determined whether each of the 3 zones was fractured. RESULTS 56 patients were included in the study. Their mean age was 79 years (R 45 - 92). The chosen treatment was: 39 Open reduction and internal fixation (ORIF), 10 Stem revision and 7 nonoperatively treatment. In ORIF group, no implant complications (0/24) were found in patients with a single fractured zone, while 5 implant complications (5/15) were discovered in patients with two or more fractured areas; this difference was significant (p=0.0147). All patients treated by stem revision had a fracture that involved two or more zones. In the nonoperatively group, the fracture pattern did not influence the treatment because of all of them had a very precarious functional and medical situation. CONCLUSIONS V-B2 PPHF treated via ORIF affecting only one zone (medial, lateral, or distal) have a lower risk of complication than those affecting two or more zones. We propose a sub-classification of Vancouver B2 type fractures: B2.1 (1 fractured zone) and B2.2 (≥2 fractured zones). LEVEL OF EVIDENCE Historical cohorts. Level III.
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Affiliation(s)
- David González-Martín
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
| | - José Luis Pais-Brito
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
| | | | - Ayron Guerra-Ferraz
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - Jorge Ojeda-Jiménez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain
| | - Mario Herrera-Pérez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain
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16
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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: 12] [Impact Index Per Article: 6.0] [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.
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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
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Lv H, Guo X, Wang YH, Zhang ZJ, Zou LF, Xue H, Huang DH, Tan MY. Open reduction and locked compression plate fixation, with or without allograft strut, for periprosthetic fractures in patients who had a well-fixed femoral stem: a retrospective study with an average 2-year follow-up. BMC Musculoskelet Disord 2022; 23:69. [PMID: 35045862 PMCID: PMC8772153 DOI: 10.1186/s12891-022-05008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background The use of cortical strut allograft has not been determined for Vancouver type B1 or C fracture. This study aimed to evaluate the short-term efficacy of locking compression plating with or without cortical strut allograft in managing these types of fractures. Methods We retrospectively assessed 32 patients (17 males, 15 females; 23–88 years, mean: 67.2 years) with Vancouver type B1 or C fractures. Seventeen patients (Group A; B1 fractures in 15 hips, C fractures in 2 hips) were treated with open reduction and internal fixation with locking compression plates (group A). The other 15 patients (Group B; B1 in 14 hips, C in 1 hip) were fixed by locking compression plating combined with cortical strut allografting (group B). The fracture healing rate, healing time, complications and function were compared between these two groups. Results The mean follow-up time was 32.4 months (12 to 66), and the overall fracture union rate of the 32 patients was 96.9%. Group B had a higher fracture union rate than Group A, but the difference was not statistically significant. Group A had one case of nonunion of type B1 fracture and one case of malunion; the mean time to fracture healing was 5.3 months (3 to 9). In group B, all patients reached bony union without malunion, with a mean time of fracture healing of 5.1 months (3 to 8). Conclusion Treatment of Vancouver type B1 or C fractures by locking compression plating, with or without cortical strut allografting, resulted in similar union rates in these patients. This suggest that, the use of cortical strut allografting should be decided cautiously.
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Grewal US, Bawale R, Singh B, Sandiford A, Samsani S. Outcomes following non-operatively managed periprosthetic fractures surrounding uncemented femoral stems. J Clin Orthop Trauma 2021; 24:101688. [PMID: 34853774 PMCID: PMC8607200 DOI: 10.1016/j.jcot.2021.101688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The primary aim of this study was to explore the outcomes of Vancouver B periprosthetic hip fractures that were managed non-operatively with a particular focus on 1-year mortality. Understanding this mortality data will allow surgeons to better understand the risk associated with non-operative management. The secondary aim was to evaluate our case series and current literature with regards to identifying suitable patients for non-operative treatment. METHODS Our electronic fracture database was interrogated for all Vancouver B periprosthetic fractures treated at our institution between April 2009 to April 2019; 18 patients were identified. All available data was then collected from radiographic, electronic and paper notes. A comprehensive literature search of PUBMED and EMBASE databases was then conducted with all relevant literature reviewed. RESULTS 1-year mortality of these patients was noted at 22.2%; highlighting the severity of these injuries. No patients required conversion to surgical management, sustained a dislocation or went into non-union. With regards to literature no case series focussing on non-operative management outcomes were reported. There was a marked paucity of literature relating to conservative management of these injuries. CONCLUSION To our knowledge this is the first published case series focussing solely on nonoperatively managed Vancouver B periprosthetic hip fractures. This paper provides evidence from the first reported case series with which surgeons can counsel patients on the significant mortality risk associated with these fractures. Non-operative management of periprosthetic hip fractures is possible after careful analysis of the fracture configuration, implant and patient characteristics. Whilst we have outlined several findings from our first reported case series, further research is required from a larger prospective case series in order to make evidence based recommendations.
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Affiliation(s)
- Urpinder Singh Grewal
- Medway Maritime Hospital, Medway Foundation Trust, United Kingdom, Windmill Road, Gillingham, Kent, ME7 5NY, UK,Corresponding author.
| | - Rajesh Bawale
- Medway Maritime Hospital, Medway Foundation Trust, United Kingdom, Windmill Road, Gillingham, Kent, ME7 5NY, UK
| | - Bijayendra Singh
- Medway Maritime Hospital, Medway Foundation Trust, United Kingdom, Windmill Road, Gillingham, Kent, ME7 5NY, UK
| | | | - Srinivas Samsani
- Medway Maritime Hospital, Medway Foundation Trust, United Kingdom, Windmill Road, Gillingham, Kent, ME7 5NY, UK
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19
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Uncemented femoral stem design might have an impact on postoperative periprosthetic femur fracture pattern. A Comparison between flat-wedge and dual-wedge stems. Injury 2021; 52:3461-3470. [PMID: 33648738 DOI: 10.1016/j.injury.2021.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/31/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Type I, flat-wedge and type II, dual-wedge stems are currently two common stem types used in primary, uncemented hip arthroplasty. The prevalence of periprosthetic femur fracture is higher in type I stems, possibly because of the different shapes and areas of bone contact. We aimed to compare the fracture pattern, stem stability during the fracture and type of subsequent procedures in periprosthetic femur fractures between type I and II stems. MATERIALS AND METHODS This was a retrospective, cross-sectional study conducted in a single tertiary referral hospital of Taipei, Taiwan. We included primary hip arthroplasty procedures using type I or type II stems complicated with postoperative periprosthetic femur fractures. We recorded the age, sex, ASA grade, index procedure, institution of where the index procedure was performed, trauma mechanism, time from index procedure to fracture, procedure for periprosthetic fracture and radiographic parameters including Dorr type, Vancouver classification, stem stability, fracture pattern, type and brand of the stems for analysis. RESULTS We included 132 patients who had undergone surgery for periprosthetic femur fracture for type I (N = 46) or type II (N = 86) stems. The mean age was 74.5 years and 52.3% of the patients were female. Type I stems were associated with a higher proportion of a complex fracture pattern (52.2% vs. 8.2%), femoral stem loosening (78.2% vs. 60.4%) and a higher rate of revision stem procedures (69.6% vs. 50.0%) compared with type II stems. Using multivariate analysis, type I stem was the only factor for a complex fracture pattern in the overall population (aOR: 23.60, 95% CI: 6.54-85.16), hemiarthroplasty (aOR: 160.50, 95% CI: 9.77-2635.95) and total hip arthroplasty (aOR: 14.17, 95% CI: 2.92-68.79) subgroups. CONCLUSION We observed a difference in fracture patterns between type I and type II stems. Type I stems appear to be an independent risk factor for a complex fracture pattern in patients who had undergone primary hip arthroplasty.
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20
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González-Martín D, Pais-Brito JL, González-Casamayor S, Guerra-Ferraz A, Martín-Vélez P, Herrera-Pérez M. Periprosthetic Hip Fractures With a Loose Stem: Open Reduction and Internal Fixation Versus Stem Revision. J Arthroplasty 2021; 36:3318-3325. [PMID: 34052099 DOI: 10.1016/j.arth.2021.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is recommended revision for periprosthetic hip fractures (PPHF) with a loose stem. However, several authors have argued that under certain conditions, this fracture could be treated using osteosynthesis. The aim is to compare stem revision versus internal fixation in the treatment of PPHF with a loose stem. METHODS All patients with PPHF with a loose stem treated by osteosynthesis and stem revision between January 2009 and January 2019 were included. We assessed hospital stay, American Society of Anesthesiologists, Charlson comorbidity index, surgery time, blood transfusion, complications, reoperation rate, first-year mortality, radiological, and functional results. RESULTS A total of 57 patients were included (40 osteosyntheses and 17 stem revision), with an average follow-up time of 3.1 years. Their mean age was 78.47 years (R 45-92). In the osteosynthesis group, fewer patients required blood transfusion (32.5% vs. 70.6%), surgical times were shorter (108 minutes vs. 169 minutes), and the cost was lower, both in terms of total cost (€14,239.07 vs. €21,498.45 and operating room cost (€5014.63 vs. €8203.34). No significant differences were found between the groups in terms of complications, reoperation rate, or functional outcomes. CONCLUSION Compared with stem revision, osteosynthesis requires less surgery time, has a lower need for blood transfusions, and a reduced hospital cost. Stem revision remains the treatment of choice in PPHF with a loose stem, but in V-B2 fractures in elderly patients with low functional demand, high anesthetic risk (American Society of Anesthesiologists ≥3), and many comorbidities (Charlson comorbidity index ≥5) in whom anatomic reconstruction is possible, osteosynthesis can be a viable option. EVIDENCE LEVEL Historical cohorts. Level III.
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Affiliation(s)
- David González-Martín
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain
| | - José Luis Pais-Brito
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
| | | | - Ayron Guerra-Ferraz
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pablo Martín-Vélez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain
| | - Mario Herrera-Pérez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain
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21
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Haider T, Hanna P, Mohamadi A, Merchan N, McNichol M, Wixted JJ, Appleton PT, Nazarian A, von Keudell AG, Rodriguez EK. Revision Arthroplasty Versus Open Reduction and Internal Fixation of Vancouver Type-B2 and B3 Periprosthetic Femoral Fractures. JBJS Rev 2021; 9:01874474-202108000-00009. [PMID: 34415859 DOI: 10.2106/jbjs.rvw.21.00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Revision arthroplasty (RA) continues to be considered the gold standard in the surgical treatment of Vancouver type-B2 and B3 periprosthetic femoral fractures. However, open reduction and internal fixation (ORIF) has been associated with satisfactory outcomes. Thus, there is an ongoing discussion regarding the optimal surgical strategy for the treatment of these fractures. » In this systematic review and meta-analysis, no significant differences in clinical and radiographic outcome were observed between ORIF and RA in the treatment of Vancouver type-B2 periprosthetic femoral fractures. » ORIF of Vancouver type-B3 periprosthetic femoral fractures was associated with higher revision and reoperation rates than those after RA. » Compared with RA, a significantly higher rate of subsidence was found in the ORIF group in Vancouver type-B2 periprosthetic femoral fractures whereas no significant difference in terms of loosening was observed. » In the comparison of RA and ORIF for the treatment of Vancouver type-B2 and B3 fractures, the percentage of patients achieving full weight-bearing did not differ significantly. » Mortality rates did not differ between RA and ORIF in the treatment of Vancouver type-B2 and B3 fractures. » Overall complication rates did not differ between RA and ORIF in the treatment of Vancouver type-B2 and B3 fractures. » We found a high heterogeneity in applied surgical and fixation techniques in the ORIF group.
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Affiliation(s)
- Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philip Hanna
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Amin Mohamadi
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Nelson Merchan
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Megan McNichol
- Knowledge Services Information Systems, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John J Wixted
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Paul T Appleton
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Arvind G von Keudell
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward K Rodriguez
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Harvard Medical School Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
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22
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Jain S, Mohrir G, Townsend O, Lamb JN, Palan J, Aderinto J, Pandit H. Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems. Bone Joint J 2021; 103-B:1339-1344. [PMID: 34334039 DOI: 10.1302/0301-620x.103b8.bjj-2021-0021.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. METHODS Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss' kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs. RESULTS Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement. CONCLUSION This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J 2021;103-B(8):1339-1344.
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Affiliation(s)
- Sameer Jain
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Chapel Allerton Hospital, Leeds, UK
| | | | - Oliver Townsend
- Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Jonathan N Lamb
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Chapel Allerton Hospital, Leeds, UK
| | - Jeya Palan
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Chapel Allerton Hospital, Leeds, UK
| | | | - Hemant Pandit
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK.,Chapel Allerton Hospital, Leeds, UK
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23
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Slullitel PA, Garcia-Barreiro GG, Oñativia JI, Zanotti G, Comba F, Piccaluga F, Buttaro MA. Selected Vancouver B2 periprosthetic femoral fractures around cemented polished femoral components can be safely treated with osteosynthesis. Bone Joint J 2021; 103-B:1222-1230. [PMID: 34192924 DOI: 10.1302/0301-620x.103b7.bjj-2020-1809.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. METHODS We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. RESULTS In all, nine (8.01%) surgical failures were detected. All failures occurred within the first 24 months following surgery. The 24-month implant survival was 95.4% (95% confidence interval (CI) 89.13 to 100) for B1 fractures treated with internal fixation, 90% (95% CI 76.86 to 100) for B2 PFFs treated with osteosynthesis-only, and 85.8% (95% CI 74.24 to 97.36) for B2 fractures treated with revision THA, without significant differences between groups (p = 0.296). Readmissions and major adverse events including mortality were overall high, but similar between groups (p > 0.05). The two-year patient survival rate was 87.1% (95% CI 77.49 to 95.76), 66.7% (95% CI 48.86 to 84.53), and 84.2% (95% CI 72.63 to 95.76), for the B1 group, B2 osteosynthesis group, and B2 revision group, respectively (p = 0.102). CONCLUSION Implant survival in Vancouver B2 PFFs treated with internal fixation was similar to that of B1 fractures treated with the same method and to B2 PFFs treated with revision arthroplasty. Low-demand, elderly patients with B2 fractures around well-cemented polished femoral components with an intact bone-cement interface can be safely treated with internal fixation. Cite this article: Bone Joint J 2021;103-B(7):1222-1230.
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Affiliation(s)
- Pablo A Slullitel
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gonzalo G Garcia-Barreiro
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - José I Oñativia
- Adult Reconstructive Surgery Unit, Department of Orthopaedic Surgery, Sanatorio del Norte, Tucumán, Buenos Aires, Argentina
| | - Gerardo Zanotti
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Comba
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Piccaluga
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin A Buttaro
- Sir John Charnley Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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24
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Maggs JL, Swanton E, Whitehouse SL, Howell JR, Timperley AJ, Hubble MJW, Wilson MJ. B2 or not B2? That is the question: a review of periprosthetic fractures around cemented taper-slip femoral components. Bone Joint J 2021; 103-B:71-78. [PMID: 33380191 DOI: 10.1302/0301-620x.103b1.bjj-2020-0163.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Periprosthetic fractures (PPFs) around cemented taper-slip femoral prostheses often result in a femoral component that is loose at the prosthesis-cement interface, but where the cement-bone interface remains well-fixed and bone stock is good. We aim to understand how best to classify and manage these fractures by using a modification of the Vancouver classification. METHODS We reviewed 87 PPFs. Each was a first episode of fracture around a cemented femoral component, where surgical management consisted of revision surgery. Data regarding initial injury, intraoperative findings, and management were prospectively collected. Patient records and serial radiographs were reviewed to determine fracture classification, whether the bone cement was well fixed (B2W) or loose (B2L), and time to fracture union following treatment. RESULTS In total, 47 B2W fractures (54.0%) and one B3 fracture (1.1%) had cement that remained well-fixed at the cement-bone interface. These cases were treated with cement-in-cement (CinC) revision arthroplasty. Overall, 43 fractures with follow-up united, and two patients sustained further fractures secondary to nonunion and required further revision surgery. A total of 19 B2L fractures (21.8%) and 19 B3 fractures (21.8%) had cement that was loose at the cement-bone interface. These cases were managed by revision arthroplasty with either cemented or uncemented femoral components, or proximal femoral arthroplasty. One case could not be classified. CONCLUSION We endorse a modification of the original Vancouver system to include a subclassification of B2 fractures around cemented femoral prostheses to include B2W (where cement is well-fixed to bone) and B2L (where the cement is loose). Fractures around taper-slip design stems are more likely to fracture in a B2W pattern compared to fractures around composite beam design stems which are more likely to fracture in a B2L pattern. B2W fractures can reliably be managed with CinC revision. Cite this article: Bone Joint J 2021;103-B(1):71-78.
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Affiliation(s)
- Joanna L Maggs
- Princess Elizabeth Orthopaedic Centre, Exeter, Devon, UK
| | - Eric Swanton
- Princess Elizabeth Orthopaedic Centre, Exeter, Devon, UK
| | - Sarah L Whitehouse
- Orthopaedic Research Unit, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | | | - A John Timperley
- Princess Elizabeth Orthopaedic Centre, Exeter, Devon, UK.,College of Engineering, Maths and Physical Science, University of Exeter, Exeter, Devon, UK
| | | | - Matt J Wilson
- Princess Elizabeth Orthopaedic Centre, Exeter, Devon, UK
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25
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Schreiner AJ, Steidle C, Schmidutz F, Gonser C, Hemmann P, Stöckle U, Ochs G. Hip Revision Arthroplasty of Periprosthetic Fractures Vancouver B2 and B3 with a Modular Revision Stem: Short-Term Results and Review of Literature. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:40-48. [PMID: 32746487 DOI: 10.1055/a-1209-4002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Periprosthetic fractures Vancouver type B2/B3 after total hip arthroplasty (THA) is a challenging entity with increasing numbers. Limited data are available for this type of fracture treated with modular stems. Therefore, this study evaluated the outcome of Vancouver type B2/B3 fractures treated with a modular hip revision stem using a subproximal/distal anchorage and compared it to the current literature. MATERIALS AND METHODS A consecutive series of periprosthetic Vancouver type B2/B3 fractures treated with a modular revision stem was retrospectively (2013 - 2016) evaluated. Assessment included the clinical (HHS, pain, ROM) as well as the radiological outcome (subsidence, loosening, facture healing). In adddition, the surgical technique is described in detail and results are compared with the current literature. RESULTS A total of 18 patients (female/male 12/6) with Vancouver B2/B3 (n = 12/6) fractures with a mean age of 75.5 (60 - 89) years were included. The revision stem was inserted via a modified transgluteal approach (n = 16) or classical transfemoral approach (n = 2). The mean follow-up was 18.5 months, with a mean Harris Hip Score of 72.5 ± 18.7 (35.0 - 99.0) points. The fracture healing rate was 94.4% (n = 17) with osseous integration according to Engh in all cases. Dislocations of the greater trochanter were recorded in seven patients (38.9%). According to Beals and Towers, all results were rated excellent or good. No implant-related failure or relevant subsidence during this time was observed. Major complications were observed in five patients with two periprosthetic joint infections and two cases of major revision surgery. CONCLUSION This study assessing Vancouver B2/3 fractures shows reproducible, good, short-term results in terms of subsidence and clinical functional outcome by the use of a modular revision stem. The transfemoral approach together with the modular stem allows for a stable fixation and good fracture healing. However, our data and review of the literature also documents the difficulties and higher complication rate associated with Vancouver B2/3 fractures.
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Affiliation(s)
- Anna Janine Schreiner
- Department of Arthroplasty, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen
| | - Christoph Steidle
- Department of Arthroplasty, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen
| | - Florian Schmidutz
- Department of Arthroplasty, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen.,Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU)
| | - Christoph Gonser
- Department of Arthroplasty, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen
| | - Philipp Hemmann
- Department of Arthroplasty, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen
| | - Ulrich Stöckle
- Center for Muskuloskeletal Surgery, Charité University Hospital Berlin
| | - Gunnar Ochs
- Vincentius Orthopedic Clinic, Hospital Konstanz
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