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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] [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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Ueyama H, Yamamura M, Koyanagi J, Fukunaga K, Takemura S, Nakamura S. Early Postoperative Functional Recovery in Older Patients With Periprosthetic Femoral Fractures: Comparison Between Cemented and Cementless Stem Revisions. Arthroplast Today 2024; 28:101467. [PMID: 39100417 PMCID: PMC11295462 DOI: 10.1016/j.artd.2024.101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/18/2024] [Accepted: 06/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background Early postoperative functional recovery is important in older patients with lower-extremity fractures to prevent disuse, and periprosthetic femoral fractures (PFFs) are no exception. This study aimed to compare the postoperative functional recovery in the early phase after revision for PFF with loose stems between cemented and cementless stems. Methods Eighteen patients with Unified Classification System type B2 PFF were included in this retrospective cohort study with a follow-up period of about 2 years. All patients underwent stem revision and were divided into 2 groups: the cemented stem group (n = 9) and the cementless stem group (n = 9). In postrevision, functional independence measure score, independent walk rate, activities of daily living recovery rate to the original level at 2 weeks postoperatively, the Beals and Tower classification for radiological status, and survival rate for readmission as endpoints were compared between the 2 groups. Results Patients in the cemented group recovered functional mobility earlier than in the cementless group, with higher postoperative functional independence measure functional subscale values (73 vs 50 points, P = .02), higher independent walk rate (89 vs 11%, P < .01), and more postoperative activities of daily living recovery (100% vs 44%, P = .03) at 2 weeks postoperatively. The Beals and Tower classification and survival rates were similar in both groups. Conclusions Revision using a cemented stem for PFF in older patients was a useful surgical procedure in terms of early postoperative functional recovery. Cemented stem revision was comparable with cementless in bone union and safety at 2 years postoperatively.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Mitsuyoshi Yamamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Kenji Fukunaga
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Sano Memorial Hospital, Izumisanoshi, Osaka, Japan
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Uzoigwe CE, Watts AT, Briggs P, Symes T. Periprosthetic Femoral Fractures-Beyond B2. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202408000-00003. [PMID: 39110721 PMCID: PMC11309721 DOI: 10.5435/jaaosglobal-d-23-00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 08/10/2024]
Abstract
The proliferation of hip arthroplasty has seen concomitant increases in periprosthetic femoral fractures (PFFs). The most common pattern involves fracture at the level of a loose prosthesis (B2). B2 PFFs have a unique mechanopathogenesis linked to the tendency of polished taper-slip cemented stems to subside in the cement. Such stems carry a much higher PFF risk than other cemented designs. Mega-data, consistent across national registries, suggest that increasing application of the taper-slip principle has resulted in the emergence of highly polished, very low friction cemented prostheses. These have the propensity to migrate within the cement, increasing B2 PFF risk. This would explain the strong association between cobalt-chromium stems and PFF. Is PFF the mode of failure of polished taper-slip stems rather than aseptic loosening? Established wisdom teaches that B2 PFFs should be managed with revision surgery. There is a large body of new evidence that, in certain instances, fixation results in outcomes at least equivalent to revision arthroplasty, with shorter surgical time, decreased transfusion requirements, and lower dislocation risk. This is so in B2 PFFs around cemented polished taper-slip stems with an intact bone-cement interface. We outline advances in understanding of B2 PFF with special reference to mechanopathogenesis and indications for fixation.
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Affiliation(s)
- Chika Edward Uzoigwe
- From the Harcourt House Sheffield, UK (Mr. Uzoigwe); Hull Royal Infirmary, Hull, UK (Mr. Watts, Mr. Briggs, and Mr. Symes)
| | - Arun Thor Watts
- From the Harcourt House Sheffield, UK (Mr. Uzoigwe); Hull Royal Infirmary, Hull, UK (Mr. Watts, Mr. Briggs, and Mr. Symes)
| | - Praise Briggs
- From the Harcourt House Sheffield, UK (Mr. Uzoigwe); Hull Royal Infirmary, Hull, UK (Mr. Watts, Mr. Briggs, and Mr. Symes)
| | - Tom Symes
- From the Harcourt House Sheffield, UK (Mr. Uzoigwe); Hull Royal Infirmary, Hull, UK (Mr. Watts, Mr. Briggs, and Mr. Symes)
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Venäläinen MS, Panula VJ, Eskelinen AP, Fenstad AM, Furnes O, Hallan G, Rolfson O, Kärrholm J, Hailer NP, Pedersen AB, Overgaard S, Mäkelä KT, Elo LL. Prediction of Early Adverse Events After THA: A Comparison of Different Machine-Learning Strategies Based on 262,356 Observations From the Nordic Arthroplasty Register Association (NARA) Dataset. ACR Open Rheumatol 2024. [PMID: 39040016 DOI: 10.1002/acr2.11709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/20/2024] [Accepted: 06/08/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE Preoperative risk prediction models can support shared decision-making before total hip arthroplasties (THAs). Here, we compare different machine-learning (ML) approaches to predict the six-month risk of adverse events following primary THA to obtain accurate yet simple-to-use risk prediction models. METHODS We extracted data on primary THAs (N = 262,356) between 2010 and 2018 from the Nordic Arthroplasty Register Association dataset. We benchmarked a variety of ML algorithms in terms of the area under the receiver operating characteristic curve (AUROC) for predicting the risk of revision caused by periprosthetic joint infection (PJI), dislocation or periprosthetic fracture (PPF), and death. All models were internally validated against a randomly selected test cohort (one-third of the data) that was not used for training the models. RESULTS The incidences of revisions because of PJI, dislocation, and PPF were 0.8%, 0.4%, and 0.3%, respectively, and the incidence of death was 1.2%. Overall, Lasso regression with stable iterative variable selection (SIVS) produced models using only four to five input variables but with AUROC comparable to more complex models using all 32 variables available. The SIVS-based Lasso models based on age, sex, preoperative diagnosis, bearing couple, fixation, and surgical approach predicted the risk of revisions caused by PJI, dislocations, and PPF, as well as death, with AUROCs of 0.61, 0.67, 0.76, and 0.86, respectively. CONCLUSION Our study demonstrates that satisfactory predictive potential for adverse events following THA can be reached with parsimonious modeling strategies. The SIVS-based Lasso models may serve as simple-to-use tools for clinical risk assessment in the future.
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Affiliation(s)
- Mikko S Venäläinen
- Turku University Hospital, University of Turku and Åbo Akademi University, Turku, Finland
| | | | - Antti P Eskelinen
- Coxa Hospital for Joint Replacement and University of Tampere, Tampere, Finland, and the Finnish Arthroplasty Register, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Ove Furnes
- Haukeland University Hospital and University of Bergen, Bergen, Norway
| | - Geir Hallan
- Haukeland University Hospital and University of Bergen, Bergen, Norway
| | - Ola Rolfson
- University of Gothenburg, Gothenburg, Sweden
| | | | | | - Alma B Pedersen
- Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Søren Overgaard
- Copenhagen University Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Keijo T Mäkelä
- Turku University Hospital and University of Turku, Turku, Finland, and the Finnish Arthroplasty Register, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura L Elo
- University of Turku and Åbo Akademi University, Turku, Finland
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Andrés-Peiró JV, Nomdedéu J, Aguado HJ, González-Morgado D, Minguell-Monyart J, Joshi-Jubert N, Teixidor-Serra J, Tomàs-Hernández J, Selga-Marsà J, García-Sánchez Y, Noriega-González DC, Mateos-Álvarez E, Pereda-Manso A, Cervera-Díaz MC, Balvis-Balvis P, García-Pérez Á, Rodríguez-Arenas M, Castro-Menéndez M, Moreta J, Olías-López B, Amaya-Espinosa P, Boluda-Mengod J, Bárcena-Goitilandia L, Blas-Dobón JA, Freile-Pazmiño P, Castillón P, Lanuza-Lagunilla L, Cabria-Fernández J, Valle-Cruz J, García-Coiradas J, Bonome-Roel C, Cano-Leira MDLÁ, Benjumea-Carrasco A, Chico-García M, Fernández-Juan A, Saura-Sánchez E, Sánchez-Gómez P, Ricón-Recarey FJ, García-García EM, Medrano-Morte I, Cuadrado-Abajo F, Pérez-Núñez MI, García-González S, Pozo-Manrique PD, García-Navas-García FM, García-Paredero E, Guijarro-Valtueña A, Navas-Pernía I, Videla-Cés M, Muñoz-Vives JM, Querolt-Coll J, Triana-López de Santamaría G, Serra-Porta T, Carrasco-Becerra MC, Pena-Paz S, Otero-Naveiro V, Fernández-Dorado F, Martínez-Menduiña A, Galián-Muñoz E, Hernández JM, Renau-Cerrillo M, Campuzano-Bitterling B, Carreras-Castañer A, Vives-Barquiel M, Camacho-Carrasco P, Jornet-Gibert M, Muñoz-Vicente A, Gámez-Asunción C, Plaza-Salazar N, Benito-Santamaría J, Cuenca-Copete A, Alonso-Viana L, Mingo-Robinet J, Briso-Montiano R, Barbería-Biurrun A, Chouza-Montero L, Ojeda-Thies C, Ajuria-Fernández E, Díaz-Suárez R, Gasset-Teixidor A, Domínguez-Ibarrola A, Gosálbez J, Pérez-Hevia I, Riera-Álvarez L, Roche-Albero A, Macho-Mier M, Criado-Albillos G, Cabello-Benavides HG, Cunchillos-Pascual J, Saló-Cuenca JC, Espona-Roselló J, Salamanca-Ontiveros C, García-Portabella P, Martínez-Íñiguez Blasco J, Sevilla-Ortega P, Cano-Porras JR, Martínez-Díaz S, Carabelli GS, Slullitel P, Astore I, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Sánchez-Hernández N, García-García G, Rodríguez-Gangoso A, Pérez-Sánchez JM, Piñeiro-Borrero A, Mandía-Martínez A, De Caso-Rodríguez J, Benito-Mateo M, Murillo-Vizuete AD, Herrán-Núnez GDL, Nunes-Ugarte N, Pérez-Salazar NE, De Sande-Díaz M, García-Fuentes XD, de Cortázar-Antolín UG, Sánchez DE. Predictors of outcomes after internal fixation of periprosthetic femoral hip fractures Subgroup analysis of the peri-implant and peri-prosthetic fractures Spanish registry (PIPPAS). Injury 2024; 55:111715. [PMID: 39032221 DOI: 10.1016/j.injury.2024.111715] [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: 04/02/2024] [Revised: 06/02/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE To identify risk factors predisposing patients to poor outcomes after fixation of periprosthetic hip fractures around femoral stems. METHODS Prospective multicentre cohort study of fractures around a hip replacement stem managed by internal fixation. The primary outcome was one-year mortality, while secondary outcomes were local complications and healthcare burden-related outcomes (nursing facility utilization and hospital length of stay). RESULTS One-year mortality was 16.2%. Age-adjusted Charlson Comorbidity Index score (OR=1.17; 95%CI=1.03-1.33)), Pfeiffer Short Portable Mental Status Questionnaire (SPMSQ) score (OR=1.16; 1.06-1.28), prosthetic dysfunction (OR=1.90; 1.00-3.61), and postoperative medical complications (OR=1.97; 1.06-3.68) were predictors of mortality. Patients with prior prosthetic dysfunction, lower Pfeiffer SPMSQ scores, Vancouver A fractures, and fractures fixed only using cerclages were at higher risk of local complications, which occurred in 9.3% of cases. Medical (OR=1.81; 1.05-3.13) and local complications (OR=5.56; 2.42-3.13) emerged as consistent risk factors for new institutionalization. Average hospitalization time was 13.9±9.2 days. Each day of fixation delay led to an average 1.4-day increase in total hospitalization. CONCLUSION Frail periprosthetic hip-fracture patients with poorer functional status, dysfunctional replacements, and postoperative complications are at increased risk of mortality. Postoperative complications are more common in patients with dysfunctional arthroplasties, Vancouver A fractures, and fixation using cerclages alone. Postoperative complications were the most consistent predictor of higher healthcare resource utilization.
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Affiliation(s)
- José Vicente Andrés-Peiró
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Josep Nomdedéu
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Héctor J Aguado
- Department of Orthopaedic Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain.
| | - Diego González-Morgado
- Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Minguell-Monyart
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Nayana Joshi-Jubert
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Reconstructive Surgery of the Locomotor System research group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Lara-Taranchenko Y, Nomdedéu JF, Aliaga Martínez A, Mimendia I, Barro VM, Collado D, Guerra-Farfán E, Hernández A. Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2573-2580. [PMID: 38695885 DOI: 10.1007/s00590-024-03961-3] [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: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture. METHODS A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients. RESULTS Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24 days; p = 0.037) and the time to full weight-bearing (21 days vs. 9 days; p < 0.001) were longer in the cementless stem group. CONCLUSION Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.
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Affiliation(s)
- Yuri Lara-Taranchenko
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Josep F Nomdedéu
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Andrés Aliaga Martínez
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Iñaki Mimendia
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Víctor M Barro
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Diego Collado
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Ernesto Guerra-Farfán
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Alejandro Hernández
- Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Minutillo GT, Karnuta JM, Koressel J, Dehghani B, DeAngelis RD, Donegan DJ, Mehta S. Fixation or Revision for Periprosthetic Fractures: Epidemiology, New Trends, and Projections in the United States. J Bone Joint Surg Am 2024; 106:1054-1061. [PMID: 38900013 DOI: 10.2106/jbjs.23.00868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Periprosthetic fractures can be devastating complications after total joint arthroplasty (TJA). The management of periprosthetic fractures is complex, spanning expertise in arthroplasty and trauma. The purpose of this study was to examine and project trends in the operative treatment of periprosthetic fractures in the United States. METHODS A large, public and private payer database was queried to capture all International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for periprosthetic femoral and tibial fractures. Statistical models were created to assess trends in treatment for periprosthetic fractures and to predict future surgical rates. An alpha value of 0.05 was used to assess significance. A Bonferroni correction was applied where applicable to account for multiple comparisons. RESULTS In this study, from 2016 to 2021, 121,298 patients underwent surgical treatment for periprosthetic fractures. There was a significant increase in the total number of periprosthetic fractures. The incidence of periprosthetic hip fractures rose by 38% and that for periprosthetic knee fractures rose by 73%. The number of periprosthetic fractures is predicted to rise 212% from 2016 to 2032. There was a relative increase in open reduction and internal fixation (ORIF) compared with revision arthroplasty for both periprosthetic hip fractures and periprosthetic knee fractures. CONCLUSIONS Periprosthetic fractures are anticipated to impose a substantial health-care burden in the coming decades. Periprosthetic knee fractures are predominantly treated with ORIF rather than revision total knee arthroplasty (TKA), whereas periprosthetic hip fractures are predominantly treated with revision total hip arthroplasty (THA) rather than ORIF. Both periprosthetic knee fractures and periprosthetic hip fractures demonstrated increasing trends in this study. The proportion of periprosthetic hip fractures treated with ORIF relative to revision THA has been increasing. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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MESH Headings
- Humans
- Periprosthetic Fractures/epidemiology
- Periprosthetic Fractures/surgery
- Periprosthetic Fractures/etiology
- United States/epidemiology
- Reoperation/statistics & numerical data
- Female
- Fracture Fixation, Internal/trends
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/statistics & numerical data
- Male
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Hip/trends
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Aged
- Incidence
- Middle Aged
- Femoral Fractures/surgery
- Femoral Fractures/epidemiology
- Femoral Fractures/etiology
- Tibial Fractures/surgery
- Tibial Fractures/epidemiology
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Nandra RS, Elnahal WA, Mayne A, Brash L, McBryde CW, Treacy RBC. Birmingham Hip Resurfacing at 25 years. Bone Joint J 2024; 106-B:540-547. [PMID: 38821495 DOI: 10.1302/0301-620x.106b6.bjj-2023-1064.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Aims The Birmingham Hip Resurfacing (BHR) was introduced in 1997 to address the needs of young active patients using a historically proven large-diameter metal-on-metal (MoM) bearing. A single designer surgeon's consecutive series of 130 patients (144 hips) was previously reported at five and ten years, reporting three and ten failures, respectively. The aim of this study was to extend the follow-up of this original cohort at 25 years. Methods The study extends the reporting on the first consecutive 144 resurfacing procedures in 130 patients for all indications. All operations were undertaken between August 1997 and May 1998. The mean age at operation was 52.1 years (SD 9.93; 17 to 76), and included 37 female patients (28.5%). Failure was defined as revision of either component for any reason. Kaplan-Meier survival analysis was performed. Routine follow-up with serum metal ion levels, radiographs, and Oxford Hip Scores (OHSs) was undertaken. Results Overall implant survival was 83.50% (95% confidence interval (CI) 0.79 to 0.90) at 25 years, and the number at risk was 79. Survival in male patients at 25 years was 89.5% (95% CI 0.83 to 0.96) compared to 66.9% for female patients (95% CI 0.51 to 0.83). Ten additional failures occurred in the period of ten to 25 years. These involved an adverse reaction to metal debris in four patients, a periprosthetic femoral neck fracture affecting five patients, and aseptic loosening in one patient. The median chromium levels were 49.50 nmol/l (interquartile range (IQR) 34 to 70), and the median cobalt serum levels were 42 nmol/l (IQR 24.50 to 71.25). The median OHS at last follow-up was 35 (IQR 10 to 48). During the 25-year study period, 29 patients died. Patient survival at 25 years was 75.10% (95% CI 0.67 to 0.83). Conclusion This study demonstrates that MoM hip resurfacing using the BHR provides a durable alternative to total hip arthroplasty (THA), particularly in younger male patients with osteoarthritis wishing to maintain a high level of function. These results compare favourably to the best results for THAs.
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Affiliation(s)
- Rajpal S Nandra
- Lower Limb Reconstruction, Robert Jones Agnes Hunt Hospital, Gobowen, UK
| | - Walid A Elnahal
- The Royal Orthopaedic Hospital, Birmingham, UK
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Callum W McBryde
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Woodlands, Birmingham, UK
| | - Ronan B C Treacy
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Woodlands, Birmingham, UK
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Abdudeen A, Abu Qudeiri JE, Kareem A. Groove design optimization of femoral heads in solid hip implants: Study on stress distribution and total deformation using FEA and full factorial design. Heliyon 2024; 10:e30658. [PMID: 38803910 PMCID: PMC11128830 DOI: 10.1016/j.heliyon.2024.e30658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/20/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Hip replacement surgery is a common procedure that relies on the implant's design to withstand daily activities. This study aims to investigate the impact of different surface groove designs on the performance of solid hip implants using finite element analysis (FEA) and optimization techniques. The study evaluates the influence of grooves on the stress distribution and total deformation of the implant, considering three designs: no grooves, horizontal grooves, and vertical grooves on the surface of the femoral head. The simulations were conducted using Ansys Mechanical, and the optimization process was carried out using the general full factorial design method in Minitab software. The results demonstrate that the groove design significantly affects the stress distribution and wear of the implant. The vertical groove design shows better overall results, indicating the best performance. The study also evaluated the influence of force on the performance of the implant, with different load range. The optimization process using the general full factorial design method revealed that the optimal groove design was a vertical model with an optimized groove depth and width. These findings offer valuable insights into the impact of surface groove designs on the performance of solid hip implants, leading to better patient outcomes and longer implant lifespan. Overall, this study provides a comprehensive understanding of the effect of surface groove design on the performance of solid hip implants.
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Affiliation(s)
- Asarudheen Abdudeen
- Mechanical and Aerospace Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Jaber E. Abu Qudeiri
- Mechanical and Aerospace Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Ansar Kareem
- Mechanical and Aerospace Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
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TIGANI DOMENICO, FERRANTI CALDERONI ENRICO, MELUCCI GIUSEPPE, PIZZO ALEX, GHILOTTI MARGHERITA, CASTELLI ALBERTO, PASTA GIANLUIGI, GRASSI FEDERICO, JANNELLI EUGENIO. Treatment of Periprosthetic Hip Fractures Vancouver B1 and C: The Significance of Bicortical Fixation. A Bicentric Study Comparing Two Osteosynthesis Systems. Orthop Rev (Pavia) 2024; 16:117203. [PMID: 38751453 PMCID: PMC11093722 DOI: 10.52965/001c.117203] [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: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION The incidence of periprosthetic fractures (PFFs) is estimated to range from 0.1% to 4.1%1, due to the increasing prevalence of joint arthroplasties, coupled with an aging population. Numerous risk factors, including advanced age (>80 years), female gender, implant type, prior diagnoses of osteonecrosis and rheumatoid arthritis, revision surgery, aseptic stem mobilization, and the use of non-cemented stems, have been identified. Survivors of periprosthetic fractures often experience functional deterioration, facing a fourfold higher risk of hospitalization for postoperative complications compared to patients undergoing primary implantation, especially in the first postoperative year. MATERIALS AND METHODS Between 2018 and 2022, at the Maggiore Hospitals in Bologna and the San Matteo Policlinic in Pavia, we performed osteosynthesis on 84 patients with periprosthetic fractures of Vancouver type B1 or C. In 38 patients, we employed angular stable plates with the Zimmer Biomet NCB-PP® system. In 46 patients, we utilized INTRAUMA plates: DF distal femur and PFF proximal. Relevant postoperative follow-up outcomes considered included reintervention, infectious complications, radiographic healing, and functional recovery, with reference to changes in the Glasgow Outcome Scale (GOS) and the Harris Hip Score (HHS). All patients underwent clinical and radiographic evaluations during the follow-up period, averaging 28 months (range: 12-48 months), with a minimum follow-up duration of 12 months. RESULTS At the 4-month postoperative assessment, 71% of patients maintained their preoperative functional level, 19% experienced a 1-point GOS scale drop, and 10% died (GOS 5). The average HHS at 4 months was 80.2 points (range: 65-90). At the 6-month follow-up, 98.2% of patients achieved complete healing on radiographic examination. Only 1 patient (1.2%) developed a pseudoarthrosis site with synthesis device rupture. Only 1 patient (1.2%) required additional surgical treatment 2 years later due to the development of un aseptic perisynthetic fluid collection, while the remaining 5 patients (6%) who developed complications benefited from conservative treatment: 4 patients (3.6%) with infectious complications were treated with intravenous antibiotics. In the 2 patients (2.3%) with mobilization or rupture of synthesis devices, clinical and radiographic monitoring was opted for. 8 patients (10.7%) died: one 48 hours after the surgery, and the other 7 more than one month after the surgery. CONCLUSION Our clinical findings align with to existing scientific literature on periprosthetic fractures (B1 and C according to Vancouver classification). Moreover, good stability has been guaranteed at the radiological follow up by Zimmer Biomet NCB-PP® and INTRAUMA DF distal femur and PFF proximal plates. The locking construct allows for improved stability especially in osteoporotic bone.
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Affiliation(s)
- DOMENICO TIGANI
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - ENRICO FERRANTI CALDERONI
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - GIUSEPPE MELUCCI
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - ALEX PIZZO
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | | | - ALBERTO CASTELLI
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - GIANLUIGI PASTA
- Orthopedic and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - FEDERICO GRASSI
- Orthopedics and traumatology Clinic, Department of clinical, surgical, diagnostic and pediatric sciences, IRCCS Policlinico San Matteo Foundation, 27100, Pavia, Italy, University of Pavia
| | - EUGENIO JANNELLI
- Orthopedics and traumatology Clinic, Department of clinical, surgical, diagnostic and pediatric sciences, IRCCS Policlinico San Matteo Foundation, 27100, Pavia, Italy, University of Pavia
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Singh A, Singh A, Gandavaram S, Patel K, Herlekar D. Impact of surgical timing and type of operative procedure on outcomes in periprosthetic hip fractures: an observational study at an NHS trust centre in the UK. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2099-2105. [PMID: 38551739 DOI: 10.1007/s00590-024-03900-2] [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: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE There is a global trend of increased periprosthetic fractures due to the growing number of arthroplasty procedures. The present study assessed the impact of factors such as time to surgery and type of surgery on the outcomes, which have been seldom evaluated for periprosthetic fractures. METHODS An observational study was conducted on consecutive 87 patients within an NHS district hospital trust in the UK. Patients who underwent a complete hip replacement prior to the fracture, received fixation therapy, or underwent revision surgery within the specified time were screened. Patients were grouped in two ways: based on time to surgery and based on surgery type. Logistic regression models were performed to assess for statistically significant differences in post-operative complication, 30-day, and 1-year mortality rates between groups, whilst adjusting for age, gender, and ASA grade. RESULTS Forty-one patients underwent open reduction and internal fixation (ORIF), 29 patients underwent revision arthroplasty, and 17 patients were subjected to both, ORIF and revision arthroplasty. Sixty of the 87 patients were operated on > 48 h of injury. The median hospital stay was significantly lower in the ORIF plus revision arthroplasty group, versus other surgical groups (p < 0.05) whilst it was significantly higher in the group of patients who underwent surgery after 48 h of injury (p < 0.05). Numerically higher mortality was noted in the revision arthroplasty group (31.03%, p > 0.05). The group that was operated after 48 h of injury showed greater mortality but was comparable to the other group (25% vs. 14.81%, p > 0.05). For post-operative complications, none of the variables were significantly predictive (p > 0.05). However, for 30-day mortality, ASA grade (p = 0.04) and intra-operative complications (p = 0.0001) were significantly predictive. Additionally, for 1-year mortality, ASA grade (p = 0.004) was noted to be significantly predictive. CONCLUSION Revision and delayed periprosthetic fracture management (> 48 h after injury) group showed a numerically greater mortality risk; however, this finding was not statistically significant. ASA grading at baseline is predictive of mortality for periprosthetic fractures.
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MESH Headings
- Humans
- Female
- Male
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/mortality
- Reoperation/statistics & numerical data
- Periprosthetic Fractures/surgery
- Periprosthetic Fractures/mortality
- Periprosthetic Fractures/etiology
- Aged
- United Kingdom/epidemiology
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/mortality
- Length of Stay/statistics & numerical data
- Aged, 80 and over
- Postoperative Complications/mortality
- Postoperative Complications/etiology
- Hip Fractures/surgery
- Hip Fractures/mortality
- Middle Aged
- Time-to-Treatment/statistics & numerical data
- Treatment Outcome
- Open Fracture Reduction/methods
- Time Factors
- State Medicine
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Affiliation(s)
- Abhimanyu Singh
- Trauma and Orthopaedic Surgery, Royal Lancaster Infirmary, Lancaster, UK.
| | - Amit Singh
- Trauma and Orthopaedics Surgery, Wrexham Maelor Hospital, Wrexham, UK
| | | | - Kuntal Patel
- Trauma and Orthopaedic Surgery, Royal Lancaster Infirmary, Lancaster, UK
| | - Deepak Herlekar
- Trauma and Orthopaedic Surgery, Royal Lancaster Infirmary, Lancaster, UK
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12
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Comba LC, Gagliardi L, Onorato F, Rivera F. Periprosthetic Hip Fractures around the Stem: Can the Stem Design Affect Fracture Features? J Clin Med 2024; 13:2627. [PMID: 38731155 PMCID: PMC11084834 DOI: 10.3390/jcm13092627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/21/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Total hip arthroplasty is one of the most successful orthopedic surgeries; nevertheless, many of these surgeries are the causes of failure, and among them, periprosthetic fractures are one of the major causes of revision. Our study focuses on periprosthetic hip fractures with two different stem designs. The aim of the study was to analyze the obtained results, focusing on the features of periprosthetic stem fractures observed. Methods: We retrospectively reviewed periprosthetic fractures occurring between 2010 and 2023, involving Alloclassic® or CLS® uncemented femoral stems. We analyzed demographic data, proximal femur morphology, and the fracture type. Results: We identified 97 patients. Considering the proximal femur morphology, we found that there was statistically significant prevalence of Dorr A proximal femur morphology in the CLS® group and of Dorr C in the Alloclassic® group. Considering the distribution of the fracture pattern, we reported a non-statistically significant prevalence of the fracture pattern with stable stems in the CLS® group. Conclusions: The choice of the prosthetic design of the femoral stem is a crucial element when planning total hip arthroplasty. However, we found a non-statistically significant difference between the two stems considered, raising questions about the real role of stem design as a primary determinant of periprosthetic hip fractures.
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Affiliation(s)
- Luca Costanzo Comba
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, 12038 Savigliano, Italy
| | - Luca Gagliardi
- Orthopedics and Trauma Department, Univertità degli Studi di Torino, 10100 Turin, Italy
| | - Francesco Onorato
- Orthopedics and Trauma Department, Univertità degli Studi di Torino, 10100 Turin, Italy
| | - Fabrizio Rivera
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, 12038 Savigliano, Italy
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13
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Lixa J, Vieira P, Pereira P, Pinho A, Seara M, Sousa A, Vieira L. Retrospective survival analysis of the use of uncemented modular tapered stems for revision in periprosthetic Vancouver B-type fractures. Is instability a threat to survival? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00072-9. [PMID: 38521436 DOI: 10.1016/j.recot.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Periprosthetic hip fractures show increasing incidence and complexity, representing a challenge for the surgeon. We aimed to evaluate the survival of uncemented modular tapered stems in the treatment of periprosthetic Vancouver B2 and B3 type fractures and review the main complications and factors associated with decreased survival. MATERIALS AND METHODS We performed a retrospective study of patients submitted to revision arthroplasty for treatment of periprosthetic femoral stem Vancouver B2 and B3 type fractures with an uncemented modular fluted tapered stem (MRP-Titan). Demographic and radiographic parameters were analyzed. The survival rate (free of reoperation) was calculated at 2- and 5-years using the Kaplan-Meier survivorship analysis. RESULTS Thirty-nine patients were included with a mean age of 73.5 years and a mean follow-up of 5 years. Arthroplasty survivorship at 2 years was 73.7% and at 5 years was 67.5% (mean 8.4 years; range 6.7-10.2). Survivorship was inferior in the patients with episodes of instability (mean 2.5 years; range 0-5.42) (p<0.001). At least one episode of instability occurred in 26.3% of patients and 60% of these patients had a femoral head size 32mm or lower. At least one episode of instability occurred in 71.4% of patients with a greater trochanter fracture (p=0.008). The consolidation rate was 90.6% and the mortality rate was 23.7%. In the group of patients that died, 55.6% were submitted to at least one revision surgery (p=0.044). CONCLUSION Survivorship of an uncemented modular stem (MRP-Titan) in revision for PHF is significantly reduced by episodes of instability.
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Affiliation(s)
- J Lixa
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal.
| | - P Vieira
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - P Pereira
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - A Pinho
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - M Seara
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - A Sousa
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - L Vieira
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
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14
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Mohammed Hassan Elbahri H, Ali Aydrouce Ahmed M, Omer Elgaili Yousif Y, Mohammed Ali Abd-Elmaged H. Quality of Life After Proximal Femoral Fractures Treated With Gamma Nail in Sudan. Cureus 2024; 16:e55702. [PMID: 38586703 PMCID: PMC10998661 DOI: 10.7759/cureus.55702] [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: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Background Hip fracture is a public health problem globally, and it poses one of the biggest challenges in healthcare due to its associated complications. Objectives The aim of this study is to investigate the quality of life in adult patients in Khartoum State, Sudan, after they have undergone treatment using a gamma nail for proximal femoral fractures. Methodology This cross-sectional descriptive hospital-based study was conducted at Ibrahim Malik, Omdurman, and Bahri Teaching Hospitals over six months, from April to October 2022. The data were collected using an interview questionnaire that covered relevant aspects of the study. The data were analyzed using IBM SPSS Statistics for Windows, V. 26.0 (IBM Corp., Armonk, NY). The study was approved by the Sudan Medical Specialization Board, and ethical clearance was obtained. Results The study included 37 patients. More than half of the patients (59.5%, n=22) were women. The mean age of cases was 66.7 years (standard deviation, ±15.6). The mean time from the time of the fracture to the time of surgery was eight days (±15). Twenty-three (62.2%, n=23) (JRB1) of the patients started weight bearing on the second postoperative day. Regarding the health-related quality of life, 21.6% of the patients had a good health-related quality of life, 67.6% had a fair health-related quality of life, and 10.8% had a poor health-related quality of life. None of the patients reported an excellent quality of life. Based on the Oxford Hip Score, 54.1% of the patients had satisfactory joint function, 29.7% had mild to moderate hip joint function, 13.5% had moderate to severe hip joint function disturbance, and one patient (2.7%) had severe hip joint function problems. Conclusion In this study, the vast majority of the patients who underwent gamma nail surgery for hip fracture had quality of life scores in the fair to good range afterward. The results indicate that nailing is associated with good outcomes regarding quality of life and is an acceptable option for femoral fracture surgeries in Sudan.
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Li H, Zheng Q, Niu E, Xu J, Chai W, Xu C, Fu J, Hao L, Chen J, Zhang G. Increased risk of periprosthetic joint infection after traumatic injury in joint revision patients. ARTHROPLASTY 2024; 6:8. [PMID: 38311788 PMCID: PMC10840204 DOI: 10.1186/s42836-024-00235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Although some risk factors of PJI were well studied, the association between trauma and PJI remains unknown in revision patients. MATERIALS AND METHODS Between 2015 and 2018, a total of 71 patients with trauma history before revisions (trauma cohort) were propensity score matched (PSM) at a ratio of 1 to 5 with a control cohort of revision patients without a history of trauma. Then, the cumulative incidence rate of PJI within 3 years after operation between the two groups was compared. The secondary endpoints were aseptic revisions within 3 postoperative years, complications up to 30 postoperative days, and readmission up to 90 days. During a minimal 3-year follow-up, the survival was comparatively analyzed between the trauma cohort and the control cohort. RESULTS The cumulative incidence of PJI was 40.85% in patients with trauma history against 27.04% in the controls (P = 0.02). Correspondingly, the cumulative incidence of aseptic re-revisions was 12.68% in patients with trauma history compared with 5.07% in the control cohort (P = 0.028). Cox regression revealed that trauma history was a risk factor of PJI (HR, 1.533 [95%CI, (1.019,2.306)]; P = 0.04) and aseptic re-revisions (HR, 3.285 [95%CI, (1.790,6.028)]; P < 0.0001). CONCLUSIONS Our study demonstrated that revision patients with trauma history carried a higher risk of PJI compared to those without trauma history. Moreover, after revisions, the trauma patients were still at higher risk for treatment failure due to PJI, periprosthetic joint fracture, and mechanical complications.
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Affiliation(s)
- Hao Li
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Qingyuan Zheng
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Erlong Niu
- Department of Orthopedics, Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100039, China
| | - Jiazheng Xu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Wei Chai
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Chi Xu
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jun Fu
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Libo Hao
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jiying Chen
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
| | - Guoqiang Zhang
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
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16
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Williams JA, Khawar H, Middleton R. Periprosthetic femoral fractures. Br J Hosp Med (Lond) 2024; 85:1-9. [PMID: 38416520 DOI: 10.12968/hmed.2023.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
The incidence of periprosthetic femoral fractures is rising in the UK, because of an ageing population and an increasing number of hip arthroplasty operations being performed. They can occur intra- or postoperatively, and usually follow low energy trauma. They present with pain, swelling over the thigh, and an inability to weight bear. Periprosthetic femoral fractures are usually classified as per the unified classification system. Their management usually is dependent on their classification, with type A (fracture at level of greater or lesser trochanter) managed non-operatively with protected weight bearing, type B (fracture adjacent to implant) managed with either open reduction internal fixation or revision surgery, and type C (fracture distal to implant) managed with open reduction internal fixation. Owing to their complexity, these patients must be adequately optimised before surgery and appropriately rehabilitated.
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Affiliation(s)
- Jevan At Williams
- Department of Trauma and Orthopaedics, Royal Cornwall Hospital, Truro, UK
| | - Haseeb Khawar
- School of Medicine, University of Exeter Medical School, Exeter, UK
| | - Rory Middleton
- Department of Trauma and Orthopaedics, Royal Cornwall Hospital, Truro, UK
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17
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Formica M, Zanirato A, Bori E, Revetria TA, Ditting J, Innocenti B. Biomechanical analysis of different THA cementless femoral stem designs in physiological and osteoporotic bone during static loading conditions. Arch Orthop Trauma Surg 2024; 144:917-926. [PMID: 37796284 DOI: 10.1007/s00402-023-05080-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: 06/27/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The influence of THA stem design on periprosthetic femoral fractures (PFFs) risk is subject of debate. This study aims to compare the effects of different cementless stem designs on stress-strain distributions in both physiological and osteoporotic femur under various loading conditions. MATERIALS A biomechanical study using finite-element analysis was conducted. Four models were developed: three with implanted femurs and a native one chosen as control. Each model was analyzed for both healthy and osteoporotic bone. The following stem designs were examined: short anatomical stem with femoral neck preservation, double-wedge stem, and anatomical standard stem. Three loading conditions were assessed: gait, sideways falling, and four-point bending. RESULTS During gait in physiological bone, the anatomical stem and the short anatomical stem with femoral neck preservation showed stress distribution similar to the native model. The double-wedge stem reduced stress in the proximal area but concentrated it in the meta-diaphysis. In osteoporotic bone, the double-wedge stem design increased average stress by up to 10%. During sideways falling, the double-wedge stem exhibited higher stresses in osteoporotic bone. No significant differences in average stress were found in any of the studied models during four-point bending. CONCLUSION In physiological bone, anatomical stems demonstrated stress distribution comparable to the native model. The double-wedge stem showed uneven stress distribution, which may contribute to long-term stress shielding. In the case of osteoporotic bone, the double-wedge stem design resulted in a significant increase in average stress during both gait and sideways falling, potentially indicating a higher theoretical risk of PFF.
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Affiliation(s)
- Matteo Formica
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Andrea Zanirato
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium.
| | - Tullio Andrea Revetria
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Università Degli Studi di Genova, Viale Benedetto XV N°6, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, UO Clinica Ortopedica, Largo Rosanna Benzi N° 10, 16132, Genoa, Italy
| | - Juljana Ditting
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
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Ashkenazi I, Amzallag N, Factor S, Abadi M, Morgan S, Gold A, Snir N, Warschawski Y. Age as a Risk Factor for Intraoperative Periprosthetic Femoral Fractures in Cementless Hip Hemiarthroplasty for Femoral Neck Fractures: A Retrospective Analysis. Clin Orthop Surg 2024; 16:41-48. [PMID: 38304210 PMCID: PMC10825253 DOI: 10.4055/cios23157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 02/03/2024] Open
Abstract
Background Understanding the risk factors and outcomes of intraoperative periprosthetic femoral fractures (IPFF) during hip arthroplasty is crucial for appropriate perioperative management. Previous studies have identified risk factors for IPFF in total hip arthroplasty patients, but data for hip hemiarthroplasty (HA) is lacking. The aim of this study was to determine the age associated with increased rates of IPFF in patients undergoing HA. Methods We retrospectively reviewed patients aged 65 years and above who underwent a cementless HA for a displaced femoral neck fracture and had a minimum of 1-year follow-up. Patients were stratified into five age groups (65-79, 80-84, 85-89, 90-94, and ≥ 95 years) and further divided into two subgroups (under 95 years and 95 years or older). The presence, location, and treatment of IPFF, as well as the effect of IPFF on the postoperative weight-bearing status, were compared between groups. A multivariate logistic regression was also performed. A total of 1,669 met the inclusion criteria and were included in the study. Results The rates of IPFF were significantly higher for patients 95 years or older (p = 0.030). However, fracture location (greater trochanter fractures, p = 0.839; calcar fractures, p = 0.394; and femoral shaft fractures p = 0.110), intraoperative treatment (p = 0.424), and postoperative weight-bearing status (p = 0.229) were similar between the groups. While mortality and nonorthopedic-related readmissions were significantly higher for patients 95 years or older, orthopedic-related readmissions (p = 0.148) and revisions at the latest follow-up (p = 0.253) were comparable between groups. In a regression analysis, age over 95 years (odds ratio, 2.049; p = 0.049) and body mass index (odds ratio, 0.935; p = 0.016) were independently associated with IPFF. Conclusions The findings of this study suggest that age over 95 years is a significant, independent risk factor for IPFF in patients undergoing cementless HA. Although we were unable to show an impact on perioperative outcomes and orthopedic complications, when operating on patients 95 years or older, surgeons should be aware of the increased risk of IPFF and consider the use of stem designs and fixation types associated with decreased IPFF rates.
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Affiliation(s)
- Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Nissan Amzallag
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Abadi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Samuel Morgan
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Aviram Gold
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
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Putra DP, Mustamsir E, Phatama KY, Pradana AS, Pratama YA. The effectiveness ORIF for neglected periprosthetic femoral fractures after hemiarthroplasty: A case report. Int J Surg Case Rep 2024; 115:109285. [PMID: 38266366 PMCID: PMC10832499 DOI: 10.1016/j.ijscr.2024.109285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Periprosthetic fractures are a growing concern due to the increasing frequency of primary joint replacement surgery, with total hip arthroplasty being the most common. The incidence of periprosthetic fractures after revision surgery ranges from 4 to 11 %, with up to 30 % reported after knee revision surgery. This case report aims to describe the treatment of an 81-year-old woman suffering from neglected periprosthetic femoral fracture post hemiarthroplasty. CASE PRESENTATION An 81-year-old woman with a history of hemiarthroplasty surgery and hypertension was admitted to the ER with pain in her right thigh. She had a middle shaft femoral fracture and was scheduled for open reduction and internal fixation. Despite being fully conscious and having an average pulse rate and blood pressure, she had cardiomegaly and congestive pulmonum. Unfortunately, this patient did not receive appropriate medical treatment after it occurred for 1 month. After surgery, we evaluated the implant, and the implant stabilized the fracture. After 1-3 months after surgery, the LEFS (The Lower Extremity Functional Scale) score was found that the score increase significantly after surgery. CLINICAL DISCUSSION The Vancouver classification system manages periprosthetic fractures by assessing location, stability, and bone quality. Type A fractures involve the trochanter, while type B fractures are diaphyseal and can extend distally. ORIF is used for subtype B1 fractures, but newer techniques offer shorter operating times and fewer complications. CONCLUSION From this study, we can conclude that even though neglected cases procedure with ORIF promises a good outcome based on clinical evaluation.
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Affiliation(s)
- Domy Pradana Putra
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Edi Mustamsir
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Krisna Yuarno Phatama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Ananto Satya Pradana
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Yudit Alfa Pratama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
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Rocchi C, Di Matteo V, Chiappetta K, Grappiolo G, Loppini M. Results of Utilizing Cerclage Wires in the Management of Intraoperative Vancouver B1 Fractures in Primary Total Hip Arthroplasties: A Retrospective Cohort Investigation into Clinical and Radiographic Outcomes. J Clin Med 2024; 13:819. [PMID: 38337513 PMCID: PMC10856186 DOI: 10.3390/jcm13030819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Due to an increase in total hip arthroplasties (THAs), the incidence of periprosthetic hip fractures (PPHFs) is forecast to rise considerably in the next decades, with Vancouver B1 fractures (VB1) accounting for one third of total cases. Femur fixation with cerclages (with or without screws) is considered the current treatment option for intraoperative VB1. METHODS The study retrospectively includes data from patients who developed VB1 PPHFs during THAs from 3 December 2020 to 30 November 2022. The primary outcome of this study was to identify the reintervention-free survival rate. The secondary aim was to determine clinical and radiographic assessment at follow-up, based on Harris hip score (HHS) and limb length discrepancy (LLD). RESULTS Thirty-seven patients with a mean age of 60.03 ± 15.49 (22 to 77) years old were included. Overall, the Kaplan-Meier analysis estimated a reoperation-free survival rate of 99% (CI 95%) at 6 months. The mean limb length discrepancy (LLD) improved from -3.69 ± 6.07 (range -27.9 to 2.08) mm to 0.10 ± 0.67 (range -1.07 to 1.20) mm. The mean HHS improved from 42.72 ± 14.37 (range 21.00-96.00) to 94.40 ± 10.32 (range 56.00-100.00). CONCLUSIONS The employment of cerclage wires represents an effective strategy for handling intraoperative VB1 fractures. Level III retrospective cohort study.
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Affiliation(s)
- Caterina Rocchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (C.R.); (V.D.M.)
| | - Vincenzo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (C.R.); (V.D.M.)
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy;
| | | | - Guido Grappiolo
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy;
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (C.R.); (V.D.M.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 17100 Savona, Italy;
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
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21
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Parsa A, Chishti Z, Saeed SK, Carbone AD, Domb BG, Schinsky MF. Non-metallic cerclage fixation methods for proximal femoral osteotomy and periprosthetic hip fractures offer promising outcomes: A systematic review. J Orthop 2024; 47:8-17. [PMID: 38046452 PMCID: PMC10689235 DOI: 10.1016/j.jor.2023.11.021] [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: 08/17/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
Background Periprosthetic femur fracture (PFF) is an important complication to consider in total hip arthroplasty (THA). The purpose of this systematic review was to compare outcomes of conventional metallic versus modern non-metallic cerclage systems for PFFs and proximal femoral osteotomy. Methods The PubMed, MEDLINE, and Google Scholar databases were searched for clinical studies reporting PFFs or extended trochanteric osteotomy (ETO) in THA patients and cerclage fixation techniques. Results Eight studies with 1362 patients (1366 hips) were included. The mean age ranged from 48.2 to 81.7 years, and the study population was 79.4 % female. The infection rate at the site of the PFF or ETO was 0.22 % (3 of 1366 hips), all occurring in patients with non-metallic cerclage fixation. Sixteen of 18 (88.9 %) cases of stem subsidence occurred following metallic cerclage fixation. Significant stem subsidence was substantially higher in hips with metallic device fixation compared to those with non-metallic fixation, at rates of 5.1 % and 0.19 %, respectively. Hips with non-metallic fixation had a clinical or radiologic healing rate of 93.9 %. Loss of fixation was only seen in hips with metallic fixation, at a rate of 0.6 %. Postoperative outcome scores were comparable across both groups. Conclusion The findings of this systematic review suggest that available non-metallic cerclage fixation methods demonstrate similar clinical success as conventional metallic fixation methods when utilized in hip arthroplasty. The current use of novel materials appears to be safe and reliable for these surgeries and can be considered a dependable option for surgeons. Level of evidence Level IV, systematic review of level III and IV studies.
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Affiliation(s)
- Ali Parsa
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Zayd Chishti
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Sheema K. Saeed
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | | | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
| | - Mark F. Schinsky
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
- American Hip Institute, Chicago, IL, 60018, USA
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22
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Nasser AAHH, Prakash R, Handford C, Osman K, Chauhan GS, Nandra R, Mahmood A, Dewan V, Davidson J, Al-Azzawi M, Smith C, Gawad M, Palaiologos I, Cuthbert R, Wignadasan W, Banks D, Archer J, Odeh A, Moores T, Tahir M, Brooks M, Biring G, Jordan S, Elahi Z, Shaath M, Veettil M, De C, Handford C, Bansal M, Bawa A, Mattar A, Tandra V, Daadipour A, Taha A, Gangoo S, Srinivasan S, Tarisai M, Budair B, Subbaraman K, Khan F, Gomindes A, Samuel A, Kang N, Kapur K, Mainwaring E, Bridgwater H, Lo A, Ahmed U, Khaleeq T, El-Bakoury A, Rashed R, Hosny H, Yarlagadda R, Keenan J, Hamed A, Riemer B, Qureshi A, Gupta V, Waites M, Bleibleh S, Westacott D, Phillips J, East J, Huntley D, Masud S, Mirza Y, Mishra S, Dunlop D, Khalefa M, Balasubramanian B, Thibbaiah M, Payton O, Berstock J, Deano K, Sarraf K, Logishetty K, Lee G, Subbiah-Ponniah H, Shah N, Venkatesan A, Cheseldene-Culley J, Ayathamattam J, Tross S, Randhawa S, Mohammed F, Ali R, Bird J, Khan K, Akhtar MA, Brunt A, Roupakiotis P, Subramanian P, Bua N, Hakimi M, Bitar S, Najjar MA, Radhakrishnan A, Gamble C, James A, Gilmore C, Dawson D, Sofat R, Antar M, Raghu A, Heaton S, Tawfeek W, Charles C, Burnand H, Duffy S, Taylor L, Magill L, Perry R, Pettitt M, Okoth K, Pinkney T. Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study. Injury 2023; 54:111152. [PMID: 37939635 DOI: 10.1016/j.injury.2023.111152] [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: 05/03/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip. METHODS Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period. Univariate and multivariable logistic regression analyses were performed to study the independent correlation between patient, fracture, and treatment factors on mortality. RESULTS A total of 1,109 patients were included. The in-hospital mortality rate was 5.3%. Multivariable analyses suggested that age, male sex, abbreviated mental test score (AMTS), pneumonia, renal failure, history of peripheral vascular disease (PVD) and deep surgical site infection were each independently associated with mortality. Each yearly increase in age independently correlates with a 7% increase in mortality (OR 1.07, p=0.019). The odds of mortality was 2.99 times higher for patients diagnosed with pneumonia during their hospital stay [OR 2.99 (95% CI 1.07-8.37) p=0.037], and 7.25 times higher for patients that developed renal failure during their stay [OR 7.25 (95% CI 1.85-28.47) p=0.005]. Patients with history of PVD have a six-fold greater mortality risk (OR 6.06, p=0.003). Mode of treatment was not a significant predictor of mortality. CONCLUSION The in-hospital mortality rate of PPFs around the hip exceeds 5%. The fracture subtype and mode of management are not independent predictors of mortality, while patient factors such as age, AMTS, history of PVD, pneumonia, and renal failure can independently predict mortality. Peri-operative optimisation of modifiable risk factors such as lung and kidney function in patients with PPFs around the hip during their hospital stay is of utmost importance.
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Affiliation(s)
- Ahmed Abdul Hadi Harb Nasser
- The Birmingham Orthopaedic Network, Specialty Registrar, The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK.
| | - Rohan Prakash
- The Birmingham Orthopaedic Network, Specialty Registrar, The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - Charles Handford
- The Birmingham Orthopaedic Network, Specialty Registrar, The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - Khabab Osman
- The Birmingham Orthopaedic Network, Specialty Registrar, The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - Govind Singh Chauhan
- The Birmingham Orthopaedic Network, Specialty Registrar, The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - Rajpal Nandra
- The Birmingham Orthopaedic Network, Consultant orthopaedic surgeon
| | - Ansar Mahmood
- Trauma and Orthopaedics, Consultant orthopaedic surgeon, Queen Elizabeth Hospital, Birmingham B15 2GW, UK
| | - Varun Dewan
- The Birmingham Orthopaedic Network, Consultant orthopaedic surgeon
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zain Elahi
- Stoke Mandeville hospital, Aylesbury, UK
| | | | | | | | | | - Mohit Bansal
- Princess Royal University Hospital, Orpington, UK
| | | | - Ahmed Mattar
- Princess Royal University Hospital, Orpington, UK
| | - Varun Tandra
- Princess Royal University Hospital, Orpington, UK
| | | | - Ahmed Taha
- Princess Royal University Hospital, Orpington, UK
| | | | | | | | | | | | | | | | | | - Niel Kang
- Addenbrooke's Hospital, Cambridge UK
| | | | | | | | - Andre Lo
- Addenbrooke's Hospital, Cambridge UK
| | | | | | | | | | | | | | | | | | - Bryan Riemer
- University Hospital Coventry & Warwickshire, Coventry, UK
| | - Arham Qureshi
- University Hospital Coventry & Warwickshire, Coventry, UK
| | - Vatsal Gupta
- University Hospital Coventry & Warwickshire, Coventry, UK
| | | | | | | | | | - Jamie East
- Royal Devon and Exeter Hospital, Exeter, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Laura Magill
- The Birmingham centre for observational and prospective studies (BiCOPS), University of Birmingham, Birmingham, UK
| | - Rita Perry
- The Birmingham centre for observational and prospective studies (BiCOPS), University of Birmingham, Birmingham, UK
| | - Michala Pettitt
- The Birmingham centre for observational and prospective studies (BiCOPS), University of Birmingham, Birmingham, UK
| | - Kelvin Okoth
- The Birmingham centre for observational and prospective studies (BiCOPS), University of Birmingham, Birmingham, UK
| | - Thomas Pinkney
- The Birmingham centre for observational and prospective studies (BiCOPS), University of Birmingham, Birmingham, UK
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Wood MJ, Al-Jabri T, Zaghloul A, Lanting B, Giannoudis PV, Hart AJ. Periprosthetic acetabular fractures as a complication of total hip arthroplasty. Injury 2023; 54:111058. [PMID: 37748235 DOI: 10.1016/j.injury.2023.111058] [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] [Indexed: 09/27/2023]
Abstract
Periprosthetic acetabular fractures are rare but potentially devastating complications of total hip arthroplasty. As the number of total hip arthroplasties performed annually increases, so has the incidence of periprosthetic fractures, with the topic being spotlighted more frequently in the orthopaedic community. There is a particular sparsity of literature regarding periprosthetic acetabular fractures, with periprosthetic femoral fractures after total hip arthroplasty being traditionally far more commonly reported. This article aims to provide an up-to-date review of the epidemiology, risk factors, diagnostic challenges, classifications, and management strategies for periprosthetic acetabular fractures after total hip arthroplasty.
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Affiliation(s)
- Matthew J Wood
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Talal Al-Jabri
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - Ahmed Zaghloul
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Brent Lanting
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Alister James Hart
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, HA7 4LP, United Kingdom
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Yenigül AE, Ermutlu C, Önder C, Atıcı T, Durak K. Outcomes of cable fixation after Vancouver type B1 periprosthetic femoral fractures. ULUS TRAVMA ACIL CER 2023; 29:1314-1319. [PMID: 37889025 PMCID: PMC10771244 DOI: 10.14744/tjtes.2023.87425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND In this study, it was aimed to evaluate the patients who underwent cable plate fixation due to a Vancouver-type B1 periprosthetic femur fracture and their clinical results. METHODS Vancouver-type B1 patients who were operated on for periprosthetic fractures between 2014 and 2019 were investi-gated. Age, gender, body mass index (BMI), follow-up time, operation time, bleeding amount, non-union fracture, last surgery before fracture, the time between previous surgery and fracture, implant survival, patient survival, and complications were recorded. In addi-tion, the postoperative clinical functions of these patients were compared. RESULTS 23 patients who met the study criteria (Vancouver type B1 fracture) were identified. The mean age of the patients was 60 (49-76) years, the mean BMI was 26.3 (17.5-40.7), and the postoperative mean follow-up period was 14 (6-36) months. Considering the gender distribution, there were 5 (22%) men and 18 (78%) women. The mean time between the last surgery before the fracture and the fracture was 6 months (0-30). While the mean operation time was 95 min (60-180), the average amount of bleeding was 310 mL (150-600). Functional evaluations of patients: In total, five patients had decreased ambulatory abilities after surgery. Nonunion was observed in 2 patients during the follow-ups, and these patients underwent open surgery for treatment. CONCLUSION Cable and locking plate applications are successful in Vancouver type B1 fractures, which are one of the most common forms of periprosthetic fractures. In this technique, the duration of the operation can be shortened under ideal conditions, and the need for blood and blood products is reduced as blood loss is reduced. If there is a complication, you still have the chance to treat it with the option of revision arthroplasty.
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Affiliation(s)
- Ali Erkan Yenigül
- Department of Orthopaedics and Traumatology, Bursa Uludag University, Bursa-Türkiye
| | - Cenk Ermutlu
- Department of Orthopaedics and Traumatology, Bursa Uludag University, Bursa-Türkiye
| | - Cem Önder
- Department of Orthopaedics and Traumatology, Bursa Uludag University, Bursa-Türkiye
| | - Teoman Atıcı
- Department of Orthopaedics and Traumatology, Bursa Uludag University, Bursa-Türkiye
| | - Kemal Durak
- Department of Orthopaedics and Traumatology, Bursa Uludag University, Bursa-Türkiye
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Blum P, Neugebauer J, Keiler A, Putzer D, Watrinet J, Biermeier S, Dammerer D. Mid-Term Migration Behavior of an Uncemented Proximally Anchored Straight Stem-A Retrospective EBRA Migration Analysis. J Clin Med 2023; 12:4335. [PMID: 37445370 DOI: 10.3390/jcm12134335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Aseptic loosening is one of the most-common causes of the failure of cementless stems. Einzel Bild Röntgen Analyse-Femoral Component Analysis (EBRA-FCA) allows the diagnosis of stem migration, which can be considered a factor in predicting implant survival. The current study aimed to present the migration behavior of a tapered proximally anchored straight stem. METHODS This retrospective study reviewed all consecutive patients who received a cementless CBC straight stem (Mathys AG, Bettlach, Switzerland) between 2005 and 2019. We analyzed the migration pattern using the EBRA-FCA software and reviewed their medical histories. In addition, periprosthetic radiolucency was rated according to the Gruen zones and femoral configuration according to Dorr. RESULTS A total of 333 stems in 332 patients (female 191; male 141) met our inclusion criteria. The mean age at surgery was 63 (range 21-87) years. Migration analysis by EBRA-FCA showed a mean subsidence of 1.6 mm at final follow-up at 96 months with a maximum noted mean subsidence of 2.0 mm at 72 and 84 months. Dorr Type A showed a tendency of less subsidence than did Dorr Type B and was statistically significant at 6 (p = 0.0396) and 72 months (p = 0.0127). The body mass index (BMI) and increased subsidence were not found to correlate (p > 0.05). For this cohort, the overall femoral revision-free rate was 95.2% and the revision-free rate for aseptic loosening was 99.1%. CONCLUSIONS The results showed migration behavior in cementless stems with initial increased migration and subsequent secondary stabilization, suggesting an excellent long-term outcome. Stem migration of this tapered proximally anchored stem might be lower in Dorr Type A than in Dorr Type B femurs without being statistically significant at all time points.
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Affiliation(s)
- Philipp Blum
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Johannes Neugebauer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
| | - Alexander Keiler
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Julius Watrinet
- Department of Trauma Surgery, BG Trauma Center Murnau, 82418 Murnau, Germany
| | - Sebastian Biermeier
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
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Cohen JS, Agarwal AR, Kinnard MJ, Thakkar SC, Golladay GJ. The Association of Postoperative Osteoporosis Therapy With Periprosthetic Fracture Risk in Patients Undergoing Arthroplasty for Femoral Neck Fractures. J Arthroplasty 2023; 38:726-731. [PMID: 36328102 DOI: 10.1016/j.arth.2022.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Displaced femoral neck fractures in older adults are generally treated with hip arthroplasty. One concern following hip arthroplasty is the risk for periprosthetic fractures (PPFs). Most patients who have hip fractures are candidates for antiosteoporotic therapy, but the impact of this treatment on PPFs is unknown. Therefore, the primary objective of this study was to evaluate whether patients treated with antiosteoporotic medical therapy had lower odds of PPFs following arthroplasty for hip fracture. METHODS Patients at least 65 years old who underwent hip arthroplasty for femoral neck fractures from 2010 to 2020 were identified in a national database. Patients were stratified based on whether they initiated antiosteoporotic therapy within 1 year of hip arthroplasty. Minimum follow-up was 1 year, and maximum follow-up was 10.6 years. The primary endpoint was cumulative incidence of PPF as determined using Kaplan-Meier and Cox proportional hazards regression analyses. Overall, 2,026 patients who underwent arthroplasty for femoral neck fracture received antiosteoporotic medications within 1 year following surgery (mean follow up 4.8 years; range 1.0 to 10.6 years) and 33,639 patients did not (mean follow up 4.1 years; range 1.1 to 10.3 years). RESULTS The 10-year cumulative incidence of PPF for patients treated for osteoporosis was 3.88% compared to 5.92% for those who were untreated (P < .001). Adjusting for covariates, patients who received osteoporosis treatment had a significantly lower risk for PPF than those who were untreated (hazard ratio (HR): 0.663; 95% confidence interval (CI): 0.465-0.861; P = .038). CONCLUSION The present study suggests that osteoporosis treatment is associated with lower incidence of PPF following hip arthroplasty for femoral neck fractures. Treatment of osteoporosis should be initiated in eligible patients who sustain a femoral neck fracture, especially those who undergo hip arthroplasty.
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Affiliation(s)
- Jordan S Cohen
- University of Pennsylvania, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | - Amil R Agarwal
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matthew J Kinnard
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland
| | - Savyasachi C Thakkar
- Johns Hopkins University, Department of Orthopaedic Surgery, Baltimore, Maryland
| | - Gregory J Golladay
- Virginia Commonwealth University, Department of Orthopaedic Surgery, Richmond, Virginia
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Binkley N, Nickel B, Anderson PA. Periprosthetic fractures: an unrecognized osteoporosis crisis. Osteoporos Int 2023; 34:1055-1064. [PMID: 36939852 DOI: 10.1007/s00198-023-06695-w] [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: 11/16/2022] [Accepted: 02/02/2023] [Indexed: 03/21/2023]
Abstract
Total joint replacement is common and increasing. Many of these patients have low bone mineral density preoperatively, and arthroplasty leads to bone loss. As falls are common before and after arthroplasty, it is unsurprising that periprosthetic fractures, defined as those associated with an orthopedic device, whether a joint replacement or other internal fixation devices, are not rare. These fractures engender morbidity and mortality comparable to osteoporosis-related hip fractures but remain largely unrecognized and untreated by osteoporosis/metabolic bone disease clinicians. Indeed, recent osteoporosis guidelines are silent regarding periprosthetic fractures. The purposes of this clinical review are to briefly describe the epidemiology of arthroplasty procedures and periprosthetic fractures, raise awareness that these fractures are osteoporosis-related, and suggest approaches likely to reduce their occurrence. Notably, bone health evaluation is essential following the occurrence of a periprosthetic fracture to reduce subsequent fracture risk. Importantly, in addition to such secondary fracture prevention, primary prevention, i.e., bone health assessment and optimization prior to elective orthopedic procedures, is appropriate.
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Affiliation(s)
- Neil Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin-Madison, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA.
| | - Brian Nickel
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, USA
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28
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de Ridder VA, Pape HC, Chana-Rodríguez F, Boudissa M, Claudia G, Fabian S, Steven H, Tina H, Konstantinos T, Zoe D. Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures. OTA Int 2023; 6:e266. [PMID: 37006450 PMCID: PMC10064643 DOI: 10.1097/oi9.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
Periacetabular periprosthetic fractures are rare but potentially disastrous for the longevity of the adjacent implants, leading to multiple revision surgeries. It is of paramount importance to identify and treat intraoperative fractures, which will lead to satisfactory results. Postoperative fractures may be managed operatively or nonoperatively depending on the patient's pain and function, the fracture pattern, and the stability of the acetabular component.
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Padilla-Rojas LG, Garín-Zertuche DE, López-Almejo L, Garabano G, Pesciallo CÁ, Leal JA, Pinzón A, Giordano V, Esteves-Pires R. Periprosthetic fracture management of the proximal femur. OTA Int 2023; 6:e246. [PMID: 37006453 PMCID: PMC10064640 DOI: 10.1097/oi9.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 03/30/2023]
Abstract
The most common periprosthetic fractures occur around the hip. The most widely used classification is the Vancouver classification, and management requires careful planning and skill in both arthroplasty and fracture surgery. This article presents an overview of the diagnosis, classification, and management of periprosthetic fractures of the proximal femur. This work represents a summary review from Latin American Society Members of the International Orthopaedic Trauma Association.
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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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Calkins TE, Goetz DD, Zalewski JT, Jones CA, Gaumer PR, Ford MC, Toy PC, Crockarell JR, Harkess JW, Mihalko WM, Guyton JL. Hip Arthroplasty Femoral Stem Designs and Their Association With Early Postoperative Periprosthetic Femoral Fractures. J Arthroplasty 2022; 38:849-854. [PMID: 36535442 DOI: 10.1016/j.arth.2022.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Periprosthetic femoral fractures (PFFs) in total hip arthroplasty (THA), especially those in contact with the diaphyseal stem, carry high morbidity. This study evaluated how stem design influences the risk of early Vancouver B PFF or other PFF requiring operative intervention after THA. METHODS A multicenter, retrospective study of 3,433 primary cementless THAs performed from 2014 to 2021 included 2,302 single-taper (micro M/L [n = 1,169]; M/L [n = 1,133]) and 1,131 double-taper (fit-and-fill [n = 420]; compaction-collared [n = 711]) stems. Mean follow-up was 2.2 years (range, 0.3 to 6.5 years). Primary outcomes were Vancouver B and surgically treated postoperative PFFs among differing femoral stems. Secondary outcomes included rates of intraoperative and postoperative Vancouver A and C PFFs. RESULTS Forty five postoperative PFFs (1.3%) occurred within 8.8 weeks (median), 25 of which were Vancouver B (0.7%) and 20 total PFFs that required operative intervention (0.6%). Compaction-collared stems had a decreased risk of Vancouver B (hazard ratio 0.18, 95% confidence interval: 0.03-0.97 P = .044) and any surgically treated PFF (hazard ratio 0.10, 95% confidence interval: 0.01-0.95; P = .037). Intraoperative PFFs were most common with fit-and-fill stems (3.6%, P < .001) and Vancouver A with compaction-collared stems (1.8%, P < .001). The cohort with PFF had a higher Charlson comorbidity index (P = .004), more women (P = .001), more Dorr A or C femora (P = .013), and more posterior or lateral surgical approaches compared to those without PFF (P ≤ .001). CONCLUSION After controlling for confounding variables, compaction-collared stems had a significantly lower risk of postoperative Vancouver B and PFF requiring operative treatment than single-taper and double-taper stems.
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Affiliation(s)
- Tyler E Calkins
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Jacob T Zalewski
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Caleb A Jones
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Marcus C Ford
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Patrick C Toy
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John R Crockarell
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James W Harkess
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James L Guyton
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee
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Bhadresha A, De C, El Tagy H, Neelapala V, Veettil M. A Quality Improvement Project to Improve Periprosthetic Fracture Management at District General Hospitals. Cureus 2022; 14:e31937. [DOI: 10.7759/cureus.31937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/28/2022] Open
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34
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Hip Arthroplasty, a mature surgical technique with room for improvement. Orthop Traumatol Surg Res 2022; 108:103379. [PMID: 35905900 DOI: 10.1016/j.otsr.2022.103379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/03/2023]
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35
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González-Martín D, Pais-Brito JL, González-Casamayor S, Guerra-Ferraz A, Ojeda-Jiménez J, Herrera-Pérez M. Treatment algorithm in Vancouver B2 periprosthetic hip fractures: osteosynthesis vs revision arthroplasty. EFORT Open Rev 2022; 7:533-541. [PMID: 35924638 PMCID: PMC9458940 DOI: 10.1530/eor-21-0129] [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: 11/25/2022] Open
Abstract
There is currently a debate on whether all Vancouver B2 periprosthetic hip fractures should be revised. The aim of our work was to establish a decision-making algorithm that helps to decide whether open reduction and internal fixation (ORIF) or revision arthroplasty (RA) should be performed in these patients. Relative indications in favour of ORIF are low-medium functional demand (Parker mobility score (PMS) <5), high anaesthetic risk (American Society of Anesthesiologists score (ASA) ≥ 3), many comorbidities (Charlson Comorbidity Index (CCI) ≥ 5), 1 zone fractured (VB2.1), anatomical reconstruction possible, and no prior loosening (hip pain). Relative indications in favour of RA are high functional demand (PMS ≥6), low anaesthetic risk (ASA< 3), few comorbidities (CCI<5), fracture ≥ 2 zones (VB2.2), comminuted fractures, and prior loosening (hip pain). In cemented stems, those fractures with fully intact cement–bone interface, no stem subsidence into the cementraliser, cement mantle anatomically reducible, and some partial stem-cement attachment can be safely treated with ORIF.
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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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Liu M, Yang C, Chu Q, Wang J, Wang Q, Kong F, Sun G. High serum levels of ferritin may predict poor survival and walking ability for patients with hip fractures: a propensity score matching study. Biomark Med 2022; 16:857-866. [PMID: 35704298 DOI: 10.2217/bmm-2022-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: To identify the relationship between ferritin and outcomes for patients with hip fractures. Patients & methods: All patients with hip fractures presenting between May 2017 and January 2021 were included. Univariate and multivariate analyses were performed to determine the risk factors for 1-year survival. Propensity score matching (PSM) was performed for groups divided by ferritin levels. Results: A total of 165 patients were included of whom 28 died during the first year after surgery. Ferritin levels differed significantly between groups divided by 1-year survival. High ferritin (≥308.5 ng/ml) was related to poor 1-year survival and 6-month and 1-year independent walking rate. Conclusion: High ferritin (≥308.5 ng/ml) may predict poor survival and free-walking abilities after surgery for patients with hip fractures.
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Affiliation(s)
- Mingchong Liu
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Chensong Yang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qining Chu
- Emergency Trauma Center, Nanyang Second General Hospital, No 66, East Jianshe Road, Nanyang, 473000, China
| | - Jiansong Wang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qidong Wang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Fanyu Kong
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
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Anderl C, Steinmair M, Hochreiter J. Bone Preservation in Total Hip Arthroplasty. J Arthroplasty 2022; 37:1118-1123. [PMID: 35121089 DOI: 10.1016/j.arth.2022.01.077] [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: 11/14/2021] [Revised: 12/27/2021] [Accepted: 01/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preserving bone stock in younger and more active patients after total hip arthroplasty (THA) is important for future revision. Newer prosthesis designs, including short femoral stems and isoelastic acetabular cups, are likely to preserve more bone stock. However, long-term follow-up studies on bone remodeling after short-stem THA with an isoelastic monoblock acetabular cup are few. Therefore, we evaluated bone preservation after THA using these prostheses at a 5-year follow-up. METHODS This prospective observational study is a 5-year follow-up of our previously reported 2-year observational study on the same cohort of patients. We included 45 patients with primary osteoarthritis treated with a calcar-guided femoral short-stem prosthesis and a monoblock press-fit acetabular cup. We evaluated bone mineral density (BMD) around the prostheses using dual-energy X-ray absorptiometry and reported functional outcomes preoperatively and at 3, 12, 24, and 60 months postoperatively. All complications were recorded. RESULTS At the final follow-up, the BMD was comparable with that at 24 months in Gruen zones 3, 4, 5, 6, and 7, whereas it significantly differed in Gruen zones 1 (P < .0001) and 2 (P < .004). On the acetabular side, the BMD leveled off similarly in all DeLee and Charnley zones between 24 and 60 months (P > .05). Moreover, all measured clinical outcomes significantly improved (P < .001). One perioperative dislocation was reported. CONCLUSION Patients undergoing THA with a calcar-guided femoral short-stem prosthesis and a monoblock acetabular cup can expect preservation of bone stock over a longer follow-up with excellent clinical outcomes and few complications.
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Affiliation(s)
- Conrad Anderl
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Martin Steinmair
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Josef Hochreiter
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern, Vinzenz Gruppe, Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
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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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Takegami Y, Seki T, Osawa Y, Imagama S. Comparison of periprosthetic femoral fracture torque and strain pattern of three types of femoral components in experimental model. Bone Joint Res 2022; 11:270-277. [PMID: 35514237 PMCID: PMC9130673 DOI: 10.1302/2046-3758.115.bjr-2021-0375.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS Periprosthetic hip fractures (PPFs) after total hip arthroplasty are difficult to treat. Therefore, it is important to identify modifiable risk factors such as stem selection to reduce the occurrence of PPFs. This study aimed to clarify differences in fracture torque, surface strain, and fracture type analysis between three different types of cemented stems. METHODS We conducted biomechanical testing of bone analogues using six cemented stems of three different types: collarless polished tapered (CPT) stem, Versys Advocate (Versys) stem, and Charnley-Marcel-Kerboull (CMK) stem. Experienced surgeons implanted each of these types of stems into six bone analogues, and the analogues were compressed and internally rotated until failure. Torque to fracture and fracture type were recorded. We also measured surface strain distribution using triaxial rosettes. RESULTS There was a significant difference in fracture torque between the three stem types (p = 0.036). Particularly, the median fracture torque for the CPT stem was significantly lower than that for the CMK stem (CPT vs CMK: 164.5 Nm vs 200.5 Nm; p = 0.046). The strain values for the CPT stem were higher than those for the other two stems at the most proximal site. The fracture pattern of the CPT and Versys stems was Vancouver type B, whereas that of the CMK stem was type C. CONCLUSION Our study suggested that the cobalt-chromium alloy material, polished surface finish, acute-square proximal form, and the absence of a collar may be associated with lower fracture torque, which may be related to PPF. Cite this article: Bone Joint Res 2022;11(5):270-277.
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Affiliation(s)
- Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Direct medical costs of interprosthetic femoral fracture treatment: A cohort analysis. Injury 2021; 52:3673-3678. [PMID: 33972097 DOI: 10.1016/j.injury.2021.04.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Periprosthetic femoral fractures (PPFs) represent a challenging clinical problem with a fast-rising incidence. Interprosthetic fractures (IPFs) represent one of its most difficult variants. There is a paucity of data regarding the financial burden of PPFs, and none for IPFs. This study aims to estimate the direct medical cost of the surgical treatment of IPFs in NHS, and analyse the factors influencing this when using different methods of surgical treatment. METHODS A cohort of patients with IPFs treated in a single academic unit over a period of 8-years with different surgical methods was studied. In-hospital details, as well as outpatient follow-up data, were gathered relevant to their clinical and radiological outcome until discharge. Local and national NHS data were acquired from the financial department, as well as industry-related resources. The economic analysis was structured as a cost identification analysis (CIA) of the overall cohort, but also as a comparative best-case scenario (uncomplicated course till discharge) comparison between the 3 main different management strategies (a) revision arthroplasty (RTHA), b) plate fixation (ORIF), c) combination of implants (COMBO). RESULTS Data from 28 patients (22 females) with IPFs were analysed with a median age of 78.4 years. The overall direct medical cost of treating this cohort of patients was £468,330, with a median of £15.625 (range £10,128 to 33,060). Comparing the three different surgical modalities, the median cost in groups a, b, and c was £20,793 (range £12,110 to £24,116), £12,979 (range £10,128 to £20,555), and £22,316 (range £10,938 to £23,081) respectively. In all groups, the 2/3 of the identified costs were relevant to the inpatient stay. Transfusions were the highest (3 units of cRBC on average) to the patients that received a revision THA vs the other two groups (p=0.022). There was statistically significant higher mean overall cost between the RTHA and the ORIF groups (£19,453 vs. £14,201, p=0.0242), but not when compared with the COMBO cases (£19,453 vs. £18,788, p=0.86). CONCLUSION The first cost identification study and "best case scenario" comparative analysis for IPFs demonstrated a significant overall direct medical cost, when managing these complex fractures with variable contemporary techniques. Evidence based reimbursement strategies should be developed to allow the sustainability of the clinical service we offer in this challenging patient population.
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Pflüger P, Bolierakis E, Wurm M, Horst K, Hildebrand F, Biberthaler P. Revision rate is higher in patients with periprosthetic femur fractures following revision arthroplasty in comparison with ORIF following our algorithm: a two-center 1 analysis of 129 patients. Eur J Trauma Emerg Surg 2021; 48:1913-1918. [PMID: 34767064 PMCID: PMC9192397 DOI: 10.1007/s00068-021-01832-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
Purpose Effective therapy of periprosthetic femur fractures of the hip (PPF) are challenging due to patients’ frailty and complexity of fracture patterns. The aim of this cohort study was to analyze the radiological and functional outcome following PPF. Methods A retrospective, multicenter study in the period 2009–2019 of patients with PPF at two level I trauma centers in Germany was performed. PPF were classified according to the Vancouver classification system. Demographic data, American Society of Anesthesiologists (ASA) classification, type of surgery, complications, and reoperation rate were obtained from patient records. The functional outcome was assessed by the modified Harris-Hip Score (mHHS), general health using the EQ-5D, and radiological outcome by Beals & Tower (B&T) criteria. Results A total of 129 patients with a mean age of 79 years (range 43–102) were included. 70% of all patients were female and 68% of the patients had an ASA score ≥ 3. 20 patients suffered from a Vancouver A, 90 from a Vancouver B and 19 from a Vancouver C fracture. 14% of the patients died within the first 2 years after surgery. The reoperation rate after open reduction and internal fixation (ORIF) (n = 60) was 8% and after revision arthroplasty (RA) (n = 47) 30% (OR 3.4, 95% CI [1.21–10.2]). Mean mHHS (n = 32) was 53 ± 19.4 and EQ-VAS was 50 ± 24.6. According to B&T criteria, 82% of patients treated with ORIF (n = 17) and 62% after RA (n = 13) showed an excellent outcome. Conclusion Patients with a PPF of the hip are elderly and at increased operative risk. In cases with a stable prosthesis, ORIF provides good radiological outcome with low reoperation rates. In case of RA, the risk for revision surgery is higher.
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Affiliation(s)
- Patrick Pflüger
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Eftychios Bolierakis
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klemens Horst
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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