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Axenhus M, Mukka S, Magnéli M, Sköldenberg O. Comparative outcomes of uncemented and cemented stem revision in managing periprosthetic femoral fractures: a retrospective cohort study. J Orthop Traumatol 2024; 25:35. [PMID: 39023807 PMCID: PMC11258106 DOI: 10.1186/s10195-024-00777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Periprosthetic femoral fractures (PFFs) following hip arthroplasty, especially Vancouver B2 and B3 fractures, present a challenge due to the association with a loose femoral stem, necessitating either open reduction and internal fixation or stem revision. This study aims to compare outcomes between uncemented and cemented stem revisions in managing Vancouver B2 and B3 fractures, considering factors such as hip-related complications, reoperations, and clinical outcome. METHODS A retrospective cohort study was conducted at Danderyd Hospital, Sweden, from 2008 to 2022, encompassing operatively treated Vancouver B2 and B3 fractures. Patients were categorized into uncemented and cemented stem revision groups, with data collected on complications, revision surgeries, fracture healing times, and clinical outcomes. RESULTS A total of 241 patients were identified. Significant differences were observed between the two groups in patient demographics, with the cemented group comprising older patients and more females. Follow up ranged from 1 to 15 years. Average follow up time was 3.9 years for the cemented group and 5.5 years for the uncemented group. The cemented stems demonstrated lower rates of dislocation (8.9% versus 22.5%, P = 0.004) and stem loosening (0.6% versus 9.3%, P = 0.004) than the uncemented method. Moreover, the cemented group exhibited shorter fracture healing times (11.4 weeks versus 16.7 weeks, P = 0.034). There was no difference in clinical outcome between groups. Mortality was higher in the cemented group. CONCLUSIONS This retrospective study indicates that cemented stem revision for Vancouver B2-3 fractures is correlated with lower dislocation and stem loosening rates, necessitating fewer reoperations and shorter fracture healing times compared with the uncemented approach. The cemented group had a notably higher mortality rate, urging caution in its clinical interpretation. LEVEL OF EVIDENCE III
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Affiliation(s)
- Michael Axenhus
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden.
| | - Sebastian Mukka
- Department of Diagnostics and Intervention (Orthopaedics), Umeå University, Umeå, Sweden
| | - Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
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Yin L, Liu Y, Zeng S, Shen H. BCIFS in the treatment of Vancouver type B1 periprosthetic femoral fracture combined with comminuted femoral stem fracture: A case report. Asian J Surg 2024; 47:2274-2276. [PMID: 38378428 DOI: 10.1016/j.asjsur.2024.01.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Lu Yin
- Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China.
| | - Yang Liu
- Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Shengqiang Zeng
- Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Huarui Shen
- Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China.
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Gausden EB, Bedard NA, Gililland JM, Haidukewych GJ. What's New in Periprosthetic Femur Fractures? J Arthroplasty 2024:S0883-5403(24)00360-7. [PMID: 38642853 DOI: 10.1016/j.arth.2024.04.037] [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: 12/15/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Periprosthetic femur fracture (PFF) is one of the most common indications for reoperation following total hip arthroplasty. METHODS/RESULTS This article provides a review of a symposium on PFF that was presented at the American Association of Hip and Knee Surgeons 2023 annual meeting, including an overview of the Vancouver classification and its implications on treatment and subsequent complications, an updated approach to the management of intraoperative fractures, and finally, contemporary strategies for both osteosynthesis as well as revision arthroplasty for PFFs. CONCLUSION As the incidence of PPF continues to increase, arthroplasty and trauma surgeons must be prepared to address this challenging complication with a contemporary understanding of the treatment options and their outcomes.
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Affiliation(s)
- Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Jeremy M Gililland
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah
| | - George J Haidukewych
- Department of Orthopedic Surgery, Orlando Health Medical Group, Orlando, Florida
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Aguado HJ, Castillón-Bernal P, Teixidor-Serra J, García-Sánchez Y, Muñoz-Vives JM, Camacho-Carrasco P, Jornet-Gibert M, Ojeda-Thies C, García-Portabella P, Pereda-Manso A, Mateos-Álvarez E, Manzano-Mozo J, Carrillo-Gómez R, País-Ortega S, García-Virto V, Noriega-González D, Álvarez-Ramos BA, Ganso-Pérez A, Cervera-Díaz C, Plata-García M, Ortega-Briones A, Berrocal-Cuadrado J, Criado del Rey-Machimbarrena D, Salvador J, Rey L, Tomás-Hernández J, Selga-Marsà J, Andrés-Peiró JV, Querolt-Coll J, Triana G, Vives-Barquiel M, Renau-Cerrillo M, Campuzano-Bitterling B, Hernández JM, Ostilla R, Carreras-Castañer A, Torner P, Díaz-Suárez R, Fernández EA, Olaya-González C, Fernández-Villán M, García de Cortázar U, Arrieta M, Escobar D, Castrillo E, Balvis P, Rodríguez-Arenas M, García-Pérez Á, Moreta J, Bidea I, Jiménez-Urrutia X, Olías-López B, Boluda-Mengod J, González-Martín D, Bárcena-Goitiandia L, López-Dorado D, Borrás-Cebrián JC, García-Aguilera D, Freile-Pazmiño PA, Suárez-Suárez MÁ, Lanuza-Lagunilla L, García-Arias A, Sánchez-Saz J, García-Coiradas J, Valle-Cruz J, Mora-Fernández J, Cano-Leira MÁ, Rieiro G, Benjumea-Carrasco A, Priego-Sánchez RJ, Sánchez-Pérez C, Guadilla-Arsuaga J, Fernández-Juan A, Sánchez P, Ricón J, Fuentes-Díaz A, García-García EM, Cuadrado-Abajo F, García-Portal G, del PozoManrique P, Castillo del Pozo V, Garcia-Navas FM, García-Paredero E, Beteta-Robles T, Guijarro-Valtueña A, Gutiérrez-Baiget G, Alonso-García N, Navas-Pernía I, Ariza-Herrera D, Vilanova J, Videla-Cés M, Serra-Porta T, Vázquez-García C, Carrasco-Becerra C, Pena-Paz S, Otero-Naveiro V, Fernández-Billón-Castrillo I, Martínez-Menduiña A, Hernández-Galera C, Fernández-Dorado F, Madrigal-López M, Murcia-Asensio A, Galián-Muñoz E, Castro-Sauras Á, Espallargas-Doñate T, Royo-Agustín M, Plaza-Salazar N, Gámez-Asunción C, Muñoz-Vicente A, Pareja-Sierra T, Benito-Santamaría J, Cuenca-Copete A, Verdejo-González A, González-Montero B, Giraldo-Vegas LA, Alonso-Viana L, Díez-Pérez EJ, Briso-Montiano R, Andrés AI, Mingo-Robinet J, Naharro-Tobío M, Escudero-Martínez E, Serrano-Sanz J, Peñalver-Matamoros JM, Fernàndez-Poch N, Martínez-Carreres L, Macho-Mier M, Martín-Hernández C, Laclériga-Giménez AF, Saló-Cuenca JC, Salamanca-Ontiveros C, Espona-Roselló J, Altemir-Martínez V, Criado-Albillos G, Cunchillos-Pascual J, Millán-Cid M, Cabello-Benavides HG, Martínez-Íñiguez-Blasco J, Sevilla-Ortega P, Cano JR, Ramírez A, Marqués-López F, Martínez-Díaz S, Carabelli GS, Slullitel PA, Astore I, Boietti BR, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Dot-Pascuet I, Pereira-Mosquera E, Martín-Antúnez J, Pérez JM, Mandía-Martínez A, De Caso J, Martín-Marcuello J, Benito-Mateo M, Murillo-Vizuete AD, Delgado LG, dela Herrán G, Nunes N, Pérez-Coto I, González-Panisello MR, Iglesias-Fernández S, Ruete-Gil GL, Ramos-García S, Villarreal JP. Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain. J Orthop Traumatol 2024; 25:13. [PMID: 38451303 PMCID: PMC10920552 DOI: 10.1186/s10195-024-00746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. METHODS PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. RESULTS The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. CONCLUSIONS Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge. Level of Evidence Level IV case series. TRIAL REGISTRATION registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 20-2041.
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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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Dozo MA, Abrego MO, Comba F, Zanotti G, Buttaro MA, Slullitel PA. Late Periprosthetic Femoral Stress Fracture Associated with Extra-articular Deformity in a Patient with Fibrous Dysplasia: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00013. [PMID: 37478317 DOI: 10.2106/jbjs.cc.23.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
CASE In the setting of a total hip arthroplasty performed in a patient with a proximal femoral deformity, atraumatic periprosthetic femoral stress fracture may arise as a complication. We report a rare case of a late periprosthetic femoral stress fracture around a cemented stem in a patient with a history of fibrous dysplasia of the proximal femur. After a 10-year uneventful period, the patient complained about a subtle, subacute pain in his left thigh induced by exercise but not with daily axial load. Diagnosis of a nondisplaced, incomplete (i.e., only compromising the lateral femoral cortex) periprosthetic femoral stress fracture was made with plain radiographs, blood work, and bone scintigraphy. Surgical treatment consisted of a minimally invasive plate osteosynthesis bridging the femoral deformity plus percutaneous osteoperiosteal decortication. At 5-year follow-up, the patient was asymptomatic with full return to physical activity, with radiographs evidencing callus formation. CONCLUSION Stress fractures around well-fixed femoral stems, while infrequent, should be addressed in patients with a history of severe proximal femur deformity experiencing atraumatic thigh pain.
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Affiliation(s)
- Marcelo Adolfo Dozo
- Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Scott CEH, Jain S, Moran M, Haddad FS. Which Unified Classification System type B periprosthetic fractures around cemented polished tapered stems should not be fixed? Bone Joint J 2023; 105-B:481-486. [PMID: 37121589 DOI: 10.1302/0301-620x.105b5.bjj-2022-1395.r1] [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] [Indexed: 05/02/2023]
Abstract
The Unified Classification System (UCS), or Vancouver system, is a validated and widely used classification system to guide the management of periprosthetic femoral fractures. It suggests that well-fixed stems (type B1) can be treated with fixation but that loose stems (types B2 and B3) should be revised. Determining whether a stem is loose can be difficult and some authors have questioned how to apply this classification system to polished taper slip stems which are, by definition, loose within their cement mantle. Recent evidence has challenged the common perception that revision surgery is preferable to fixation surgery for UCS-B periprosthetic fractures around cemented polished taper slip stems. Indications for fixation include an anatomically reducible fracture and cement mantle, a well-fixed femoral bone-cement interface, and a well-functioning acetabular component. However, not all type B fractures can or should be managed with fixation due to the risk of early failure. This annotation details specific fracture patterns that should not be managed with fixation alone.
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Affiliation(s)
- Chloe E H Scott
- Department of Orthopaedics, The University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Matt Moran
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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González-Martín D, Hernández-Castillejo LE, Herrera-Pérez M, Pais-Brito JL, González-Casamayor S, Garrido-Miguel M. Osteosynthesis versus revision arthroplasty in Vancouver B2 periprosthetic hip fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2023; 49:87-106. [PMID: 35790555 DOI: 10.1007/s00068-022-02032-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Several studies comparing osteosynthesis and stem revision in Vancouver B2 (VB2) periprosthetic hip fractures (PPHF) have been published. This work aims to be the first systematic review and meta-analysis to include only studies involving statistical comparison between the two techniques. METHODS MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to October 2021 for studies involving a comparison between VB2 treated by osteosynthesis versus revision arthroplasty. The effect size (ES) was calculated using Cohen´s d index. RESULTS From 17 published studies selected, a total of 856 patients were recruited (363 osteosynthesis / 493 revision arthroplasty). The pooled ES estimates for the Parker mobility score were 1.03 (95% CI, 0.22-1.84; I2 = 87.7%) for ORIF surgery, and 0.54 (95% CI, - 0.10-1.17; I2 = 83%) for revision surgery. The pooled ES estimates for the operative time, reintervention, complications, hospital stay and needing for blood transfusion were significant lower in ORIF than in revision surgery. There were no differences in first-year mortality between groups. There was a higher proportion of ASA > 3 patients in the ORIF group. CONCLUSION Osteosynthesis versus revision arthroplasty has a shorter operative time, less need for blood transfusion, fewer complications and reoperation rate and shorter hospital stay. Nonetheless, similar results were found for functional tests and first-year mortality. These results support the use of osteosynthesis in selected patients (low functional demand, multiple comorbidities, and high anesthetic risk). LEVEL OF EVIDENCE 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
| | | | - Mario Herrera-Pérez
- 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.
| | | | - Miriam Garrido-Miguel
- Health and Social Research Center, Universidad de Castilla La Mancha, 16071, Cuenca, Spain
- Faculty of Nursing, Universidad de Castilla La Mancha, 02006, Albacete, Spain
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Martorell de Fortuny L, Coelho Leal A, Sánchez-Soler JF, Martínez-Díaz S, León A, López F M. Mini-invasive approach vs. traditional open reduction for periprosthetic hip fracture osteosynthesis with the NCB® plate. Injury 2023; 54:706-711. [PMID: 36371317 DOI: 10.1016/j.injury.2022.10.015] [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: 03/20/2022] [Revised: 10/12/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative hip periprosthetic fracture (PPF) is a frequent complication whose treatment does not achieve optimal results among eldery fragile patients. Locking compression plate (LCP) osteosynthesis is the gold standard treatment for Vancouver B1 and VC fractures and there is a growing consensus in doing the same with B2 fractures in patients with high comorbidity. Following that trend of being as non-aggressive as possible we investigated whether a mini-open (MO) approach would lead to better outcomes in LCP plate osteosynthesis of hip PFFs when compared to the traditional open approach. METHODS We retrospectively evaluated a cohort of 43 VB1, VB2 or VC hip PPFs treated with non contact bridging (NCB®) plate osteosynthesis by two possible approaches. MO vs traditional open approach. The main objective was to assess whether MO approach decreases operative time, bleeding and local complications. The secondary objective was to demonstrate that this may have a positive effect on patient function. RESULTS The mean age was 79.6 years old and 74.5% patients had an ASA score of III or IV. The surgical time was 148.53 min (SD 33.2) in the open approach versus 107.42 min (SD 25.6) in the MO, which was 31 min shorter (p<0.001). Hemoglobin dropped 0.9 points less, on average (p. 0.005) and 0.82 fewer blood concentrates were required (p. 0.022) with MO approach. There were no differences among complications but there was a trend towards greater independence and better mobility in the MO approach group with a postoperative Barthel of 74.37 (sd. 13.21) compared to the 66.67 points (sd. 13.7) in the traditional approach group. CONCLUSION MO approach in osteosynthesis of hip PFFs decreases operative time and intraoperative bleeding so it must be considered in fragile patients with high comorbidity.
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Affiliation(s)
| | - Alexandre Coelho Leal
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | | | - Santos Martínez-Díaz
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Alfonso León
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Marqués López F
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
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Li J, Ma M, Liu M, Huang T. Periprosthetic fracture revision with bone ingrowth on the coated surface of the prosthesis: A case report. Asian J Surg 2022; 45:2594-2596. [PMID: 36030161 DOI: 10.1016/j.asjsur.2022.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jian Li
- Department of Joint Surgery, Binzhou Medical University Hospital, 256603, Shandong, China.
| | - Mingliang Ma
- Department of Joint Surgery, Binzhou Medical University Hospital, 256603, Shandong, China.
| | - Mingting Liu
- Department of Joint Surgery, Binzhou Medical University Hospital, 256603, Shandong, China.
| | - Tao Huang
- Department of Joint Surgery, Binzhou Medical University Hospital, 256603, Shandong, China
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Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern. Arch Orthop Trauma Surg 2022; 142:3221-3228. [PMID: 34390386 PMCID: PMC9522678 DOI: 10.1007/s00402-021-04113-6] [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] [Received: 05/29/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The aim of this study was to identify factors associated with the level of periprosthetic fracture involving a cemented polished tapered stem: Vancouver B or Vancouver C. METHODS A retrospective cohort study of 181 unilateral periprosthetic fractures involving Exeter stems was assessed by three observers (mean age 78.5, range 39-103; mean BMI 27.1, 17-39; 97 (54%) male). Patient demographics, deprivation scores, BMI and time since primary prosthesis were recorded. Femoral diameter, femoral cortical thickness, Dorr classification and distal cement mantle length were measured from calibrated radiographs. Interobserver reliability was calculated using intraclass correlation coefficients (ICCs). Univariate and multivariate analysis was performed to identify associations with Vancouver B or C fractures. RESULTS 160/181 (88%) Vancouver B and 21/181 (12%) Vancouver C-level fractures occurred at a mean of 5.9 ± 5.4 years (0.2-26.5) following primary surgery. Radiographic measurements demonstrated excellent agreement (ICC > 0.8, p < 0.001). Mortality was significantly higher following Vancouver C compared to B fractures: 90 day 14/160 Vs 5/21 (p = 0.05); 1 year 29/160 Vs 8/21 (p = 0.03). Univariate analysis demonstrated that Vancouver C fractures were associated with female sex, bisphosphonate use, cortical bone thickness, and distal cement mantle length (p < 0.05). On multivariate analysis, only female sex was an independent predictor of Vancouver C-level fractures (R2 =0.354, p = 0.005). CONCLUSION Most PFFs involving the Exeter stem design are Vancouver B-type fractures and appear to be independent of osteoporosis. In contrast, Vancouver C periprosthetic fractures display typical fragility fracture characteristics and are associated with female sex, thinner femoral cortices, longer distal cement mantles and high mortality.
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